A Physician’s Quick Guide to
Natural Hormone Use In Women
Basic Hormone Evaluation
  • Pituitary: FSH, LH, possibly prolactin in younger, anovulatory patient
  • Ovary: estradiol, estrone, progesterone, testosterone
  • Glucose metabolism: glucose, insulin, HbA1c (note the time and content of prior meal).
  • Thyroid: TSH, total T4, free T4, total T3, free T3. If warranted: TPO Ab, Anti-thyroglobulin Ab, TSI (Thyroid Stimulating Immunoglobulin) If warranted: Reverse T3.
  • Adrenal: DHEA-S, cortisol (note the time of the blood draw) or salivary cortisol X 4 at: am/noon/6:00 pm/h.s., pregnenolone, androstenedione

Therapy Guidelines

Young teens with PMS, irregular cycles, dysmenorrheal, not in need of contraception:
Progesterone 100mg P.O., H.S. Day 10-26 of cycle

Young woman with irregular cycles: Mild PCOS, not desirous of pregnancy right now, normal glucose, insulin:
Progesterone 100mg P.O., H.S. day 10-26 of cycle (day 7-27 may be required in some women to control bleeding). If in need of birth control or high testosterone, excess hair or acne: Birth control pills.

Young woman with irregular cycles and abnormal glucose, insulin resistance: Mild PCOS, not desirous of pregnancy:
Consider Metformin therapy progesterone 100mg P.O., H.S. day 10-26 of cycle (day 7-27 may be required in some women to control bleeding). If in need of birth control or high testosterone, excess hair or acne: Birth control pills.

Early pre-menopause (35-50): with fibroids or endometrial polyps:
Progesterone 100mg P.O., H.S. day 10-26 of cycle

Middle pre-menopause (35-50): irregular, heavy cycles, PMS, hot flashes, with normal or mildly elevated FSH and LH, adequate estrogen:
Progesterone 100mg P.O., H.S. day 10-26 of cycle

Established Menopause (45-55): No periods, mild to no hot flashes: Progesterone 50-100 mg P.O., H.S. 3 weeks on/1 week off. Add biest 1-5 mg, or estradiol patch, or oral estradiol.

S/P hysterectomy with or without hot flashes, elevated FSH but adequate estrogen levels:
Progesterone 100mg P.O., H.S. day 10-26 of cycle

S/P hysterectomy with or without hot flashes, elevated FSH but low estrogen levels:
Progesterone 100mg P.O., H.S. day 10-26 of cycle. Add biest 1-5 mg, or estradiol patch, or oral estradiol.

Menopausal Diabetic:
Progesterone 50-100 mg P.O., H.S.

Late Menopause:
Elevated FSH and LH, low estradiol, progesterone and testosterone.

Supplement hormones as needed for patient comfort. Measure levels. Occasionally, stop progesterone for one week to evaluate for endometrial stimulation.