Individualisation of hormone replacement therapy
every woman is different
The Individual amount
Normal concentrations range from low to high. Most women have a median concentration but some are used to much higheror lower concentrations. The Bioavailability after 1 administration varies at least 4 times: any dose will have in individual women higher or lower concentrations varying with bioavailability. Therefore the match between the ususal concentration and the bioavailability in an individual women varies more than 4 times, 0.5 mg being insufficient in some, and 2 mg being too much in another woman.
Unfortunately, there are no solid markers to dtermine what the individual women 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 product: hals a dose could be given but consider to give 3/4 or 5/4.
The indivdual administration
Except contra-indications, it is a choice of the woman to prefer otral, transdermal or vaginal administration or implants.
Individualisation of the oestrogen, progestagen and androgen
Each of the 4 availble oestrogens, of the >10 progestagens and of the androgens has slightly different effects on the end-organs. Although the relative efficacy on the several end organs as breast, vagina and uterus are relatively well known, the effects on the brain are poorly studied. This is not surprising since research and trials address the ‘median effect in the median woman‘: variability and individualisation remain clinical experience and requires an MD with experience.
This lack of individualisation results in many women not being happy with a standard dose, and unfortunately most medical doctors with little experience tend to ignore their ignorance. 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 ofblood loss can be adapted .
- oestrogeen alone in women without a uterus
- continuous combined will result in amenorrhoea inmost womenbut 30ù will have spotting which can generally be solved by changing products
Conclusion: individualisation or HRT is necessary
- Commercially available procuts are a compromise for the median woman
- Individualisation requires knowledge and experience, althoug simple rules as >10 days of progestagensremain vaild
- Not very combination id ok ffor every woman, but for every woman an optimal therapy canbe found.
Praktische beslissingsboom voor elke vrouw:
I do not have complaints and I do not like hormones: only symptoms are treated .
I understand the advantages of HRT
- to feel better
- with many advantages .
- and less colon cancer and cardiaovascular diseases as a bonus
- Breast cancer; nnot more cancers but increased growth and early diagnosis of a less invasive cancer
Considering the need to individualisae hormone replacement therapy knowledge and exrperience based trial en error are essential.
We are all different, such as eye and hair color. Also in menopause , concentrations and dose 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 melatonine and growth hormone ar not celar