Virtual Clinic for Women's Hormonal Health & Digestion in Ontario


Details Of Bioidentical Hormone Therapy

The Process Of Taking Bioidentical Hormones

Bioidentical Hormone Therapy

We often get new patients who book with us because they are interested in trying bioidentical hormones, and then in the intake it’s revealed that their family doctor has actually prescribed them hormones, they are just not comfortable taking it. We’ve realized that this is because the woman did not receive enough education around the bioidentical hormone prescription, and they are looking for more closer monitoring to ensure efficacy and safety. At Sequence Wellness our naturopathic doctors are thorough! We make sure that our patients are fully informed and safely monitored as much as possible. Here is our Standard of Care for our menopausal hormone therapy patients.

Want a personalized assessment of your hormones in menopause?

Our Process For Bioidentical Hormone Therapy

Appointment #1
  • Intake and assessment
  • Lab testing request

A first visit with a woman seeking bioidentical hormone therapy with a naturopathic doctor is the same as for any other patient; we perform a thorough case review (including nutrition, sleep, stress, menstrual symptoms, medical history, etc), and will translate the woman’s case back to her within a medical framework, but in language and context that she can best understand. We also will requisition any lab testing required to complete our understanding of her case. These will be basic labs such as cholesterol, blood sugar, vitamin D, B12, thyroid levels, etc. It may also include hormone testing such as FSH, estradiol and other hormonal tests

Appointment #2 (2-4 weeks later)
  • Review of labs
  • HRT benefit/risk calculations template
  • Schedule of care and HRT info to review
  • General nutrition suggestions

The second visit usually takes place 2-3 weeks after the first, in which we review the lab test results, and start our discussion about the risks and benefits of hormone therapy (the use of bioidentical hormones). We will use the woman’s individual data to precisely calculate their risk of breast cancer, heart disease and osteoporosis, and with that data help her make a fully informed decision about using bioidentical hormones. We will then outline a short- and long-term schedule of care, so that she can anticipate what visits and testing she will need in the next 12-14 months. The woman will be sent home with detailed information from various medical menopause research groups about the risks and benefits of menopausal hormone therapy, so that she can go even more in depth into the literature at her own pace. We also provide some general nutrition suggestions that she can start on. If the lab testing revealed any other concerns, we will prescribe treatment for these concerns appropriately.

Appointment #3 (2-4 weeks later)
  • HRT (hormone replacement therapy is actually an outdated term, and Menopausal Hormone Therapy is more accurate) prescription
  • HRT patient instructions and responsibilities

In the third appointment we usually prescribe the starting dose of bioidentical hormones. We also do one last risk benefit assessment and ensure that the woman is fully knowledgeable about how to take/use the hormone therapy.

Between appointments #3-4:
  • Nutritionist appointment #1: intake/plan
  • Nutrition appointment #2 (1 month later): check-in

Many of our patients then bounce over to our nutritionist to go deeper with their nutritional health. This is very important for overall disease prevention and generally feeling better day to day. And while waiting for the bioidentical hormones to kick in, it’s a great way to improve the body’s terrain. 

Appointment #4 (3 months later) and #5 (3 months after that)
  • HRT check in on symptoms
  • Re-test hormones
  • Ensure mental health and stress support established

Visit #4 and #5 come at 3 months and 6 months after hormone therapy prescribing, and we check in on hormonal symptoms and any side effects they may be having. If all is well, we just continue to monitor, but we may need to tweak the dose of the medication. We will also re-test hormone levels to make sure we have achieved a therapeutic dose, and will re-test any other lab markers that had previously been off. We also want to make sure that the woman’s stress response and mental health are being addressed. Often we work in tandem with their psychotherapist to ensure her health care team is on the same page. 

Follow-up every 6 months thereafter:

   After hormone therapy has been established and balanced, we then check-in every 6 months before renewing the prescription to make sure the bioidentical hormones are still warranted, helpful and safe. 

Interested in trying bioidentical hormones? Want to have a discussion with a knowledgeable medical practitioner to determine if it’s a good choice for you?
Dr. Elizabeth Miller, a licensed Naturopathic Doctor

Your Doctor: Meet Dr. Miller

Dr. Elizabeth Miller Naturopathic Doctor with a focus in female hormones, digestion and pediatric care.

Dr. Miller completed her doctor or naturopathic medicine degree at the Canadian College of Naturopathic Medicine, and holds a Master’s and Bachelor’s of science in Human Health and Nutrition from the University of Guelph. Her extensive knowledge of nutrition and her strong foundation in scientific research allows for a very thorough approach to your care. She is licensed and registered as a Naturopathic Doctor in Ontario by The College of Naturopaths of Ontario (CONO) and is a member of the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).

She is passionate about teaching holistic health to help women understand their bodies and get to the root cause of their health issues. 

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