Monica's Question: 
Hi, Thank you for providing such great information regarding BHRT, this has been a great resource and one of the best sites I have visited. My question is: I am currently going through peri-menopause; while back in July my hormones levels tanked and I started having terrible problems with hot flashes and night sweats, after about 3 mos in and no period blood test confirmed my levels are very low. I decided to go with BHRT cream and within a week I could tell a huge difference. I do have uterus and my cream included Bi-est (50-50) plus P Plus T 1.8 mg plus 200 mg plus 5mg/ml cream. On my second month in I started my period within another 10 days I started bleeding again for about 3 weeks straight. During this time I was given a 7 day supply of 10 mg oral progestin this didn't help slow down the heavy bleeding and returned to talk back to my doctor. I was told most likely I was not absorbing the progesterone. I explained my concerns of not really wanting to take the oral progesterone and was changed over to 100 mg progesterone capsule finally after about 7 more days this meds had stop the bleeding. While during this time frame of a few weeks of bleeding, I decided to get in with my regular gyno for an ultrasound although I had one in 2018 for a side pain in which everything was healthy and looked normal. I want to make sure I am getting on track and taking the oral progesterone with using the cream is the better safer option. It was also mentioned that I might consider pairing the Mirena insert with BHRT cream I am not really crazy about that idea. I always had a regular cycle with no issues and only took birth control for a short time frame in my early twenties. At age 47 I am hoping I am on the right track to have a well balance and using the least I can and feel confident in making good choices. Any suggestions or feedback is greatly appreciated.
Short Answer: 
First off, for a woman new to BHRT, we don’t like to combine so many hormones into one cream. If issues arise and the dose needs to be modified, that inital cream can’t be used. Typically, we will not start a woman on a 50:50 ratio right away. We will start with an 80/20 ratio to see how she responds. We will usually wait on the testosterone for later, once the Biest dose is optimized. Finally, we will prescribe a bioidentical progesterone sustained release capsule, instead of using a cream. This is important if the woman still has her uterus.
PYHP 085 Full Transcript: 
Download PYHP 085
Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki
Dr. Davidson: And I’m Dr. Davidson. 
Dr Maki: How you doing this morning? 
Dr. Davidson: I’m doing great. How are you? 
Dr. Maki: Pretty good. Pretty good. The weather’s nice. We’re still in lockdown, but we’re getting a lot of podcasts done. 
Dr. Davidson: That’s certainly are.
Dr. Maki: Good thing, we're going to do another question. We have a few to catch up on so this is very appropriate. This one is from Monica. Dr. Davidson once you go ahead and read the question.
Dr. Davidson: Sure. I know we’re on this kind of trend answering questions, but we’ve