Individualisation of hormone replacement therapy
every woman is different
Individuale the dosis
Normal concentrations range at least 2 fold. The Bioavailability after intake of a pill varies at least 4 times. Therefore the match between the right or usual concentration and the bioavailability in individual women varies more than 4 times, with 0.5 mg being enough in some, and 2 mg being not enough in another woman.
Unfortunately, there are no solid markers to determine what the individual woman needs
Therefore hormone replacement, like all commercial products, starts with a standard dose, which avoids an occasional overdose in some, but knowing that this will be too low for most.
The update of dosis is mainly clinical based on experience. This is difficult using commercially available products: half a dose could be given, but consider giving 3/4 or 5/4.
The individual administration
Except for contra-indications, it is a choice of the woman to prefer oral, transdermal or vaginal administration or implants.
Which oestrogen, progestagen and androgen?
The 4 available oestrogens, the >10 progestagens and the androgens have slightly different effects on the end-organs. The relative efficacy on several end organs, such as the breast, vagina and uterus, is relatively well known, but the effects on the brain are poorly studied. Unfortunately, research and trials address the ‘median effect in the median woman‘, and variability and individualisation result from clinical experience, requiring an MD with experience.
Without individualization, many women are not happy with a standard dose, and unfortunately, medical doctors with little experience ignore this. Not every pill is ok for every woman but there is a perfect pill for every woman 
Individualisation of the regime of administration
- sequential with menstruation. This mimics the menstrual cycle, but the amount of blood loss can be adapted.
- estrogen alone in women without a uterus
- continuous-combined with amenorrhoea in most women, but 30% will have spotting, which can generally be solved by changing products
Conclusion: individualisation or HRT is necessary
- Commercially available products are a compromise for the median woman
- Individualisation requires knowledge and experience, although simple rules such as >10 days of progestagens remain vaild
- Not every combination is okay for every woman, but for every woman, an optimal therapy can be found.
Decision tree
I do not have complaints, and I do not like hormones: only symptoms are treated.
or
I understand the advantages of HRT
- to feel better
- with many advantages.
- and less colon cancer and cardiovascular diseases as a bonus
- Breast cancer; not more cancers but increased growth and early diagnosis of a less invasive cancer
Considering the need to individualise hormone replacement therapy, knowledge and experience-based trial en error is essential.
We are all different, such as eye and hair colour. Also, in menopause, concentrations and doses of hormones can be very different.
This also applies to food-, sports, oxidative stress, microbiota etc
Ageing versus HRT
Hrt is not a prevention of ageing.
The mechanisms of ageing and the place of melatonin and growth hormone are not clear
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