Safety and Risks

Is BHRT safe? What are the risks?

BHRT, when prescribed and monitored by a qualified healthcare provider, is generally considered safe for most women. The safety profile depends on several factors, including your medical history, the type and dose of hormones used and how they are administered.

The key to safety is personalization and ongoing monitoring. We conduct thorough health assessments, regular blood work, and adjust your treatment based on your individual response. This customized approach helps minimize risks while maximizing benefits

Is BHRT safer than synthetic hormones?

Bioidentical hormones have the same molecular structure as the hormones your body naturally produces. This structural similarity contributes a much higher safety profile as well as fewer side effects and better overall tolerance.

In addition, bioidentical hormones can be customized to your specific needs, allowing for more precise dosing.

Can BHRT cause cancer, especially breast cancer?

This is one of themost important questions women ask.  The answer is that both synthetic and bioidentical estrogens, namely estradiol (a form of estrogen) are protective against breast cancer. This means that women who are or had been on estrogen therapy have a lower risk of developing breast cancer than those who never took any form of estrogen or estradiol.   In addition, women who took HRT in the past and eventually developed breast cancer had a much lower risk of dying from breast cancer than those who never took HRT. 

Will BHRT increase my risk of blood clots or stroke?

Current medical literature has shown that oral bioidentical estradiol does not increase the risk of bloot clots, stroke or heart attacks in women. This is in contrast to synthetic estrogens, which should not be used in the first place. Oral estradiol has a strong protective effect on the cardiovascular system, as opposed to transdermal estradiol (estradiol patches).  This is contrary to popular belief and is a common theme of misinformation from healthcare providers to patients as well.  I will show you the literature on these important topics during your appointment.

Results & Benefits

How long does it take to see results from BHRT?

Some benefits of BHRT apperar quickly, while others take longer. 

Quick results (1-2 weeks): Improved sleep, reduced hot flashes and night sweats

Moderate  timeline (4-8 weeks): Better mood, increased energy, reduced brain fog, improvement in libido

Longer term (6-12 months): Weight management, increase in lean muscle mass, decreased bone loss

Will BHRT help wtih vaginal dryness and low libido?

Yes, BHRT is very effective for vaginal dryness, discomfort during intercourse, and declining libido. Estrogen therapy helps restore vaginal tissue health, elasticity, and natural lubrication.

For sexual desire, we may include testosterone in your treatment plan, as this hormone plays a key role in libido. Many women report significant improvements in sexual function, comfort, and desire within 2-3 months of starting therapy.

Local vaginal estrogen therapy can also be used in conjunction with systemic BHRT for targeted symptom relief.

Can BHRT help with brain fog and memory issues?

Absolutely. Brain fog, difficulty concentrating, and memory lapses are common during menopause and can be very distressing. Estradiol, progesterone and testosterone each alleviate brain fog and improve cognitive function.

Most women notice improved mental sharpness, better focus, and enhanced memory within 4-8 weeks of starting BHRT. This improvement often correlates with better sleep quality, which also supports cognitive function.

Estrogen has neuroprotective effects and supports cognitive function, so declining levels can affect mental clarity.

Progesterone also acts as a neurosteroid, helping to protect the brain from damage and promote nerve fiber repair. 

Testosterone can be beneficial for certain individuals with low testosterone to improve focus and cognitive function. 

Will BHRT improve my mood, anxiety and depression?

Many women experience significant mood improvements with BHRT. Hormones play a crucial role in neurotransmitter function, and declining estradiol can contribute to anxiety, depression, irritability, and mood swings through a decrease in serotonin, a neurotransmitter that helps regulate mood and feelings of well-being. 

As progesterone levels drop, the production of gamma-aminobutyric acid (GABA) decreases. Since GABA has calming effects, lower levels contribute to feelings of anxiety and sadness. 

BHRT helps by stabilizing hormone levels, which supports better emotional regulation. Many women report feeling more like themselves again—calmer, more patient, and emotionally balanced.

If you’re currently taking antidepressants or anti-anxiety medications, BHRT may complement your current treatment or, in some cases, reduce the need for these medications over time.

Can BHRT help with weight gain during menopause?

BHRT can help address hormonal factors contributing to weight gain and make it easier to maintain a healthy weight. Declining estrogen affects metabolism, fat distribution, and muscle mass—all factors in menopause-related weight changes.

While BHRT isn’t a weight-loss treatment per se, it can help by restoring metabolic function, improving sleep quality (which affects weight), increasing energy for exercise, and reducing stress-related cortisol that promotes fat storage.

Best results come when combining BHRT with healthy lifestyle choices including balanced nutrition and regular exercise.

Will BHRT help prevent bone loss and osteopoross?

Yes! Estradiol plays a crucial role in maintaining bone density. During menopause, declining estradiol levels lead to accelerated bone loss, increasing the risk of osteoporosis and fractures.

BHRT helps preserve bone density and can significantly reduce the risk of osteoporosis-related fractures.  This protective effect is most beneficial when started earlier I menopause, but women at any stage can benefit from bone health support through BHRT combined with adequate dietary calcium, supplemental vitamin D3 and weight-bearing exercises.

Treatment Options

What hormones are included in BHRT?

BHRT is a customized form of precision medicine.  Your specific hormone combination and ratios are determined through comprehensive testing and assessment of your symptoms and health goals. It is a process for the rest of your life, to enable and empower you to remain healthy, prevent chronic diseases of ageing and live a fulfilling life. 

The three main hormones we use are estradiol, progesterone and testosterone. We may also need to replace thyroid hormone for optimal function, DHEA and melatonin depending on your needs. 

Please see the page on BHRT in this website for more comprehensive information. 

How is BHRT administered? What are my options?

BHRT can be delivered through several methods, each with unique advantages:

  • Creams/Gels: Applied daily to the skin, easy to adjust dosing, good absorption
  • Patches: Changed every few days, convenient, but provide lower cardiovascular protection.  Absorption can vary as well so adequate blood levels may not be achieved for optimal health
  • Pellets: Inserted under the skin every 3-6 months. See next section for disadvantages and the reason I personally do not like nor do I offer BHRT pellets
  • Oral tablets: Taken daily, excellent cardiovascular protection
  • Vaginal preparations: Specifically for vaginal/urinary symptoms

Disadvantages of BHRT pellets and the reasons I do not use or offer them:

Dosing Inflexibility:

  • Once inserted, the pellets can’t be removed or adjusted easily if side effects occur
  • You’re committed to that dose for 3-6 months until the pellet is absorbed
  • If the dose is too high or too low, you have to wait it out or add supplemental hormones

Potential for Supraphysiologic Levels:

  • Pellets can sometimes deliver higher hormone levels than what your body naturally produced
  • Risk of “roller coaster” effect – very high levels initially that decline over months
  • May lead to testosterone levels that are too high in women (acne, hair growth, mood changes)

Insertion Procedure Issues:

  • Requires a minor surgical procedure every 3-6 months
  • Risk of infection at insertion site (though rare)
  • Possible pellet extrusion (pellet works its way out)
  • Bruising, bleeding, or discomfort at insertion site
  • Small scar formation over time with repeated insertions

Cost Considerations:

  • More expensive upfront than other delivery methods

 

How do you determine the right dose for me?

Determining your optimal dose involves several steps:

  • Comprehensive lab testing: We measure your baseline hormone levels including estrogen, progesterone, testosterone, and other relevant markers
  • Symptom assessment: Your specific symptoms and their severity guide initial dosing
  • Medical history review: Your health history, risk factors, and medications influence dosing decisions
  • Start low, go slow: We typically begin with lower doses and adjust based on your response
  • Follow-up testing: Regular lab work and symptom tracking help us fine-tune your dose

This is truly personalized and precision medicine—your dose is unique to you and may change over time based on your body’s response and evolving needs. and 

Am I a Candidate for BHRT?

Am I a good candidate for BHRT?

You may be a good candidate for BHRT if you’re experiencing menopause symptoms that affect your quality of life and:

  • Are in perimenopause or postmenopause
  • Have bothersome symptoms like hot flashes, night sweats, mood changes, or sleep problems
  • Don’t have contraindications such as active hormone-sensitive cancer or recent blood clots
  • Want a personalized, precise approach to hormone therapy
  • Are committed to regular monitoring and follow-up care

A family history of breast cancer or blood clots is not a contraindication to BHRT.  
Even if you had breast cancer in the past and don’t have a recurrence, you may be a good candidate.  It has been demonstrated that estradiol, progesterone and testosterone are protective against breast cancer. 

During your consultation, we’ll conduct a thorough evaluation to determine if BHRT is right for you and discuss any concerns about your candidacy.

Everything discussed during your appointment is backed by evidence-based medicine and the most current literature. 

When should I start BHRT? Perimenopause or menopause?

You can start BHRT during perimenopause (the transition period before menopause) or after menopause, depending on your symptoms. There’s evidence that starting hormone therapy earlier—ideally within 10 years of your last period or before age 60—may offer greater benefits and lower risks. However, it’s better late than never! There are significant benefits to your overall health (cardiovascular, bone, brain, metabolic, etc) even if you start BHRT later in life.  Do not feel discouraged!

The key is addressing symptoms that are impacting your quality of life, regardless of where you are in the menopause journey and even more importantly, preventing chronic diseases of ageing and early death due to lack of optimal hormone levels.

What medical conditions would prevent me from using BHRT?

Certain conditions may make BHRT inappropriate or require extra caution.  

Some contradications to BHRT may include:

  • Current
    history of active breast cancer or other hormone-sensitive cancers
  • Active
    blood clots
  • Active
    liver disease
  • Unexplained
    vaginal bleeding
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