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Restore your balance

Women typically start experiencing hormonal changes around the age of 35. These symptoms may continue to worsen as a women ages. From loss of interest in sex and vaginal dryness, to decreased concentration, poor energy levels, hot flashes, night sweats, and insomnia, we are all impacted differently. Women no longer need to suffer from these debilitating symptoms. Bio-identical hormone replacement therapy for women refers to hormones that are structurally and chemically identical to our endogenous (or natural) hormones.

The goal of bio-identical hormone therapy (BHRT)

Bio-Identical Hormone Replacement Therapy for Women in Cincinnati can help with many of the symptoms of hormonal decline but also can reduce and sometimes even help reverse many diseases associated with aging. There is a lot of published data showing how different hormones reduce the risks of: cardiovascular disease, osteoporosis, diabetes, Alzheimer’s disease, macular degeneration, cataracts, improves immune function and lowers cholesterol.

Testosterone Benefits

  • Contributes to muscle mass, strength
  • Decreases fat
  • Increases exercise tolerance
  • Enhances sense of well-being
  • Increases libido
  • Reduces risk of cardiovascular disease
  • Lowers cholesterol
  • Reduces blood sugar
  • Increases bone density

Estrogen Benefits

  • Protects against heart disease and stroke
  • Reduces osteoporosis
  • Reduces risk of Alzheimer’s disease
  • Protects against vaginal atrophy (vaginal dryness)
  • Helps with urinary incontinence
  • Treats hot flashes and night sweats

Progesterone Benefits

  • Prevents Estrogen dominance
  • Promotes breast health (along with Testosterone)
  • Protects against uterine cancer, breast cancer, fibrocystic disease
  • Helps women relax and sleep better

Consultation

Your initial consultation with one of our providers for Bio-Identical Hormone Replacement Therapy for Women in Cincinnati will begin with a thorough look into your past medical and surgical history, family history, and current medications, with specific attention paid to the symptoms you are struggling with.

Tests

Next, we will obtain several blood tests to look at your sex steroid hormone levels, other hormones which can contribute to endocrine disruption, and serum markers to get a better picture of your overall health, including a complete blood count, and vitamin D level. Additional testing is available on request. The consultation and associated blood work is billed to your insurance company.

Follow Up

We will see you back in the office in 1 to 2 weeks, review your test results and initiate therapy if appropriate. Diet, exercise, and optimal supplementation are all discussed as an important part of this therapy.

Treatment Options

We prescribe hormones in the form of topical creams, injections or pellet therapy. Progesterone, when indicated, is usually given as an oral capsule or sublingual route. There are pros/cons to each method. We will discuss with each patient which option is best for their individual needs. We do not prescribe oral Estrogen or testosterone due to the increased risk of blood clots, including stroke, pulmonary embolism and heart attack. We also do not prescribe long term use of synthetic progestins for menopausal management (Provera, Prempro, Activella etc) due to overwhelming data in the medical literature showing the risks with progestins.

Pellet Therapy (Subcutaneous Implants)

Testosterone +/- Estradiol pellets are placed with a local anesthetic, through a 3 mm incision in the hip or buttocks. The procedure is done here in our office by one of our providers in about three minutes and is relatively painless. You will leave the office with adhesive tape covering the wound, this will be removed in four days. Benefits are usually enjoyed within two weeks and last for approximately 3-4 months for women We ask that you do not participate in any intense exercise for 2-3 days, as well as avoid soaking in water (bathtub, swimming pool) for 3 days.

Advantages include:

  • Testosterone/Estradiol is delivered in a slow and steady fashion
  • Mimicks the body’s inherent physiology
  • Superior results
  • Enhanced compliance (insertions 3-4 times a year)
  • No risk of transfer of hormones to family members
  • Hormone Levels monitored via bloodwork

 

Testosterone Injection Therapy

For those women who do not need/desire estrogen therapy, testosteore injections may be an option. Testosterone injections are self-administered (1-2 times a week) into subcutaneous fat (typically the belly or “love handle”) in the comfort of your own home.

Advantages include:

  • No downtime due to a pellet procedure
  • Little or no pain at the injection site
  • Hormone levels monitored via bloodwork
  • No risk of transfer of hormones to family members

 

Bioidential Hormone Cream Therapy

Estrogen/Progesterone/Testosterone cream is self-administered on a daily basis to the skin in the comfort of your own home.

Advantages include:

  • No needles or procedure required

How long do I continue BHRT?

You can stop Bio-Identical Hormone Replacement Therapy for Women in Cincinnati at any time, which will cause your hormones to drift back to your pre-treatment levels. Hormone deficiency symptoms and propensity to develop disease will return. There is no age limit on treatment. Though uncommon, patients as young as 25 (such as those with PCOS and severe PMS) as well as women in their 70’s or older, have had wonderful benefits with this therapy.

Most women start to notice improvement in symptoms approximatelly 3 weeks after starting therapy with an improvement in libido/vasomotor symptoms at that time. Overall sense of wellbeing, mood and effects on quality of life occur at 3-4 weeks after initiation of therapy. Improvements in lipids, CRP (marker of inflammation) and visceral fat usually occur after 6-12 months of therapy.

If I take Bioidential Hormones, will all my symptoms resolve?

It’s not always that simple. There’s more to us than just our sex steroids (estrogen, progesterone and testosterone). Our practice strives to optimize all aspects of your hormones: thyroid, insulin, adrenals (cortisol,DHEA) and growth hormone. There are several lifestyle factors that are essential for optimized health:

Things to consider for optimal results are:

  • Sound Sleep (7-8 hours/night)
  • Regular exercise
  • Appropriate Supplementation, Micronutrient Evaluation
  • Stress Management and Treatment of Adrenal Dysfunction (cortisol and DHEA)
  • Regular Bowel Movements (1-3 times/day)
  • Clean Eating
  • Treatment of food sensitivities
  • Periodic detoxification (2x/ year)
  • Optimal Thyroid function
  • Optimal Growth Hormone function
  • Optimal Insulin function

If hormone optimization does not give you the results you desire, we have structured our practice and tailored our training to provide you with a comprehensive evaluation of health and wellness. As a “one stop shop” for women’s healthcare needs, we will work with you to reach your desired goals. From our wellness coaches who specialize in nutrition and weight loss, to our medical providers who integrate both traditional and functional medicine, our goal is to approach your health care from a holistic perspective. Our goal is to give you the most complete care in whatever areas you may need.

Is Bio-identical hormone therapy covered by insurance?

The consultation and associated blood work is billed to your insurance company. Otherwise, ongoing therapy for compounded custom made bio-identical hormone therapy in our practice is not covered by insurance. Our providers have been trained by experts in the field of Bio-Identical Hormone Replacement Therapy from across the country. We have numerous certifications in BHRT, as well as functional medicine sub-specialties, and bring a high level of expertise to your customized treatment. Please note that we do not prescribe Premarin or Prempro, which are synthetic (non bio-identical) hormone treatments. We do not prescribe oral Estradiol or Estradiol troches, due to the increased risk of thromboembolism (blood clots) with oral Estradiol.

What is the price range and what is included?

Our Bio-Identical Hormone Therapy (BHT) program starts at $350 for women and includes an office visit with the provider every 3 months and the management of the hormone treatment. This visit includes discussion of symptoms as it relates to compounded hormones (estrogen, testosterone, progesterone), dosing, side effects and education from a provider with extensive training and experience in BHT management.  The program also includes the medication, pharmacy logistics and shipping (if needed), supplies for administration (if needed), needle disposal (if needed) the insertion procedure for pellets, and the administrative, and logistics fees for managing your care, and review of sex hormone values.

Hormones affect many aspects of our health, but this program is targeted at sex steroid management (estrogen, testosterone, progesterone.)  Medical issues or symptoms that related to the pillars of hormone health including but not limited to thyroid, insulin, adrenals, (ex. Fatigue, insomnia, mood issues) are covered services through insurance plans. We are required to follow federal and state law pertaining to insurance billing for medical visits.

Therefore, all other medical management other than that related to management of sex steroids (testosterone, estrogen, progesterone) is billed to insurance, or is the responsibility of the patient if we do not accept your insurance.  This includes, but may not be limited to: annual preventive care, labs and review of results, procedures, visits pertaining to abnormal bleeding, insulin management, cardiovascular concerns, fatigue, cortisol, thyroid, weight management, sleep issues, hair loss, vitamin deficiencies, and other medical concerns that need addressed.

We understand that you may choose to manage these medical visits with another provider’s office, such as a cardiologist, OB/GYN provider, endocrinologist or family medicine provider.

For creams or injections, you have the right to choose your own pharmacy if you do not want to use the pharmacy we work through.  However, you will still pay the base program fee for the management of your hormones and then will incur separate charges from the pharmacy for the prescriptions.

What are the side effects of estrogen and/or testosterone therapy?

Benefits and potential side effects are discussed in detail during the consultation process. Here are some common side effects that we discuss.
Potential side effects with Estradiol include: Estrogen dominance/overload can lead to many symptoms including breast tenderness, uterine bleeding, weight gain and irritability. We believe It is imperative to balance estrogen therapy with progesterone.

Testosterone excess/sensitivity can lead to excess facial hair or body hair, oily skin and/or acne. Lowering the dose or other measures can be used to combat unwanted side effects.

Oral progesterone can occasionally lead to drowsiness, sleepiness or breast tenderness.

The term “bioidentical” means the hormones in the product are chemically identical to those your body produces Several hormone therapy products approved by the FDA and prescribed by health care providers contain bioidentical hormones. Some FDA approved products (such as Estrace, Climara, Vivelle- Dot, Prometrium ) are bioidentical. However, compounded hormones are not FDA approved and have not been evaluated by the FDA. Compounded pharmacies are monitored at the state level. Statements on the webpage relating to compounded BHRT have not been evaluated by the FDA . Compounded hormones are are not intended to diagnose , cure or prevent any disease. Compounded hormones may be produced in doses and forms that differ from those in FDA approved products. Testosterone is not an FDA approved medication for women. Individual results may vary.

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