The Hormonal Nightmare

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Women can take biologically identical [bio–identical] hormones in many different ways. There are however, advantages and disadvantages to each of the different ways. As Mother Nature has the patent on biologically identical [bio–identical] hormones [which are exactly the same as a woman’s body makes], pharmaceutical companies cannot patent biologically identical [bio–identical] hormones. What the pharmaceutical companies can patent however, is the way that their products deliver biologically identical [bio–identical] hormones to a woman’s body. Therefore, some pharmaceutical companies, not wishing to miss out on making money off the sale of biologically [bio–identical] hormones, are producing them in various forms.

Combined Forms

Some biologically identical [bio–identical] hormone products made by the pharmaceutical companies combine estrogen and progesterone in one product. Also, some health practitioners will prescribe compounded biologically identical [bio–identical] hormones such as estrogen and progesterone in a combined dose, even though there are many disadvantages to doing so.

Having biologically identical [bio–identical] estrogens and progesterone in a combined form means that a woman will be taking her estrogens and progesterone at the same time of the day. Since every woman’s body uses and breaks down her estrogens at a different rate [in 6 to 18 hours] compared to progesterone, estrogens usually need to be taken twice a day, while progesterone is often only taken once a day. Having a combination of estrogens and progesterone in a dosage form does not allow for this difference in the way a woman’s body uses estrogens and progesterone.

Another problem that occurs when biologically identical [bio–identical] estrogens and progesterone are in a combined form is, if the dosages of either the estrogens or the progesterone’s need to be adjusted. This is impossible to do with combined bio–identical estrogen and progesterone products made by the pharmaceutical companies as their products are made in specific dosages. It is easier to change the dosages of either the estrogens or progesterone when they are compounded individually. However, a new batch of the hormones needs to be made and the remainder of the previous prescription of biologically identical [bio–identical] hormones usually can no longer be used and should therefore be properly disposed of.

Having estrogens and progesterone in a combined form also affects when a woman has to take her biologically identical [bio–identical] hormones. Many health professionals recommend that we should mimic nature and that a woman should take her biologically identical [bio–identical] estrogens and progesterone in the same cyclic way that her body makes her own estrogen and progesterone. When a woman's biologically identical [bio–identical] estrogens and biologically identical [bio–identical] progesterone are in a combined form, it is not possible for her to cycle them individually and in the same way that nature does.

Combined dosages also eliminate the ability to prescribe the estrogens and the progesterone’s in different delivery forms. For example, if for some reason her biologically identical [bio–identical] estrogens need to be given by using transmucosal cream, and her biologically identical [bio–identical] progesterone needs to be given by using a buccal lozenge.

Individual Forms

Individual dosages of the estrogens, progesterone, and testosterone appears to be the most common method of prescribing biologically identical [bio–identical] hormones to a woman.

Individual doses make it easier to change the prescription for any or all of the biologically identical [bio–identical], allows for a woman to take her biologically identical [bio–identical] cyclically, and allows her biologically identical [bio–identical] hormones to be prescribed using different delivery forms.


Some health practitioners still prescribe biologically identical [bio–identical] in the oral form. Compounding pharmacies make up these bio–identical hormones in the gelatin capsule form and pharmaceutical companies also make biologically identical [bio–identical] hormone products in an oral form.

Prometrium is an example of biologically identical [bio–identical] product made by a pharmaceutical company where biologically identical [bio–identical] progesterone is put into a gel capsule with peanut oil and made in 100 mg doses. In her book The Wisdom of Menopause, Dr. Christine Northrup M.D., talks about the fact that if a woman swallows a 100 mg capsule of Prometrium, she is lucky if she is able to get 30 to 40 mg of usable progesterone.

The reason that so little biologically identical [bio–identical] hormone is usable when a woman swallows a hormone, occurs because when biologically identical [bio–identical] hormones are swallowed, the liver is stimulated to release what is called steroid or sex hormone binding globulin [SHBG]. The SHBG attaches or binds to much of the progesterone making it unavailable for use at the tissue level. Steroid or sex hormone binding globulin [SHBG] is also released by the liver when capsules of biologically identical [bio–identical] hormones made by compounding pharmacies are swallowed. Swallowed biologically identical [bio–identical] hormone, which is not bound by steroid hormone binding globulin, is often broken down by the digestive juices in the stomach.

It is also known that testosterone travel’s in a woman’s blood stream bound to steroid hormone binding globulin [SHBG]. Therefore, if a woman takes the birth control pill or even biologically identical [bio–identical] hormones in the oral form, this causes an increase in her steroid hormone binding globulin [SHBG]. This tends to cause very low levels of testosterone in these women and also, with the birth control pill, tends to cause a decrease in a woman’s sex drive over time as well as a tendency for her to gain weight.


Estra Dot is an example of a biologically identical [bio–identical] estrogen product made by a pharmaceutical company. This patch contains only one of the three main estrogens made in a woman's body [17 Beta Estradiol]. This patch is attached to a woman's body and is made in such a way as to slowly release the estrogen into her body through her skin. With patches, a woman is receiving estrogen every single day instead of in the rhythmical pattern that estrogen is normally produced in a woman's body throughout her cycle. Also, many women can develop a localized sensitivity to the adhesive used to attach the patch to a woman's skin.


Surgically inserted subdermal [under the skin] biologically identical [bio–identical] hormone pellets have been used in England for several years and now are becoming popular in Northern America. Their main use in England appears to have been to replace the sex hormones that the woman was no longer able to produce when her ovaries were removed. However, now many health practitioners are recommending that even women who still have their ovaries can have the convenience of the pellets surgically inserted every 3 months. But, with subdermal pellets, a woman is receiving biologically identical [bio–identical] hormones every single day instead of in the rhythmical pattern that the hormones are normally produced in a woman's body throughout her cycle.


Biologically identical [bio–identical] creams have been used for many years. They became very popular with the publication of Dr. John Lee's book What Your Doctor May Not Tell You About Menopause and they continue to this day, to be the most popular treatment form. They are given transdermally [applied to the skin] in various locations on a woman’s body.

The most common ways of applying biologically identical [bio–identical] hormones are by rubbing into the inner arms and inner thighs. However, the skin must be completely free of oils, creams and soap and the skin must be rubbed hard enough to bring the blood close to the surface of the skin. Unfortunately, as many women get dressed soon after applying the cream, much of the cream is absorbed into the person’s clothing. Labs testing hormonal levels have found that transdermal creams give a very uneven daily level of hormones in the body.

Also, a major concern that is occurring with transdermal creams is the cross contamination of a partner, pets and children and/or grandchildren with the biologically identical [bio–identical] hormones that the woman is using. This cross contamination occurs when the woman hugs her loved ones, or when her loved ones are using or sharing the same bed that she sleeps in, as the biologically identical [bio–identical] hormones often get on the bedclothes. I have done saliva testing on numerous men who have very high levels of estrogen and progesterone in their systems because of this cross contamination. Therefore, many professionals are recommending transdermal creams only in specific situations.

Many health practitioners are now recommending transmucosal cream instead of transdermal cream stating that transmucosal cream is a more beneficial and effective way of giving women their biologically identical [bio–identical] hormones. It has been found that biologically identical [bio–identical] transmucosal cream is well absorbed, relieves menopausal symptoms, helps make the vaginal tissue and bladder tissue healthier, protects a woman’s blood vessels, does not increase the risk of blood clots, and does not stimulate breast tissue [does not increase the risk of breast cancer]. Biologically identical [bio–identical] transmucosal cream is applied in a woman’s vagina and, sometimes to her labia.

Unfortunately, although I educate women regarding the transmucosal method of taking their biologically identical [bio–identical] hormones, most women do not even want to try taking their biologically identical [bio–identical] hormones in this way. Also, 95% of my patients, who tried biologically identical [bio–identical] transmucosal cream did not like using it for a variety of reasons, and switched to another way of taking their biologically identical [bio–identical] hormones.

Sublingual Drops

As biologically identical [bio–identical] hormones are absorbed very quickly from mucus membranes, sublingual drops have been used as a way of giving biologically identical [bio–identical] hormones. This has been found to be a very effective way of giving biologically identical [bio–identical] progesterone for symptoms of PMS.

Unfortunately, sublingual drops often tend to produce a lot of saliva when they are placed under the tongue. This results in a woman swallowing a lot of the hormone with the saliva before it can be absorbed by the mucous membrane under the tongue. When biologically identical [bio–identical] hormones are swallowed, the liver releases steroid hormone binding globulin [SHBG] which binds to the majority of the biologically identical [bio–identical] hormone making it unavailable for use in the body. Swallowed biologically identical [bio–identical] hormone which is not bound by steroid hormone binding globulin is often broken down by the digestive juices in the stomach.


Both vaginal and rectal suppositories of biologically identical [bio identical] hormones were first prescribed by Dr. Katarina Dalton, M.D. to treat PMS symptoms or specifically biologically identical [bio–identical] progesterone in high dose suppositories as a treatment for medical conditions such as endometriosis and fibroids, or as a form of birth control.

Buccal Lozenge

Buccal lozenges are parked between a woman’s teeth and her cheek. They take about 30 to 45 minutes to dissolve and are absorbed directly through the mucous membrane of the mouth into the bloodstream. As they do produce some saliva as a dissolve, some of the hormone is swallowed and inactivated by the steroid hormone binding globulin [SHBG] and the digestive juices. However, many women who have taken the biologically identical [bio–identical] hormones using other delivery forms and have tried the buccal lozenge appear to prefer the buccal lozenge. These women state that they can feel the biologically identical [bio–identical] hormones working in eliminating their symptoms quicker than with other delivery forms.

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