This question was sent to me by Kelly L. who is 40 years old suffering from perimenopause.
It depends on your clinical goals. If your goal is to manage the symptoms of your hormone deficiencies, then you can take a patch or a low-dose compounded cream. This method also requires pharmaceutical drugs to assist the hormones in managing the side effects of hormone deficiencies, aka, hormonal imbalances. The reason drugs are needed with this approach is because the dose of hormones is so low that it doesn’t fix the hormone deficiency issue. Therefore, you will need to consider taking drugs to manage the side effects of hormone imbalance like depression, anxiety, insomnia, estrogen dominance, fibromyalgia pain, etc., that otherwise wouldn’t exist if hormones were dosed in a manner that pulls you out of “imbalance”.
If your goal is to establish and maintain a regular and incident-free menstrual cycle, then you’d need a more advanced HRT protocol like a rhythmic or physiological dosed system that involves high dosed transdermal creams or injections, and some orals (depends on the hormone).
The goal of advanced female HRT approaches is to restore hormones in adequate amounts to each hormone's sweet spot, which is a specific lab range for each hormone. This approach doesn't require so many drugs if any, because the goal is to restore hormones to the ranges of a healthy reproductive woman. When this happens, you will not need to manage the side effects of hormone deficiencies with drugs because there would most likely not be any on account of you’d be taking care of the deficiency issue with the amounts of hormones you take.
There are different approaches and methods of delivery to get hormones in those specific ranges (of which I call the Hormone Sweet Spot™). For instance, one person may need a transdermal cream for one hormone, while another hormone may require a different route of delivery to achieve the sweet spot range for that hormone.
Balancing hormones is a bit complicated and requires a doctor who isn’t afraid of estrogen and understands how it works, and further understands how to use different types of HRT to get hormones balanced in each sweet spot and keep them balanced. If you understand how this process works and what is required to get your hormones balanced, then you will have more control over your hormone balancing care.
If you want to know where you stand with your own hormone balance, I encourage you to take the Hormone Balance Test. It will give you a good place to start on your journey to getting your hormones balanced and keeping them balanced.