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Bio-Identical Hormone Replacement Therapy (BHRT) dosing guide
Peri-Menopausal
Menopausal Late-Menopausal
Pre-Menstrual Syndrome (approx. 45-49 years old)
(50's - 60's) (60's++)
Estrogen Dominance phase
Oral Slow
25-200mg daily. Once or twice daily dosing.
Release
25-400mg daily. Split daily dose and give 25-200mg daily. Once or twice daily dosing. 20 - 200mg/day, dosed once or twice daily.
Progesterone Oral - Slow Give 12-14 days each month at end of cycle.
twice daily. Give 12-14 days total at end of May use continuously or stop 3-5 days per May use continuously or stop 3-5 days per
Release Caps If taking with estrogen, may give together on
cycle month. month.
days 1-25
5-50mg daily. Once or twice daily dosing. 5-30mg daily. Once or twice daily dosing. If
Topical
5-60mg daily. Split daily dose and give 2 or 5-20mg/day, dosed once (or twice daily in
Give 12-14 days each month at end of cycle. used without estrogen, give 14-21 days each
Progesterone Topical more times daily. Give 12-14 days total at
If taking with estrogen, may give together on month. If using with estrogen, give cyclically
divided doses). May use continuously or
end of cycle stop 3-7 days per month.
days 1-25 with estrogen on days 1-25
Bi-Estrogen or Tri-Estrogen S.R. capsules
Oral Slow
Bi-Estrogen or Tri-Estrogen S.R. capsules Bi-Estrogen or Tri-Estrogen S.R. capsules
Release
(if progesterone alone does not control
Natural Estrogen Oral - Slow (if progesterone alone does not control 1.25mg- 2.5mg/day. Dose once or twice
rarely necessary symptoms). 0.625 - 5.0mg/day. Dose once
Release Capsule symptoms). 0.625 - 5.0mg/day. Dose once daily. May use continuously or stop 3-5 days
or twice daily. May use continuously or stop
or twice daily. Give cyclically on days 1-25. per month.
3-5 days per month.
Bi-Estrogen or Tri-Estrogen cream (if Bi-Estrogen or Tri-Estrogen cream (if
progesterone alone does not control progesterone alone does not control Bi-Estrogen and Tri-Estrogen cream. 0.3125-
Topical
symptoms). 0.3125 - 2.5mg/day. Daily dose symptoms). 0.3125 - 2.5mg/day. Daily dose 1.25mg daily, dosed once, or twice daily in
Natural Estrogen Topical rarely necessary
may be applied once daily or divided in two may be applied once daily or divided in two divided doses. May use continuously or stop
doses depending on symptom control. Give doses depending on symptom control. Give 3-5 days per month.
cyclically on days 1-25 cyclically on days 1-25
Oral Slow
Release
Occasionally necessary Occasionally necessary Occasionally necessary
Testosterone Oral - Slow
rarely necessary Testosterone SR caps 0.25 - 2.0mg (dosed Testosterone SR caps 0.25 - 2.0mg (dosed Testosterone S.R caps 0.5 - 2.5mg (dosed
Release caps once a day) once a day) once a day)
Topical Sublingual
Occasionally necessary Occasionally necessary Occasionally necessary
Testosterone sublingual Testosterone sublingual tablets Testosterone sublingual tablets Testosterone sublingual tablets
rarely necessary
(given 2-3 times per week) 1.25 - 2.5mg under the tongue 1.25 - 2.5mg under the tongue 1.25 - 2.5mg under the tongue
2-3 times per week 2-3 times per week 2-3 times per week
Occasionally necessary Occasionally necessary Occasionally necessary
Testosterone Topical rarely necessary Testosterone cream. 0.25 - 1.0mg (dosed Testosterone cream. 0.25 - 2.0mg (dosed Testosterone cream. 0.25 - 2.0mg (dosed
once a day) once a day) once a day)
All formulations listed in this chart require a prescriber's written or verbal prescription.
Standard Tri-Estrogen formulation = Estrone (E1) 10%, Estradiol (E2) 10%, Estriol (E3) 80% - Bi-Estrogen formulation = Estradiol 20%, Estriol 80%
For patients at high risk of cancer, or breast cancer survivors, a pure Estriol (E3) product can be prepared. Topical dose = 0.5 - 4mg/day. Oral S.R. dose = 2-8mg daily
Transdermal delivery avoids the first-pass effect of the liver. Transdermal doses are 1/5th - 1/10th of oral doses of the same medications
Progesterone alone may alleviate menopausal symptoms. If estrogen is required use the lowest dose needed to control symptoms but not cause monthly bleeding.
When converting to natural estrogen - do not stop synthetic estrogen replacement abruptly or hot flashes and vaginal dryness could resume. Wean gradually over 2-4 months
Premarin 0.625mg = Tri-Est 5.0mg slow release capsule (approximate conversion)
Saliva testing will help establish baseline levels and better correlate the symptoms a woman is experiencing to hormone levels in the body.
