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What Am I Taking...& Why?!

You've been prescribed, read, or told that XYZ is great...but what actually is it, and what is it supposed to do?

We have provided a brief overview of the main resources women use when trying to relieve menopausal side effects, especially ones like vaginal dryness, itching, and pain, as well as painful sex. Now, we always recommend talking to your doctor about what you are taking/using, as medications can interact with one another - and your body - in lots of unique ways. But, when it comes to research, we understand the need to be in charge and have some knowledge of what your options are.



OTC (over the counter)



$400/$500 per session



Approx $50/60


Silky Peach





$186 (GoodRX)








Ok, now you have a brief idea of how things differ in cost, whether you can get them ‘Over the Counter’ and whether they contain hormones. But, let’s take a more in depth look at what each item actually is, what it is supposed to do, and whether it might be a good option for you!





Pellet BHRT

Hormone pellets which are inserted into the subcutaneous tissue in the hip or stomach area with a small incision. The pellet dissolves slowly over a period of months releasing a stable amount of hormone.

Easy - once inserted don’t need to think about it again

Provides a more or less stable stream of hormone

Have to work with a provider which increases cost.

Peak hormone rise is felt during the first month and then a drop thereafter. Symptoms return around 3-4 months.

More expensive than other forms of BHRT.

Risk of pain/infection at the insertion site.

Can’t change the dose after implantation, could be too low or too high.

Hormones will be released into fatty tissue where they are stored, a smaller portion gets into the bloodstream.

DHEA – hormone supplement

The major hormone from which many other sex hormones flow as well as supporting health in its own right. Creams have the advantage over pills and capsules because they are not processed by the liver first.

Supplementation can provide the base for production of many other sex hormones. DHEA is linked to wellness, vitality and optimal body function.

Overuse can result in aggression in men; male pattern baldness and hirsutism in women.

DIM – a supplement called diindolylmethane, a metabolite of indole-3-carbinol

Breakdown of the estrogens estradiol and estrone both lead to the formation of estrogen metabolites. These include 2-hydroxyestrone (2-OH), 4-hydroxyestrone (4-OH), and 16a-hydroxyestrone (16a-OH). These metabolites have different biological activity. The 2-OH metabolite has weak estrogenic activity and is protective. The 4-OH and 16a-OH have a greater amount of estrogenic activity and can be harmful and carcinogenic.

Diindolylmethane (DIM) promotes healthy estrogen metabolism and creates a better balance of estrogen metabolites.

DIM helps to restore healthy hormone balance by adjusting the balance of estrogens and also by blocking an enzyme called aromatase which converts testosterone to estrogen.

DIM is produced when we eat cruciferous vegetables like broccoli. A supplement provides a higher level of DIM.

Estrone is often the predominant estrogen post menopause. DIM helps metabolize estrone to the more protective metabolite 2-hydroxyestrone (2-OH)

If cancer cells are present, studies have shown that DIM can inhibit the growth of tumors.

Reduces symptoms of estrogen dominance

Rarely, may cause an upset stomach if taken without food.

Estriol creams

Provide a supply of estriol. Estriol creams are primarily applied to the vulva to restore the health and plumpness of vaginal and vulva tissue.

Easy to use


Estriol is the weakest estrogen and is safe for long term use

Can be used even after breast cancer

Always discuss use of estriol with your practitioner if you currently have breast cancer

Estradiol creams

Estradiol is a more powerful estrogen and most often prescribed by a doctor. Estradiol supplementation is most often provided post menopause when estrogen levels have dropped significantly. The estradiol will be used throughout the body. It is ideally balanced by progesterone. Application can be vaginal or on thin areas of the skin such as the inner arms, behind the knees.

Easy to apply.

Provides estrogen postmenopause to reduce symptoms associated with low estrogen

Estradiol should be used along with progesterone to reduce symptoms of estrogen dominance and to protect breast and uterine tissue.

Some women may not need the strength of estradiol and do better with estriol- the weaker estrogen.

Hormone Replacement like Premarin

Pharmaceutical progestin and estrogen cream used for relieving symptoms associated with hormone imbalance that occurs with menopause. These hormone-like substances do not have the same chemical structure as the hormones made by the body.

Doctors are familiar with Premarin and will prescribe it

Premarin may be covered by insurance

Synthetic hormones do not interact with the body in the same way as bioidentical hormones and may have unintended consequences. Progestins do not help and protect the brain, bones, heart, and other organs in the way that bioidentical progesterone does.

Despite insurance coverage may not be cheap

Estrogen only Hormone Replacement like Estrace

Estrace is an example of a vaginal estrogen product made by a pharmaceutical company. The estrogen in this cream is typically estradiol, the powerful estrogen. This type of vaginal estradiol has "systemic" effects, meaning that it can affect parts of the body other than where the medicine is directly applied.

Doctors are familiar with Estrace and will prescribe it

Estrace may be covered by insurance

The estradiol in the cream may be too strong for women and cause symptoms of estrogen dominance, especially if the cream is not balanced with progesterone.

Despite insurance coverage may not be cheap

Ideally, will need to add progesterone as well.

Vaginal Atrophy and Lasers.

Another option that comes up frequently is the use of lasers to help repair the lining of the vagina. Lasers are their own beast, and we have talked about them in depth in this blog. You can check it out if you want to understand how vaginal lasers work, and the pros and cons of this option.