Steadier sleep, mood and energy through perimenopause and beyond.
Bioidentical hormone replacement therapy (BHRT) uses estradiol and progesterone, hormones with the same structure as the ones your body makes, to support women through perimenopause and menopause. It starts with your labs and a conversation about your goals.
Perimenopause can begin in your forties, sometimes earlier, and it rarely arrives as one dramatic symptom. More often it's a slow drift. You sleep, but wake up not feeling rested. Hot flashes or night sweats arrive at the worst moments. Cycles change, patience runs shorter, and weight can settle differently even when habits haven't changed. Many women are told this is just what this decade feels like. It can also be measured, planned for and supported.
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How BHRT works
As your own production falls, BHRT replaces it. Estradiol, the main form of estrogen, plays a part in temperature regulation, sleep, mood, vaginal and skin health, and bone. Progesterone is added for women who have a uterus, to protect its lining, and some women find it helps them sleep.
Your clinician chooses the form with you and sets a starting dose from your labs, history and goals. We start low and adjust against your labs and how you feel, so your plan is curated to you rather than a fixed protocol.
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What to expect
Your first visit is a conversation and a blood draw. We go through your symptoms, cycle, history, medications and goals, and Danielle or Rosie draws your panel on site. If you're still having periods, your clinician may time the draw to your cycle. Results are usually back within a week, and you review them line by line at a second visit.
If BHRT fits, you leave with a written plan: what's prescribed, how to use it, what to watch for and when your next labs are due. Follow-ups sit closer together while your dose settles, then space out. Between visits, you can reach the practice with questions.
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Who you'll see
Danielle and Rosie, our nurse practitioners, prescribe and follow every BHRT plan, so the person who reads your labs is the one who adjusts them, under Medical Director oversight
Women in perimenopause or menopause whose sleep, temperature, mood or energy have changed
Women who want their levels measured before anything is prescribed
Women planning ahead for the years around menopause rather than waiting them out
Women who are comfortable with repeat labs and follow-ups as part of a personalized plan
Not suited for: women who are pregnant, or who have a history of breast or uterine cancer, blood clots, stroke or heart attack, unexplained vaginal bleeding or active liver disease; your clinician will talk through other options.
It's gradual, and it varies from woman to woman. Your first dose is rarely your final one: your clinician reviews how you feel and your follow-up labs, and adjusts from there.
What are the risks, and who shouldn't do this?
The most common side effects are breast tenderness, bloating, headaches, mood changes and spotting or irregular bleeding. They tend to settle within the first few months or with a dose change. Less common but more serious risks include blood clots, stroke and gallbladder disease, and with some regimens and longer use, breast or uterine cancer. Your risk depends on your age, how long it's been since menopause, your history, and the dose and form you use, which is why we screen before prescribing and recheck as you go. BHRT isn't right for women with the histories listed above, and we'll tell you if it isn't right for you.
What does "bioidentical" mean?
It means the hormone has the same molecular structure as the one your body makes; estradiol and progesterone are the two we use. Some bioidentical hormones are commercial products and some are prepared by a licensed compounding pharmacy for one patient. Your clinician will explain which form you're being prescribed and why.
Can I start if I'm still having periods?
Yes. Perimenopause often starts years before your last period, and that's when many women first notice changes. Your clinician will look at your cycle and labs together.
Will I need to stay on it?
Not necessarily. Some women use BHRT through the menopausal transition and taper off with their clinician; others stay on it longer. It's reviewed at every follow-up, and you can stop with your clinician's guidance.
Book your appointment today.
Start with your labs and a conversation about your goals.
