Estrogen Therapy in San Diego, CA

Bi-Est is a compounded combination of estradiol and estriol — typically 80% estriol and 20% estradiol (referred to as 80/20), though ratios are personalized. The idea is to deliver enough estradiol for systemic benefits while leveraging estriol's gentler, tissue-specific action. It's a longstanding bioidentical HRT approach. Whether it's right for you depends on your symptoms, lab work, and treatment goals — Dr. Dubroff will assess and recommend the formulation that fits your case.

Transdermal estrogen (patch, cream, gel) bypasses the liver and is generally preferred — it has a different metabolic profile than oral, including less impact on clotting factors and triglycerides. Oral estrogen is sometimes appropriate but carries more cardiovascular and clotting considerations. Injections are rarely used for women. The right choice depends on your health history, other medications, and what your body responds to.

For most women, when properly dosed, monitored, and combined with appropriate progesterone (if you have a uterus), yes. Risk profiles depend on individual health history — particularly history of hormone-sensitive cancer, blood clots, or active liver disease. Dr. Dubroff conducts a thorough review of your medical history and reassesses periodically through follow-up labs.

If you have a uterus — yes. Estrogen alone causes uterine lining buildup, which over time increases endometrial cancer risk. Progesterone protects the uterine lining and balances estrogen's effects. Bioidentical progesterone is also clinically valuable on its own for sleep, anxiety, and overall hormonal balance. If you've had a hysterectomy, the calculation is different and Dr. Dubroff will discuss the options with you.

Estrogen dominance describes a pattern where estrogen activity is high relative to progesterone — often producing PMS, heavy periods, fibroids, breast tenderness, mood symptoms, and weight gain. It's most often a perimenopausal pattern where progesterone drops first while estrogen still swings high. Treatment is rarely "less estrogen" — it's usually adding bioidentical progesterone, supporting healthy estrogen metabolism, and addressing factors like cortisol and gut function that influence the picture.

Earlier is generally better. Research strongly supports starting HRT within the menopausal "window" — within 10 years of your last period, or before age 60 — for the best safety profile and the strongest protective effects on bone, brain, and cardiovascular health. Starting later isn't impossible, but the calculations change. If you're in or near the transition, this is the right time to be having the conversation.

No. Younger women with surgical menopause, premature ovarian insufficiency, hypothalamic amenorrhea, or hormonal deficiencies tied to other medical issues are often excellent candidates for estrogen therapy. Treatment is based on your hormonal picture and symptoms, not your age.