Peri-menopause and Pre-menstrual Syndrome (PMS)

Program Overview

Our hormone replacement team collaborates with you to tailor a hormone program that aligns with your unique needs and lifestyle.

This personalized therapy includes a blend of bio-identical hormones, along with doctor consultations and lab work conducted either in the office or virtually.

Common Symptoms of Perimenopause and PMS

Symptoms such as mood swings, headaches, insomnia, and emotional fluctuations are often linked to estrogen dominance compounded by low progesterone levels. Additionally, low testosterone levels may contribute to symptoms like decreased libido, fatigue, and weight gain, indicating a hormonal imbalance.

Hormone Replacement Strategies

Addressing Estrogen Dominance

  • Dr. Rogers Centers offers Estrogen Dominate capsules, with instructions to increase dosage when experiencing breast tenderness.
  • Our weight loss program is recommended to balance hormones by reducing non-ovarian estrogen production in fat tissues.
  • We also advise monitoring and minimizing environmental estrogen exposure by limiting the intake of hormone-exposed meat, milk, butter, and dairy products.

Managing Progesterone Deficiency

  • Low progesterone may manifest as increased anxiety, moodiness, and disrupted sleep patterns, particularly after ovulation and until menstruation.
  • Treatment involves dosing progesterone based on symptom patterns throughout the menstrual cycle or during irregular cycles.
  • Peri-menopause patients may experience these symptoms all the time as the progesterone levels start to decline with ovarian fatigue.

Progesterone Dosage Timing Guidelines

Continuous Symptoms

If you experience symptoms consistently throughout the typical 28-day cycle or have irregular missed cycles, take progesterone every night before bedtime. However, omit the dose for the first two days of your menstrual period. Once menstruation begins, pause the nightly dose for two nights, then resume on the third night. Repeat this cycle accordingly.

Pre-Menstrual Symptoms

If symptoms manifest a week or two before your menstrual cycle begins, initiate progesterone supplementation on the night of ovulation (typically around day 12 or 13 of your cycle). Maintain the nightly dosage until the first day of menstruation. Discontinue the nightly dose until ovulation occurs again, then repeat the aforementioned regimen.

Progesterone Treatment Options

Treatment Options

Options include oral progesterone in sustained-release or Prometrium capsule forms, sublingual rapid dissolve tablets, or various compounded formulations. Costs vary depending on the type and formulation of progesterone.


  • Prometrium- oral progesterone capsule
    • Limitations: Contraindicated if you have a peanut allergy.
    • Limitations: Only formulated in the 100mg and 200mg dose.
  • 30-day supply- cash pay- $63 and with insurance coverage @$10.

Compounded forms

  • Capsule SR release- 30-day supply - $45 and $90 day supply @ $105
  • Liquid form 30-day supply - $55 and limited by a bitter taste.
  • Cream-based form- $45.
  • Vaginal troche form- $55

Testosterone Treatment Options

Treatment Options

Testosterone treatment for females is not typically covered by insurance.

Options include pellets, creams, rapid dissolve troches for vaginal or oral use, or intramuscular injections. Costs vary based on the chosen method and supply duration.


  • Pellet- $299-$350 (placed every 3 months)
  • Cream 30-day supply - $45.
  • Cream 90-day supply - $105.
  • Rapidly dissolve troche for vaginal or oral dosing -30 day supply - $45.
  • Intramuscular injections are dosed once a week. Injections can be administered in the clinic or at home.
  • Your medication stored at the clinic- $10 per injection
  • IM Testosterone- @ $75 a month or $125 for a 3-month supply.
  • Testosterone for females must be compounded at a specialty pharmacy.

Manifestations of Testosterone Deficiency

  • Low libido, decreased vitality, dry skin, abnormal weight gain, and loss of muscle mass are signs of low testosterone.
  • Testosterone is produced in the ovaries. With age, the testosterone levels start to decrease and show the symptoms.

Perimenopause and PMS Lab Draw Considerations

Ideally, labs should be drawn during the week before menstruation begins.

Lab draws for different hormone replacement methods should be timed accordingly, ensuring accurate assessment and dosage adjustments.

Pellet Therapy

Following pellet insertion, the provider schedules a lab draw after one or two months to assess the appropriate dosage. This lab analysis aids in determining the subsequent pellet insertion dose. Once the optimal dosage is established, further lab draws are conducted as needed.

Creams Lab Work Instructions

For patients using hormone creams, lab work should be completed at least one week before the scheduled hormone visit. To ensure accurate results, ensure that there is no cream residue on the arms during the lab draw. It's advisable to skip applying hormone cream on the day of the lab draw to prevent contamination.

Troches/RDT Timing Guidelines

For individuals using troches or rapid dissolve tablets (RDTs), the ideal timing for lab work is at least four hours after taking the troche. This timing provides a snapshot of peak hormone levels. Lab draws should be scheduled at least one week before the planned hormone visit.

Testosterone Injections Lab Draw Protocol

Lab work for patients receiving testosterone injections should be conducted at least one week before the scheduled hormone visit. It's crucial to draw the labs before the next scheduled dose to accurately assess hormone levels. For example, if administering testosterone injections on Saturdays, schedule the lab draw on Fridays.

Considerations for Hormone Replacement Therapy

  • Patients with a history of certain cancers or blood clotting disorders should consult with specialists to evaluate the risk-benefit ratio of HRT.
  • Maintaining healthy weight, cholesterol, and blood pressure levels while on therapy reduces the risk of adverse events such as blood clots, strokes, and heart attacks.
  • Potential side effects of estrogen, progesterone, and testosterone therapy should be considered, including bloating, headaches, breast tenderness, blood clots, and various gynecological issues.