Skip to main content

Diane Brzezinski, D.O. FACOI

Call for an appointment | 239.261.9990

Dr. B's Blog

hormone replacement therapy


To say that the use of hormone replacement therapy (HRT) has been historically controversial is an understatement. Ever since the FDA in 1942 approved the first HRT drug—Premarin—for the treatment of menopausal hot flashes, the popularity of HRT has gone up and down like a spasmodic yo-yo. While some studies, publications, and books touting HRT’s effectiveness made its popularity surge, others would backpedal the surge by warning of health risks. Among the former was the 1966 bestselling book Feminine Forever, which claimed that taking estrogen would allow a woman to remain just that despite menopause. An example of the latter was the 1977 bestselling book Women and the Crisis in Sex Hormones, which warned about studies linking HRT to breast cancer, strokes, and blood clots.

Cut to the early 2000s, when HRT’s popularity took a huge hit with the release of early results from the ongoing Woman’s Health Initiative (WHI) study, which linked HRT to cancer and several other significant health issues. Follow-up research eventually identified flaws in the WHI’s initial findings and determined that HRT benefits outweigh potential risks, and the FDA and numerous medical organizations support the controlled use of HRT. However, the damage was done, and the number of women undergoing HRT today remains significantly subdued compared to pre-2000 numbers.

Naples, Florida-based internal medicine specialist Dr. Diane Brzezinski, D.O., can tell you that interest in HRT is increasing again. With two decades of safely and effectively treating her patients with the therapy, Dr. B is an HRT proponent. Dr. B notes that many patients she sees today understand HRT’s health benefits to risk profile and have already decided to undergo the treatment. Instead of questions about health benefits and risks, she says, her patients most frequently ask what the difference is between traditional and bioidentical hormone replacement therapy. So, let’s take a closer look at the difference.


Hormone Replacement Therapy (HRT) is designed to restore hormone levels lost due to menopause or medical conditions. This restoration of estrogen and other hormone levels helps alleviate the numerous symptoms associated with the three phases of menopause, including:

  • Hot flashes
  • Night sweats
  • Insomnia
  • Mood swings
  • Vaginal discomfort and dryness
  • Decreased libido
  • Urinary problems
  • Loss of concentration
  • Headaches
  • Weight gain
  • Hair loss
  • Emotional distress

HRT has also proven effective at limiting age-related bone loss in post-menopausal women and may help protect women who experience early menopause against heart disease.

Today, potential HRT health risks are mitigated by adjusting the type of hormones and dosage according to age, medical history, and family health profile. In men, HRT helps restore unnaturally low levels of testosterone, which is known as testosterone deficiency syndrome.


If we were talking about HRT 75 years ago, the only available therapy was provided by “all-natural” hormones derived from human placentas or, with the FDA approval of Premarin, made from the urine of pregnant mares. While this was the original “traditional” formulation for HRT, scientists in the 1950s began developing chemical-based synthetic hormones in the lab that approximate the natural hormones our bodies produce.

Thus, traditional HRT today refers primarily to the use of man-made synthetic hormones but can also include the still-prescribed pregnant horse urine-derived Premarin. These traditional HRTs have been widely studied, with the resultant research guiding HRT protocols to ensure efficacy and safety.


Like synthetics, bioidentical hormones are manufactured, though they are derived from natural plant sources. However, instead of approximating our natural hormones, they have the same exact chemical and molecular structure—that is, “bioidentical.” In addition to providing better absorption and utilization rates than synthetic hormones, researchers believe the body’s ability to metabolize them efficiently may help reduce potential side effects. Bioidentical HRT has also been developed to make it easier to tailor hormone dosages to meet the unique needs and health profile of each patient. Traditional HRT tends to be much more reliant on standardized dosing.


Like traditional HRT, bioidentical hormones can be administered in many forms, including pills, patches, creams, gels, and injections. However, Dr. B relies on grain-of-rice-size bioidentical hormone pellets that are inserted under the skin. BHRT pellet therapy delivers hormones into the body at a steady rate to maintain consistent 24-hour hormone levels for multiple months. Other forms of traditional and bioidentical HRT provide inconsistent hormone levels throughout the day, which can mitigate their effectiveness and cause minor side effects.

BHRT’s ability to ease symptoms varies among patients due to dosage and their unique health and hormone level profile. It typically takes about three months for the full effects of any hormone therapy to set in, though some patients experience relief within a few weeks and others within two months.

Each BHRT session lasts three to six months, depending on dosage and hormonal profile. In subsequent sessions, the dosage may be adjusted to account for hormonal profile changes or shifts in patient health. With a “whole patient” approach to medical care, Dr. B often recommends combining BHRT with other holistic treatment options and lifestyle changes to optimize results.


To learn more about the benefits of BHRT and determine whether you are a good candidate for the therapy, Dr. B would be glad to meet with you. To schedule an appointment at her Naples-based internal medicine practice, contact her office at (239) 261-9990.