WOMEN'S HORMONAL HEALTH | MONTANA TELEMEDICINE
Bio-identical Hormone Therapy
Personalized perimenopause and menopause treatment with Dr. Dawn Dalili, ND
Hot flashes. Disrupted sleep. Changes in mood, menstrual cycles, or sexual wellbeing.
When your body begins changing in ways you don't recognize, it's reasonable to wonder whether hormones are responsible—and whether hormone replacement therapy could help.
At Montana Center for Vibrant Living, we offer individualized evaluation and treatment for women navigating perimenopause and menopause, including prescription hormone therapy when appropriate.
We don't assume every symptom is hormonal. But we also don't dismiss hormone therapy when it may be an effective option.
Could Hormone Therapy Help You Feel Better?
Perimenopause can begin years before your final menstrual period. As estrogen and progesterone fluctuate, you may notice changes in how you feel, sleep, and function.
Common concerns include:
Changes in mood or irritability
Hot flashes and night sweats
Difficulty sleeping, particularly when night sweats interrupt sleep
Irregular or changing menstrual cycles
Vaginal dryness or discomfort with intimacy
Changes in sexual interest and response
Some women also experience fatigue, difficulty concentrating, and changes in body composition during midlife.
These symptoms deserve attention, but they don't all have the same cause—or necessarily respond to the same treatment.
The goal isn't simply to replace hormones. It's to understand what's changing and determine which treatments are likely to help.
Bioidentical Hormone Replacement Therapy:
A Personalized Approach
Hormone therapy isn't one-size-fits-all. The hormones we choose, how they're delivered, and the doses we prescribe all matter.
At Montana Center for Vibrant Living, I use bioidentical hormones—hormones that are molecularly identical to those produced by the human body.
My preference is for vaginal delivery rather than oral estrogen, with treatment tailored to each woman's symptoms, medical history, and response.
Supporting Your Changing Estrogen Needs
Estradiol is the primary estrogen produced during the reproductive years. As estrogen production changes during perimenopause and menopause, some women experience hot flashes, night sweats, sleep disruption, and vaginal symptoms.
Patches and creams avoid first-pass metabolism through the liver and may have a more favorable risk profile than oral estrogen.
Progesterone: An Essential Partner to Estrogen
For women who have a uterus, adequate progesterone is essential when prescribing systemic estrogen to protect the uterine lining.
Bioidentical micronized progesterone is one option I use, with the regimen selected according to each woman's clinical needs.
Progesterone may also influence sleep and other symptoms, although individual responses vary.
Customized Compounded Hormone Creams
I value the ability to prescribe individualized hormone formulations through a local compounding pharmacy.
Compounded vaginal creams can provide flexibility in hormone combinations, concentrations, and dosing when commercially available products don't adequately meet a patient's needs.
Why I Take an Individualized Approach to Bioidentical Hormones
Two women can arrive with similar symptoms and need very different treatment plans.
Their medical histories, hormone exposure, sensitivities, and responses to therapy may differ considerably.
That's why I don't begin with a standard hormone protocol.
Why I Favor Non-oral Hormone Delivery
I don't prescribe oral estrogen.
Instead, I favor non-oral delivery, including customized vaginal hormone preparations when appropriate.
Avoiding oral administration can reduce first-pass hepatic exposure.
Follow-Up Is Part of the Treatment
Prescribing hormones is only the beginning.
After treatment begins, I assess your symptom response, side effects, and overall clinical progress.
I also use follow-up systemic hormone testing as part of my prescribing approach.
Testing can provide information about systemic hormone exposure, although hormone measurements alone cannot establish whether a compounded regimen is safe, effective, or providing adequate endometrial protection.
Treatment decisions consider the full clinical picture rather than relying on a single laboratory result.
Thoughtful Prescribing, Ongoing Care
My goal isn't to achieve a predetermined hormone number or prescribe the same combination to every patient.
It's to help you make informed treatment decisions, monitor your response, and adjust your care as appropriate.
Bioidentical hormone therapy is one tool within a broader approach to women's midlife health.
The right treatment begins with understanding the woman receiving it.