🌸 Goals of HRT

Stabilise hormones during perimenopause

Improve energy, mood, sleep, libido

Reduce fat gain, brain fog, anxiety

Support bone, skin, hair, and metabolic health

🔬 Baseline Tests (before starting)

Ideally done day 19–21 of cycle (if still cycling):

Estradiol (E2)

Progesterone

Total + Free Testosterone

SHBG

DHEA-S

Cortisol (AM)

Thyroid panel (TSH, FT3, FT4)

Lipids, glucose, insulin

🧴 Typical Bio-Identical Cream Protocol (Perimenopause)

1️⃣ Progesterone (foundation hormone)

Most important hormone in your 40s

Dose: 20–40 mg per day

Timing: Evening / before bed

Cycle-based:

Days 14–28 of cycle (if cycling)

Continuous:

If cycles are irregular

📍 Apply to: inner arms, thighs, lower abdomen

💤 Benefits: better sleep, calmer mood, reduced anxiety, less water retention

2️⃣ Estrogen (only if low or symptomatic)

Use only if needed (low estrogen symptoms)

Dose: 0.25–0.5 mg estradiol daily (transdermal)

Apply: morning

Avoid overuse → bloating, breast tenderness, fat gain

⚠️ Always balance estrogen with progesterone

3️⃣ Testosterone (very low dose, optional)

For fatigue, low libido, poor muscle tone

Dose: 0.5–1.0 mg daily (cream)

Apply: morning

Cycle: 5 days on / 2 days off

📍 Apply to inner thigh or glute

⚠️ Watch for acne or hair growth → lower dose if needed

4️⃣ DHEA (if low)

Dose: 5–10 mg daily (oral or cream)

Supports adrenal health, libido, mood

🕒 Example Daily Schedule

Morning

Estrogen (if prescribed)

Testosterone (if prescribed)

Evening

Progesterone cream

🧠 Lifestyle Support (VERY important)

HRT works best when combined with:

Protein intake: 1.6–2.0 g/kg

Strength training: 3–4x/week

Reduce chronic cardio

Sleep: 7–8 hours

Stress management (cortisol ruins hormone balance)

🔁 Re-testing & Adjustments

Recheck bloods after 8–12 weeks

Adjust based on:

Symptoms

Energy

Sleep

Body composition

Mood & cycle regularity

⚠️ Red Flags (reduce dose if present)

Breast tenderness

Mood swings

Water retention

Anxiety spikes

Acne / facial hair (testosterone too high)