A lot of traditionally trained physicians may not be familiar with bioidentical hormone replacement. It is relatively new on the scene however it has been used for many years. It is not endorsed by the pharmaceutical companies which tend to do a lot of the postgraduate medical education or support it in this country and therefore there is not a big media push or medical academy push to learn more about bioidentical hormones. They are something that cannot be patented in most cases and are obtained from a local compounding pharmacy so it is not driven by money. Therefore, a lot of doctors have not heard about it since the pharmaceutical industries are not pushing it and it has not become as widespread as I believe it will be one day.

I think some people may find it ineffective for a few reasons that are not related directly to the BHRT but rather to its proper use and dosing. Some reasons that it may not work for some women are if they are not using it consistently as prescribed by their doctor. This will lead to low levels in the body and you are not going to feel an improvement in symptoms. Additionally, if the dose that is prescribed is either too low or too high, this will lead you to not feel your best and likely discontinue its use. The best way for it to be effective is to test early and often your hormone levels to adjust hormone dosing as often as needed to accommodate hormonal loss with time and hormonal changes with time. Your initial dose will absolutely not be the dose you will use for life. Your needs will change, your levels will change and especially in the beginning, especially for women in perimenopause, levels are fluctuating and we really need to get a handle on those initially and that may take a trial of different dosing. So if you can commit to the process, I found that those women have had every success with BHRT.

This varies from patient to patient. It does take a full three months to get up to a steady state level of hormones in the body so I tell patients to stay on their prescribed dose of hormones everyday for the first three months and at that point we recheck hormone levels to see what the dose of hormone has done for them. If their symptoms are controlled and their hormones on testing are within the optimal range, then we will stay on that dose. If they are not in the optimal range and/or if symptoms are not well controlled, we will adjust the dose until they are, but it may take 6, 8 up to 12 weeks to notice a complete improvement in symptoms. It does not happen overnight.

A pellet for the most of its lifespan will give you a consistent amount. However, as time goes on, just like with any form of replacement, it is going to start to decrease its output. If you are very consistent with replacement then this should not be a problem if you keep up your appointments to have a new pellet reinserted. However, I do not find it any more preferential than the other types of bioidentical hormone replacement. My preference is to use the transdermal cream.