Menarche, the onset of menstruation, occurs in the early to mid teens. It marks the onset of ovarian function with resultant ovulation. Menses are irregular at first, but regularize into a monthly cycle as ovulation is established.

Hormone production becomes highest around age twenty-five, then gradually declines by two percent per year until menopause, which usually occurs between ages forty and fifty-five.

Three forms of estrogen – estrone (E1), estradiol (E2), and estriol (E3) – are produced by the human female. By far the most potent of the three is estradiol. At menopause estradiol and estriol decline to very low levels while estrone (E1) rises. Unfortunately, estrone is much the weakest of the three and does not provide sufficient protection against degenerative processes in the cardiovascular system or bones, nor does estrone relieve symptoms such as hot flashes, depression, fatigue, decreased libido, and weight gain.

Therefore, replacement of both estradiol and estriol is recommended in addition to pregnenolone, DHEA, testosterone, and progesterone. A non-oral route of administration is crucial because of the “first pass” removal of oral hormones by the liver. This is best accomplished using compounded transdermal creams or subcutaneous slow release pellets. Commercial products including patches which are available don’t include estriol with the estradiol.

Two other hormones are also important to consider for replacement, oxytocin and melatonin. Intravaginal DHEA cream known as the mother of hormones can also be used to supply a substrate for hormone production in the pelvis, an approach being advocated by Dr. Fernand Labrie and his group at Lasalle University in Canada, which he calls “Endoceutics.”