PERI-MENOPAUSE OR PRE-MENSTRUAL SYNDROME (PMS)

 

How Does The Program Work?

Dr. Rogers’ hormone replacement team will work with you to personalize a blend of bio-identical hormones to fit your individualized needs and lifestyle. Simply put or goal is to restore your hormone levels to where they were during your early reproductive years and when you felt your best.

The hormone replacement program is designed to conveniently meet the needs of patients in office and virtually. Lab work can be completed on site as well.

Common Symptoms of Peri-menopause and PMS

Moodiness, headache, insomnia, and emotional liability are symptoms usually related to estrogen dominance compounded by low progesterone production levels. In addition, symptoms of low testosterone levels may also present which may include low libido, fatigue, and weight gain suggesting testosterone imbalance.

Hormone Replacement Strategies for Peri-menopause and PMS

Treatment of Estrogen Dominance

Dr. Rogers Centers Estrogen Dominate capsules- Take one capsule by mouth everyday and increase to two a day when breast tenderness is present.

Dr. Rogers Weight loss program is also recommended to balance hormones by decreasing non-ovarian estrogen production, which is occurring in fat tissue.

Monitoring and lowering environmental estrogen exposure by decreasing hormone exposed meat, milk, butter and other dairy products.

Manifestations Progesterone Deficiency

Low progesterone is manifested symptomatically by increased anxiety, moodiness, and inability to sleep typically after ovulation until menses starts. During this time period is when you will experience these PMS symptoms.

Peri-menopause patients may experience these symptoms all the time as the progesterone levels start to decline with ovarian fatigue.

Dosed Timing per Progesterone Symptoms

If symptoms are present throughout the typical 28-day cycle or you have irregular missed cycles then take the progesterone every night before bed except the first two days of your menses. Once your menses starts then hold the nightly dose for two nights then resume nightly dosing the third night and repeat above.

If symptoms are noticed a week or two before your menses starts then take your first progesterone dose the night of ovulation i.e. (Typically day 12 or 13 of your cycle). Continue the nightly dose until the first day of your menses and then stop the nightly dose until ovulation occurs again and repeat the above.

Progesterone Treatment Options

Oral progesterone compounded in the sustained release capsule form or prometrium capsule form is the best option for insomnia described as not being able to stay asleep all night.

Progesterone in the sub-lingual rapid dissolve tablet form is the best compound for insomnia described as not being able to fall asleep.

Cost:
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

Manifestations of Testosterone Deficiency

Low libido, decreased vitality, dry skin, abnormal weight gain, and loss of muscle mass are signs and symptoms of low testosterone. Testosterone is produced in the ovaries. As we age the testosterone levels can decrease and create the above symptoms.

Testosterone Treatment Options

Insurance will not cover testosterone treatment for females.

Cost: Pellet- $350 (placed every 3 months)
Pellets are convenient; supply a consistent hormone therapeutic level and best of all no cross exposure of hormones to other family members.

Cream 30 day supply – $45.
Cream 90 day supply – $105.
Rapid 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
  • Dr. Rogers Centers supplies medication- $20 per injection

IM Testosterone- @ $75 a month or @ $125 for a 3 month supply. Testosterone for females must be compounded at a specialty pharmacy.

Perimenopause and PMS Lab Draw Considerations

The best time to draw labs is during the week before your menses starts if possible. HRT lab work does not require fasting.

Pellet Therapy – Prior to the patient’s first hormone pellet treatment, lab work will be completed in order to determine the pellet dose to be inserted. Thereafter, lab work will be completed, as needed usually one month after insertion.

Creams – Prior to beginning hormone replacement cream therapy, lab work must be completed in order to determine the individual’s initial hormone levels. Thereafter, when lab work is ordered, do not apply the hormone replacement cream on the arms until your lab has been drawn for the day. Lab work must be drawn one week before scheduled appointment to have results in time for discussion at follow-up in clinic or virtually.

Troches/RDT – Prior to beginning hormone replacement troche therapy, lab work must be completed in order to determine the individual’s initial hormone levels. Thereafter, the best timing is at least 4 hours after taking the troche in the morning or can be in the morning if only dosing at night. This timing gives us a snap shot of your peak levels. The lab needs to be drawn at least one week before planned hormone visit.

Testosterone Injections – Prior to beginning hormone replacement testosterone injection therapy, lab work must be completed in order to determine the individual’s initial hormone levels. Lab needs to be drawn at least one week before planned hormone visit. The timing of the lab draw is important. The lab should be drawn before next dosing.

Example: If you administer your injection on Saturdays then draw your lab on Friday. If you administer on Monday, then draw labs before injection on Monday.

Where Can I Apply The Hormone Cream?

Hormones creams are very versatile meaning they can be applied to various surfaces areas such as the inner surface of the forearms, behind the knees, on top of the feet, or vaginally. Please note: we suggest that patients do not apply creams mixed with testosterone to hairy areas because it may promote unwanted hair growth.

The vaginal cream does not have to be inserted directly into the vaginal opening unless desired. The cream can be applied directly to the outer surface of the vaginal and clitoris area for best absorption.

You do not want the cream to come into contact with others.

How Do I Take My Troche or RDT?

Both the troche and the RDT need to completely dissolve in the mouth when taken orally. Most patients either place the troche or RDT under their tongue or between their check and gum. You should only swallow your salvia and none of the troche or RDT to prevent liver distress.

The troche or the RDT may be dosed once or twice a day to maintain consistent levels of hormone.

Some patients prefer the troches for vaginal insertions. Patients typically place the troche vaginally at night after bathing.

Considerations for Hormone Replacement Therapy

Patient’s with a history of breast, uterine and/or ovarian cancer or high risk of getting breast, uterine or ovarian cancer should consider a consult with an oncologist to determine the risk/benefit ratio of HRT.

Persons with a history of blood clots or a family history of blood clots may need to be evaluated by a hematologist to determine the risk/benefit ratio of HRT.

Maintaining a normal weight, cholesterol and blood pressure during therapy will reduce the risk of blood clots, stroke and heart attacks while on HRT.

Side effects of estrogen can be bloating, headaches, breast tenderness, blood clots and ob/gyn cancers.

Side effects of progesterone can be morning sleepiness and increased risk of ob/gyn cancers.

Side effects of testosterone can be scalp hair loss, hair growth on the face, acne, enlargement of the clitoris, and personality changes.

Blood donations may be required because testosterone therapy can increase the red blood cell count, which can increase the viscosity of the blood creating an increased risk for heart attack and stroke.