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• HRT (hormone replacement therapy is actually an outdated term, and Menopausal Hormone Therapy is more accurate) prescription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.