Bioidentical Hormone Therapy in Toronto
Prescribing bioidentical hormones in perimenopause is a different job than prescribing them in menopause, and much of what goes wrong with hormone replacement therapy, also known as HRT, comes down to that difference.
In perimenopause, hormones are still moving. Estrogen swings irregularly for several years, often far higher than it ever was and dropping to low levels randomly. Whereas progesterone often drops to almost zero unless ovulation happens, which is rare.
Menopause is very different from the perimenopause picture: a stable deficiency of both estrogen and progesterone that protocols can dose into predictably. Most of the women who find this page arrive from one of two places.
They asked about hormones and were told they’re too young because they still have periods, or their symptoms aren’t bad enough. Or they may have already tried hormone therapy in perimenopause and it made things worse, often with heavy bleeding.
Hormone prescribing at White Lotus Clinic is led by Dr. Fiona McCulloch, ND, who has spent roughly twenty-five years working in hormonal health, much of it managing the irregular cycles, heavy bleeding, and thickened uterine lining in conditions like PCOS/PCOM and perimenopause.
That background helps us treat some of the hardest problems in perimenopausal HRT prescribing. If you’re considering bioidentical hormone replacement therapy in Toronto, or researching BHRT (bioidentical hormone replacement therapy) after a first attempt elsewhere, the starting point here is a 90-minute consultation through our menopause and perimenopause program.
If You've Been Told You're Too Young
The most common type of patient we see
The most common patient looking for help with perimenopause and HRT has already asked her doctor about hormones and was told she’s “too young,” or her “symptoms aren’t bad enough,” or that she doesn’t need them. Some patients have been prescribed antidepressants for hot flashes instead of hormone replacement therapy.
She’s read about the hormones and their benefits online, but the information is confusing and it’s difficult to know who to trust. What most of our patients actually want is a long, unhurried conversation about the pros and cons so questions get fully answered. In our assessment, we look at symptoms and their severity, cycle pattern, sleep, prior treatment response, and the timing of changes they have noticed.
If you tried hormones before and they made things worse
The second pattern we often see: patients who tried hormone replacement therapy in perimenopause who had side effects or problems with bleeding. Many patients in perimenopause are prone to heavy or prolonged bleeding in general, and if the correct protocol isn’t given, this can simply aggravate the bleeding. Most of these patients were then moved onto the birth control pill.
In these cases the hormones themselves usually weren’t the problem. The protocol was built for a stable low hormonal environment like menopause, and perimenopause just isn’t the same. Perimenopause includes swings between high and low estrogen and low progesterone and often doesn’t respond the same way to menopause-specific HRT protocols.
The mechanism behind the failure of the HRT protocol, and what a perimenopause-specific protocol does differently, is outlined here to help you understand the difference.
Presentations that HRT can help with in Perimenopause and Menopause
- Mood and sleep symptoms that don’t match how you were before perimenopause. These patients have significant trouble with sleep, or changes in mood, that read as a departure from their own baseline rather than a continuation of something they’ve always had.
- Heavy or prolonged periods. Some patients in perimenopause have heavy periods that standard HRT protocols can actually make worse. Alongside specific estrogen protocols, we’re skilled in using progesterone to manage perimenopausal bleeding.
- Sudden weight gain around the midsection. This can signify that hormone changes have triggered insulin resistance or a thyroid condition. We can analyze this and treat accordingly, rather than filing it under symptoms to accept.
- Severe hot flashes. The patients who get the most severe hot flashes are often those who had high estrogen levels throughout their lives or vascular issues like high blood pressure. It’s a pattern we’ve observed rather than a rule, but for these patients it tends to explain the intensity of what they’ve been experiencing.
- Waking at 2 or 3 in the morning, wired but exhausted. High nighttime cortisol combined with the natural mid-night rise in core body temperature triggers these wakings, and sometimes hot flashes with them. It’s a specific pattern, distinct from general stress or primary insomnia.
What many have already tried - Standard Bioidentical HRT Protocols and Other Treatments
Many of the patients we see have already tried something. Outdated Non-bioidentical higher risk HRT. Standard Bioidentical HRT protocols. Antidepressants for hot flashes. The birth control pill, offered after a perimenopause HRT attempt caused bleeding. A primary-care hormone conversation that ended before their questions did. Each of these is useful history: what was tried, and how the body responded, shapes what we’d consider next. We always look at you as an individual, every patient is unique and every symptom guides us.
Bioidentical progesterone for heavy periods in the reproductive years, outside perimenopause
The Perimenopause Bioidentical HRT Protocol
Why perimenopause prescribing is a different problem
Menopause protocols tend to be stable and similar from one patient to the next, because the hormonal environment they’re dosed into is itself low and stable. Perimenopause protocols simply vary much more between patients and may need more adjustment. In perimenopause, estrogen is often still elevated, sometimes far higher than the doses used in HRT, and it swings irregularly up and down from month to month and even from day to day. Progesterone drops much earlier than estrogen does, and often there is very little progesterone in perimenopause. A perimenopause protocol has to manage a moving target rather than dose into a steady low state.
This is where prior attempts most often fail to manage the situation. A common example: a patient starts a standard protocol built for menopause while her ovaries are still producing estrogen in irregular surges on top of it. The progesterone side of the protocol wasn’t dosed or timed to cover that combined estrogen load, so the uterine lining keeps building from estrogen and eventually bleeds. Not enough suppression of the endometrial lining is the most frequent design flaw we see in prior perimenopause prescriptions. The breakthrough bleeding it causes is a protocol problem that can typically be solved, and initial bleeding says very little about whether hormone therapy can work for that patient when dosed appropriately.
Where our PCOS background applies
Managing a lining under unpredictable estrogen is a challenge we’ve worked with for two decades through PCOS/PCOM care. PCOS often produces prolonged heavy bleeding, thickened endometrial lining from unopposed estrogen, and lack of ovulation with low progesterone. In order to manage this problem, protocols must work to handle the lining and oppose high levels of estrogen. That’s the same type of management that perimenopausal bleeding demands. Dr. Fiona McCulloch, ND, who peer-reviewed the 2023 International Evidence-Based PCOS Guidelines and wrote 8 Steps to Reverse Your PCOS, has spent much of her clinical experience working with patients with this problem.
How the protocol is chosen
Whether we start with progesterone alone, or estrogen and progesterone together, depends on the patient. Progesterone alone is an option, especially at first in perimenopause, where there’s still significant estrogen present but a serious lack of progesterone. Sometimes the fluctuating estrogen itself is the problem, and estrogen can be given specifically to stabilize it, pushing back on the negative-feedback signalling from the brain. Treatment options for bioidentical HRT depend on your symptom pattern, your cycle pattern if cycles are still occurring, prior treatment response, family history, and your goals.
When the issue is metabolic, not endometrial
For some patients, the thing that changed in perimenopause wasn’t bleeding at all. Weight gathers suddenly around the midsection and doesn’t respond the way it used to. This can signify that the hormone shift has triggered insulin resistance, or a thyroid condition surfacing for the first time; losing the metabolic effects of estrogen often worsens metabolism in this window. We can analyze for both and treat accordingly. Midsection weight gain in perimenopause is a signal worth investigating as a few different root causes may be involved.
What Bioidentical Hormone Therapy Involves
Bioidentical hormone replacement therapy isn't the same as compounding
A common assumption is that “bioidentical” means compounded at a specialty pharmacy. It doesn’t. Bioidentical describes molecular structure: a hormone whose chemical structure matches what the human body produces. Even the conventional hormone therapy we prescribe is bioidentical; it’s simply produced by the pharmaceutical industry at scale. This type of bioidentical hormone replacement therapy is extremely easy to access. Estradiol patches and gels, micronized progesterone, and vaginal estrogen are all pharmaceutical-grade bioidentical hormones, dispensed at standard pharmacies and typically covered by insurance as ordinary prescriptions. Compounding is needed only when a particular form isn’t commercially available, progesterone cream being the main example, and insurance coverage for compounded preparations varies by plan. Compounding can also be used when patients prefer to avoid additives, or require custom formulations. We work with many trusted hormone compounding pharmacies for those patients who prefer this service. That said, many of our bioidentical prescriptions are pharmaceutically produced and available at any pharmacy.
Formulations and prescribing scope at this clinic
| Hormone / Form | Route | Ontario ND Status |
|---|---|---|
| Estradiol (patches, gels) | Transdermal | Direct-prescribe. Avoids the liver first-pass metabolism discussed in the safety section. |
| Vaginal estrogen (cream, suppository) | Vaginal | Direct-prescribe. Minimal systemic absorption; used for vaginal dryness, sexual function, and urinary symptoms. |
| Micronized progesterone (e.g., Prometrium) | Oral | Referred. Outside the Ontario ND direct-prescribe scope; we refer to a collaborating prescriber. |
| Vaginal progesterone suppositories | Vaginal | Direct-prescribe. |
| Estriol | Vaginal | Direct-prescribe. A gentler estrogen used for genitourinary symptoms. |
| Testosterone | Various | Referred. We refer to a collaborating prescriber when it's indicated. |
| Oral estrogen | Oral | Referred. Rarely the route we'd suggest in any case, for the safety reasons below. |
So, can naturopaths prescribe bioidentical hormones in Ontario? Yes, within a regulated scope. Licensed Ontario NDs hold prescribing authority under the College of Naturopaths of Ontario for transdermal estrogen, vaginal estrogen, and vaginal progesterone, which covers most of what perimenopausal and menopausal prescribing calls for. We can’t prescribe DHEA or testosterone currently and when one of those is indicated we refer to a collaborating prescriber.
Standard pharmaceutical prescriptions are filled at any regular pharmacy. Compounding is used for dose customization when it’s clinically indicated, or when a form isn’t commercially available; neither option is inferior, and the choice depends on the clinical fit. Partner pharmacies ship throughout Ontario, which matters for patients outside central Toronto, but the prescription can be filled wherever you prefer.
Safety: What the Evidence Now Shows
Where the cancer and clot fear comes from
The cancer, clot, and stroke worries most readers bring to this page trace back to the 2002 Women’s Health Initiative findings. Those studies caused a lot of fear, and it helps to look at what they actually tested: high doses of oral conjugated equine estrogens combined with synthetic progestins, given to women whose average age was 63, many of whom had pre-existing cardiovascular disease or were smokers. Both the drug profile and the study population shaped those results and the risk they caused has now been thoroughly understood.
The route of administration for estrogen matters most. Oral estrogen passes through the liver and turns into metabolites that stay very high in the blood for a long time, and those same metabolites cause blood clots. The same is true of the oral estrogen in birth control pills.
Transdermal bioidentical estrogen (patches, creams and gels) is absorbed through the skin, doesn’t produce the same clotting metabolites, and this is why it hasn’t been found to create the same clot risk as oral estrogen.
The progesterone side of this research changes the risk picture even further. Synthetic progestins, used in those older studies, are extremely powerful, and have a fundamentally different risk profile than natural bioidentical progesterone. Natural progesterone has never been shown to cause clots, and it may have protective actions with respect to breast cancer rather than harmful ones.
HRT, once analyzed thoroughly including transdermal estrogen and natural progesterone, also hasn’t been shown to cause breast cancer.
There’s another point about perimenopause that most patients haven’t heard. Estrogen levels in perimenopause are often significantly higher than the estrogen given in HRT. In some cases, the estrogen in HRT reduces the high spikes the body produces on its own, so a patient on HRT may be exposed to less total estrogen than she was without it.
For women who’ve had high estrogen throughout their lives, the ones we often see with the most severe hot flashes, the benefits of regulating and minimizing high estrogen spikes may be even more marked.
Due to these and other updates, in November 2025, an FDA advisory panel completed a review of the accumulated evidence on hormone therapy, and the boxed warnings applied to HRT products since the early 2000s were removed.
A personal or family history of breast cancer, blood clots, or stroke is always addressed individually at consultation. It isn’t a blanket disqualifier to have breast cancer in the family, as this is a very complex condition that includes multiple risk factors.
It is important to note that cancers that develop incidentally can feed off hormones, which is why following the breast screening guidelines for your age range remains essential on HRT.
From First Visit to Ongoing Care
1
Comprehensive assessment (90 minutes)
We review your full health history, current symptoms, menstrual cycle patterns, family history, past experiences with hormones or supplements, and your personal preferences and concerns. This is a detailed clinical conversation meant to help us understand your goals, so you can feel comfortable and confident with your decisions.
2
Hormone and metabolic testing, if appropriate
Testing can help identify specific hormonal patterns and ensure blood levels of hormones are optimized. Though testing can be extremely helpful, it’s not required for everyone: clinical assessment of symptom patterning and cycle history is also informative and often correlates well with the overall hormonal picture. Learn more about comprehensive hormone testing.
3
Treatment discussion
All available options are presented with benefits and risks for each. Progesterone alone, estrogen and progesterone, compounded formulations, non-hormonal approaches are available. With all of the information, you can choose what is right for your situation.
4
Ongoing monitoring and adjustment
Regular follow-up to assess treatment response, adjust doses, and monitor safety markers. We prescribe to optimal dosing for your goals with gradual titration, guided by symptom response. Blood testing to determine hormone levels is also available where helpful. Individual hormone levels can vary significantly and are a useful factor alongside symptoms in determining dose and delivery type.
Each protocol is individualized because prescribing bioidentical hormones for perimenopause requires different clinical reasoning than prescribing for menopause, and every patient within each stage presents differently.
Many patients notice improvement within two to four weeks of starting bioidentical hormone therapy, with continued improvement over three months. Some changes, particularly tissue health and musculoskeletal improvements may take longer, due to the nature of how these tissues heal. These are general clinical observations, not guarantees, and individual responses vary.
When treatment is working well, patients often describe something beyond symptom improvement. They describe being able to do all the other things they want to do in life, whether that is exercise, activities, or work with the right hormonal support. Sometimes patients do not realize how well hormone therapy can work, or how much more quickly they can feel better, until they experience it.
What Happens at a First Visit
The first visit is a complete intake
The first visit runs up to 90 minutes. It’s a complete intake that helps us understand your goals and start developing a customized treatment plan you feel comfortable with. We take a full symptom history, your cycle pattern, prior treatments and how you responded to them, family history, and what you’re hoping to get from treatment. Lab testing isn’t a prerequisite; treatment can begin at this visit when that’s the appropriate clinical decision.
Two paths for the prescription, decided by you
You’ll leave the first visit with a treatment plan. How the prescription itself unfolds depends on what you prefer.
- If you’d like to begin hormone therapy right away and it’s clinically indicated, the prescription is issued at the first visit.
- If you’d rather have testing or analysis completed first, the prescription is issued at the follow-up visit, once that testing is done.
Your preference and comfort determine the path, throughout. Whether you book future visits and whether you continue treatment are your decisions at every stage; we give honest clinical feedback on the options and you set the pace.
At the visit, all available options are presented with benefits and risks for each: progesterone alone, estrogen and progesterone together, vaginal preparations, and non-hormonal approaches where they fit better. Hormone lab testing is offered to help us understand how your hormones are working in your body. The aim is that you leave with your questions actually answered and a clear picture of the choices in front of you.
Follow-up at 4 to 6 weeks
At the follow-up we assess how your symptoms have responded and adjust the protocol if that’s indicated. Any starting-phase effects get reviewed here too.
Regular follow-up is conducted depending on individual need. Prescribing adjusts to your symptom response over time, including changes to dose, route, and form when they’re clinically indicated; we prescribe to optimal dosing for your goals, guided by symptom response. Blood testing for hormone levels is offered as a complement to symptom assessment rather than a requirement. Some patients show meaningful variation in their levels that explains variation in symptoms, and the lab values then help refine dose and delivery.
Standard pharmaceutical bioidentical hormones, including micronized progesterone, estradiol gels and patches, vaginal estrogen, and natural desiccated thyroid, are covered by most insurance plans as standard prescriptions. Coverage for compounded prescriptions varies by plan. Insurance for the prescription itself is separate from insurance for the consultation visit.
Frequently Asked Questions About Bioidentical Hormone Therapy
Safety
I have a family history of breast cancer. Can I still consider bioidentical hormone therapy?
Often yes, but the answer is individual, and it’s worked out at consultation. We go through your personal and family history in detail and weigh the decision against your specific risk picture, including the formulation and route differences described in the safety section above.
How is the endometrial lining monitored on perimenopause progesterone?
We follow standard protocols for progesterone that are proven to thin the lining. In patients who have a thickened lining or endometrial hyperplasia without atypia, higher or prolonged doses of progesterone may be needed. We can coordinate this with your conventional care.
Does vaginal estrogen carry the same risks as systemic estrogen?
No. Vaginal estrogen doesn’t enter the bloodstream in significant amounts, so its systemic risks are minimal. It’s used for localized indications: vaginal dryness, painful intercourse, urinary urgency or frequency, and recurrent urinary tract infections. Because the systemic exposure is so small, the safety considerations that apply to transdermal or oral estrogen are largely a different conversation from vaginal estrogen. Patients with a history of breast cancer often qualify for vaginal low dose estrogen treatment.
Candidacy and Prior Experience
I tried bioidentical hormone therapy in perimenopause and it caused heavy bleeding. Does that mean hormones aren't for me?
Usually not. There are solutions for patients like this, using specific combinations of HRT built for the hormonal ups and downs of perimenopause. The most common reason a prior protocol caused breakthrough bleeding is that it didn’t include enough endometrial suppression for a still-fluctuating estrogen background. The fix is careful progesterone dosing and timing. The experience we draw on for these protocols comes from two decades of managing heavy bleeding, irregular bleeding, and thickened lining in PCOS.
I had a bad experience on the birth control pill. Does that predict how I will respond to bioidenticals?
No, response to birth control is a weak predictor at best. The pill contains synthetic progestins along with ethinyl estradiol, a powerful synthetic estrogen. Bioidentical hormone therapy uses micronized progesterone and bioidentical transdermal estradiol, which are different molecules that bind hormone receptors differently and produce different downstream effects. A patient who felt awful on the pill (some patients have even found the pill gave them hot flashes), can respond quite differently to bioidentical formulations. Your pill history still matters as part of the intake, because your response tells us something about your sensitivities.
Can I get a second opinion on my current HRT protocol?
Yes. Patients bring existing prescriptions for review fairly often. The assessment looks at whether the current protocol fits your hormonal picture: perimenopausal versus post-menopausal, the route and formulation, the progesterone dose and timing relative to the estrogen, and how your symptoms have responded since it started. Some patients don’t absorb or metabolize hormones at the same rate – in these cases we can often see different hormone levels in lab tests and adjust the dose for symptomatic improvement. Where the current protocol is working, that’s what the assessment finds. Where adjustment is indicated, we discuss the options with you and document the reasoning for your other providers.
Process and Access
What side effects are common when starting, and how are they managed?
The most common side effects of bioidentical HRT are bloating, bleeding, and breast tenderness. These often resolve within 3-6 months of starting HRT and can be alleviated by changes in dose and prescriptions.
How long does it usually take to notice a difference?
Many patients notice an improvement within two to four weeks, with further changes over the first three months. Hormones have different types of effects, and some are quicker than others: hot flashes and sleep tend to respond on the shorter end, while tissue-level changes, such as musculoskeletal complaints or vaginal tissue health, take longer because those tissues heal slowly. These are observations from practice, and individual responses vary.
What if the prescription doesn't work for me?
An inadequate response prompts adjustment, and dose, route, formulation, and timing are the variables we work with first. A patient whose hot flashes persist on progesterone alone might do better with estrogen added; a patient with side effects on one route might do better on another. Sometimes blood testing will reveal poor absorption. No matter the underlying cause we can look deeply to determine more. Where the assessment shows hormone therapy isn’t the appropriate fit, non-hormonal options are part of the conversation. There are many causes for symptoms other than perimenopausal and menopausal hormone changes.
Can I stop bioidentical hormone therapy if I want to? What does a taper look like?
Yes, stopping is always your decision. Depending on the dose, gradual tapering can be done for patients who are more sensitive. We require annual assessment to continue hormone replacement therapy prescriptions and to determine if it is safe and beneficial to continue.
Do I need lab work before my first visit?
No. Treatment can begin at the first visit when that’s the appropriate clinical decision, and lab work isn’t a prerequisite. Hormone testing is offered when it would refine the protocol; patients with confusing or atypical patterns often benefit from a baseline panel, and some prefer testing before starting, which is one of the two prescription paths described above. See hormone panel testing for what the panels cover.
Cost and Insurance
Are bioidentical hormones covered by insurance in Canada?
Standard pharmaceutical bioidentical hormones, including micronized progesterone, estradiol gels and patches, vaginal estrogen, and natural desiccated thyroid, are covered under most insurance plans as standard prescriptions. Coverage for compounded prescriptions varies by plan. Insurance for the prescription itself is separate from insurance for the consultation visit.
Is my naturopathic doctor visit covered by insurance?
Naturopathic consultations are often covered by extended health insurance. We offer direct billing for many common insurance providers and our receipts are made to provide all details needed by insurers.
Will my GP support this?
Bioidentical hormone prescribing through a licensed Ontario ND is regulated prescribing under the College of Naturopaths of Ontario, and the formulations involved, estradiol patches and gels, vaginal estrogen, vaginal progesterone, are pharmaceutical-grade products filled at standard pharmacies. We always include our rationale, and the monitoring plan for the chart. In our experience, family physicians are generally supportive as they may have limited time to cover HRT discussions in their practice. We are always willing to collaborate with your family physician if you desire.
Will I be locked into compounded prescriptions or one specific pharmacy?
No. Standard pharmaceutical formulations are the default, and they’re filled at any regular pharmacy. Compounding is used when dose customization is clinically indicated or when a particular form, such as progesterone cream, isn’t commercially available. Partner pharmacies who have trusted compounding services ship throughout Ontario, which is convenient for patients outside central Toronto, but the prescription can be filled wherever you prefe
When Conventional Care Is the Right Path
Where conventional management comes first
Bioidentical hormone therapy isn’t the right starting point for everyone. Active or recently treated breast or endometrial cancer, a current blood clot, and any active hormone-sensitive malignancy are areas where conventional management is critical.
When referral is the right move
- For patients with a personal cancer history, oncology consultation is the appropriate collaboration pathway before hormone decisions are made.
What the evidence does and doesn't cover
trials studied post-menopausal populations, so extrapolating that data to perimenopause carries genuine uncertainty. Our answer to that uncertainty is individualized assessment and graduated titration: start from your specific picture, adjust against your response, and avoid applying one protocol to every patient.
Bioidentical hormone therapy through a licensed Ontario ND adds to your primary-care management rather than replacing it.
Meet our Practitioners
Both Dr. Fiona and Dr. Alex see PCOS patients at White Lotus Clinic using the same clinical framework. Fees differ by practitioner.
Fees for Dr Alexandra Triendl-Dimitriu, ND
Perimenopause care using the same clinical framework as Dr. Fiona. For complex or challenging cases, Dr. Alex has direct access to Dr. Fiona's guidance — so you benefit from that depth of expertise regardless of which practitioner you see.
| Time | Description | Price |
|---|---|---|
| Up to 90 mins | Initial Naturopathic Consultation | $350 |
| 30m | Followup Naturopathic Consultation | $110 |
Fees for Dr Fiona McCulloch, RAc, ND
Author of 8 Steps to Reverse Your PCOS. Treating Menopause for 20+ years with a clinical focus in hormonal health, thousands of patients assessed.
| Time | Description | Price |
|---|---|---|
| Up to 90 min | Initial Naturopathic Consultation | $420 |
| 45m | Followup Naturopathic Consultation | $215 |
Click Links in description to see booking options. All new patents must start with an initial consultation.
Insurance Coverage
Insurance is not provided by OHIP but is typically included on most extended insurance plans.
Prescribing note
Both practitioners are licensed naturopathic doctors in Ontario with prescribing authority for bioidentical hormones, cyclic progesterone and natural dessicated thyroid medication. Prescribed medications may be covered by your prescription drug insurance.
Getting here
Location
121 Willowdale Ave Suite 301
Toronto / North York, Ontario M2N 6A3
Located near Yonge & Sheppard.
Clinic Hours
| Monday | 9:00 AM – 5:00 PM |
| Tuesday | 9:00 AM – 5:00 PM |
| Wednesday | 9:00 AM – 5:00 PM |
| Thursday | 9:00 AM – 7:00 PM |
| Friday | 9:00 AM – 5:00 PM |
| Saturday | 9:00 AM – 4:30 PM |
| Sunday | Closed |
Located in North York, Toronto.
Transit and parking:
3-minute walk from Sheppard–Yonge Station
3 minute drive from the Highway 401 Bayview exit by car
Street parking available
Accessibility:
Elevator access
Entrance Ramp
Please contact us if accommodations are needed.
Serving Our Community:
We provide registered acupuncture care to patients across North York, including Willowdale, Lansing, Newtonbrook, Bayview Village, and the Greater Toronto Area.
Your Next Step
If you are considering bioidentical hormone therapy and want to understand what approach may be right for your situation, a consultation through our menopause and perimenopause program is the place to start. The first visit is a comprehensive, 90-minute assessment — we review your symptoms, health history, and goals before discussing any treatment options. With this consultation you’ll gain a full uournderstanding of y hormonal picture and what your options are.
Or call (416) 730-8218
You have done the research. The next step is an assessment with someone who can evaluate your specific situation. Whether you are exploring bioidentical hormones for the first time or trying again after a previous experience we can help.
References
- Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-333.
- Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women’s Health Initiative randomized trials, 20-year follow-up. JAMA. 2025.
- The Menopause Society. The 2025 Position Statement on Hormone Therapy. Menopause. 2025.
- The North American Menopause Society. The 2022 Hormone Therapy Position Statement. Menopause. 2022;29(7):767-794.
- Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015;44(3):497-515.
- U.S. Food and Drug Administration. FDA advisory panel review of hormone therapy labelling, including removal of the boxed warnings on systemic estrogen products. November 2025.
- Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103-111.
- Prior JC. Progesterone for treatment of symptomatic menopausal women. Climacteric. 2018;21(4):358-365.
- Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008;336(7655):1227-1231.
- Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469.