Key Takeaways
Bioidentical hormones match the structure of what the body already produces
Dr. Brown explained that bioidentical hormones have the same molecular structure as hormones produced by the body. The term itself does not determine whether a treatment is safer or more effective; formulation, dose, delivery method, and a woman’s individual health history also matter.
Transdermal HRT carries a lower stroke risk than oral pills
Oral estrogen passes through the liver before entering systemic circulation and can affect clotting factors. Dr. Brown explained that transdermal estrogen bypasses this first-pass liver metabolism and may carry a lower risk of blood clots than oral estrogen, which can be an important consideration when choosing a delivery method.
There's a safer window for starting systemic HRT around menopause
Dr. Brown noted that starting systemic hormone therapy has a higher risk after age 60 or more than ten years past a woman's final period. Outside that window, vaginal estrogen remains a safe, effective option for genitourinary symptoms.
DHEA is unlikely to cause hair loss at the doses Winona prescribes
Dr. Brown explained that hair loss is a known side effect of high-dose testosterone, but Winona starts patients on a low 25-milligram dose of DHEA. She noted that hormonal hair thinning during perimenopause is more often tied to the broader hormone shift than to DHEA itself.
Constipation after starting HRT often resolves with fiber, water, and time
Dr. Brown attributed post-HRT constipation to the body adjusting to a new hormone regimen. She recommended increasing dietary fiber, staying hydrated, and using a gentle over-the-counter option like MiraLAX if symptoms persist.
