Hormone Replacement Therapy
Prescription hormone therapy for perimenopause and menopause — a naturopathic doctor managing the whole picture.
Book nowHormone therapy, properly individualized
Hormone replacement therapy (HRT) replaces the estrogen and progesterone that decline through perimenopause and menopause. Used appropriately, it relieves hot flashes and night sweats, supports sleep, mood, cognition, and libido, protects bone, and addresses the genitourinary symptoms (vaginal dryness, painful sex, urinary urgency) that often persist for years after the final period.
I prescribe bioidentical hormone replacement therapy (BHRT) — estradiol and progesterone in the same molecular forms the body produces, manufactured by pharmaceutical companies and approved by Health Canada.
For the midlife transition, and beyond
HRT is worth considering if you're experiencing:
- Perimenopausal symptoms — irregular cycles, hot flashes, night sweats, sleep disruption, mood and anxiety changes, brain fog, new joint aches, heavy or unpredictable bleeding
- Menopausal symptoms — the above, after twelve months without a period
- Surgical or premature menopause — after oophorectomy, or premature ovarian insufficiency (POI), where HRT is the standard of care to age 51 minimum
- Genitourinary syndrome of menopause (GSM) — vaginal dryness, painful sex, recurrent UTIs, urinary urgency
- Bone health concerns — family history of osteoporosis, low bone density, or fracture history
It's also worth a conversation if you've been told you're "too young" to be in perimenopause, or if you have unanswered questions about whether HRT is right for you.
"Perimenopause is diagnosed clinically — from your symptom picture, not a hormone panel."
In BC, naturopathic doctors with prescriptive authority can prescribe and manage HRT. An initial consult is built around a full history, symptom picture, lab review, and risk-benefit conversation. Sleep, thyroid, iron, nutrition, stress, weight, and exercise all interact with hormone symptoms — I look at all of them, and follow-ups are with me.
Estradiol and progesterone
Estrogen (estradiol)
Bioidentical estradiol delivered via:
- Transdermal patch — applied twice weekly. The default route in current guidelines for most patients because it bypasses the liver and carries a lower clot risk than oral estrogen.
- Transdermal gel — applied daily. Useful for patients who don't tolerate the patch adhesive or prefer dose flexibility.
- Vaginal estrogen — for genitourinary symptoms specifically. Local action, minimal systemic absorption, can be used long-term.
Progesterone
Micronized oral progesterone — taken at bedtime, daily or cyclically depending on whether you still have a uterus and where you are in the transition. The bedtime timing is intentional — micronized progesterone has a mild sedating effect that supports sleep.
Measured before prescribed
A first HRT visit is built around your symptom picture and history more than around lab numbers — perimenopause is diagnosed clinically, not from a hormone panel. That said, I do order baseline labs to rule out other causes of symptoms and to guide some treatment decisions.
Typical baseline panel:
- TSH
- Ferritin and CBC
- Vitamin D
- Lipid panel
- Fasting glucose / HbA1c
- FSH and estradiol
- AST and ALT
If you've had labs done in the last 6 months we can usually start there. If not, we can arrange testing at the visit.
When menopause comes early
For patients whose menopause comes early — after oophorectomy, or because of premature ovarian insufficiency (POI) — HRT is the standard of care, not an optional quality-of-life decision. Continued estrogen exposure to roughly the typical age of natural menopause (around 51) is recommended for bone density, cardiovascular health, and cognitive protection.
I see patients in this group at any age. The consult is structured the same way as a perimenopause or menopause assessment, with attention to:
- Bone density — earlier and more proactive monitoring than for menopause that arrives at the typical age.
- Dose and duration — calibrated to age at menopause, not chronological age.
If you've previously been told HRT isn't an option for you, it's worth a current-evidence conversation.
Assessment, then follow-up
HRT care is structured as an initial assessment (60 minutes) followed by follow-ups at a regular cadence to titrate dose and monitor response.
Full history and symptom mapping
Cycle pattern, symptom timeline, sleep, mood, libido, GSM, family history (cardiovascular, breast cancer, blood clots, osteoporosis), current medications and supplements.
Risk-benefit conversation
What HRT can do, what it can't, where the evidence is solid and where it isn't, and the contraindications relevant to you.
Labs review
What we already have, and what we need.
Treatment plan
The specific preparations, dose, route, and how we'll know it's working — prescription provided at the visit when appropriate.
Follow-up is typically 3 months after starting, to check symptom response and adjust dose. After dose is dialed in, follow-ups move to roughly every 6 months for ongoing review and prescription renewal.
Common questions
Is HRT safe?
For most patients in the first ten years after their final period, the benefits of HRT outweigh the risks — the current evidence-based position from the Menopause Society and the Canadian Menopause Society. Risk depends on your individual history, and the risk-benefit conversation is part of every initial assessment.
Are these bioidentical hormones?
Yes. The estradiol and progesterone I prescribe are bioidentical — the same molecular forms your body produces. The products are manufactured by pharmaceutical companies and approved by Health Canada, rather than compounded by a pharmacy. Same molecules, regulated supply chain.
Do I need to be in menopause to start?
No. Perimenopause is when most patients first benefit from HRT — symptoms often start years before the final period. The approach in perimenopause differs from menopause, but the conversation can start as soon as symptoms do.
How long do I have to be on HRT?
There's no automatic stop date. Duration is individualized, and we reassess at each annual visit based on symptom response, bone density and cardiovascular picture, and your personal risk profile. The decision is made together, with current evidence in mind.
What if I don't want HRT?
Many patients don't, and there's still a lot we can do. Sleep, exercise, nutrition, stress, and selected botanicals or supplements can meaningfully reduce symptoms. We'll discuss the full picture.
How much does HRT cost?
Visits are billed at the standard naturopathic consult rate and are typically covered by extended health plans that include naturopathic medicine. The medications are covered by BC PharmaCare for eligible BC residents.
Book your initial HRT assessment
HRT visits are booked under Naturopathic Consultation in the service list once you land on Jane.