HORMONES -
ESTROGEN REPLACEMENT PROTOCOL

Natural, bio-identical estrogens are available and may be compounded into a variety of dosage forms.  There are three main estrogens, estrone (E1), estradiol (E2), and estriol (E3). There are normally present in the body in fairly fixed ratios. However, it is not always necessary to supplement them in any specific ratio. For example, a combination product of E3 and E2 is commonly prepared with amounts ranging from a 50/50 mixture to 80/20 or even 90/10. The important factor is using the correct estrogens for you.

Estrogens may be compounded into oral capsules, oral liquids (never taste good), sublingual drops, vaginal suppositories, lozenges or topical creams. In our opinion the creams offer the best of many choices. They are easy to use; they're well absorbed; and the doses are easy to adjust.

You may hear the words, TriEst and BiEst. These refer to a triple estrogen and a double estrogen combination, respectively. The TriEst formulas are not often used these days because of a concern for their estrone (E1) content.

The BiEst formulas contain estriol (E3) and estradiol (E2).

Women may need estrogen supplements for a variety of reasons (menopause, hysterectomy, etc.).  Regardless of the reason, we believe using natural, bio-identical hormones makes much more sense than any of the synthetic drug products or "natural" products derived from other animals.

Doses vary for each woman - and can change over time. While it is difficult to recommend a specific dose, we can offer a suggestion for a starting dose. 

We believe it is important to look at actual hormone levels and symptoms.

Some practitioners use serum or blood tests to determine levels. We have found that the saliva test is often very closely associated with reported symptoms. The saliva test is easy and non-invasive.  Whatever testing is used, we suggest it be performed periodically to verify that the hormone supplements are being absorbed and remaining in balance. Because we recommend the creams the total amounts can be adjusted when needed.

A common starting point is BiEst 2.5mg per day, usually divided into two doses (1.25mg per dose). The ratio of E3 to E2 can range from 50/50 to 80/20. 

A BiEst 2.5mg, 50/50 mixture would provide 1.25mg E3 and 1.25mg E2 per dose. We commonly make a transdermal cream, that provides this amount in 0.2ml of cream base.

A BiEst 2.5mg, 80/20 mixture would provide 2.0mg E3 and 0.5mg E2 per dose. We commonly make a transdermal cream, that provides this amount in 0.2ml of cream base.

While it is possible to combine estrogens with progesterone and testosterone into a single compound it isn't recommended - particularly when starting out. There's no way to adjust any particular hormone if they're all mixed up in a single cream or capsule.

The topical creams are dispensed in a syringe-like device that usually contains 1.0ml. You will be shown how much of the cream is to be applied each time. A common amount is usually between 0.1 and 0.2ml. This is a relatively small amount - about the size of a small pea.

One particular advantage of the topical cream is that you can adjust the dose by using a little more or a little less per dose. If your doctor starts with 1.25mg per dose and you find it isn't enough you can adjust the dose to 1.875mg by using 0.15ml instead of the original 0.1. The markings on the syringe barrel make this easy.

 Estrogen capsules are prepared in similar ratios of BiEst (50/50, 80/20, 90/10, etc).  Unlike progesterone, oral estrogen doses are similar to the transdermal dose.  BiEst 2.5mg 80/20 capsule provides 2.0mg E3 and 0.5mg E2 in each capsule.