Bioidentical Hormone Replacement Therapy

Bioidentical Hormone Replacement Therapy for Perimenopause and Menopause

Are you experiencing hot flashes, night sweats, mood changes, or other symptoms of menopause? At SPOKEmed, we provide personalized bioidentical hormone replacement therapy (BHRT) — also known as Menopause Hormone Therapy (MHT) — designed to help you feel like yourself again. Our approach focuses on addressing your unique symptoms while providing protective benefits for your long-term health.

Michelle Middleton, PA-C, takes time to understand your specific concerns and develops a customized treatment plan that aligns with the latest medical research. Experience relief from debilitating menopausal symptoms while potentially gaining protective benefits for your heart, brain, and bones.

Schedule Your BHRT Consultation

Understanding Bioidentical Hormone Therapy for Menopause

Bioidentical hormone replacement therapy addresses the natural decline in hormone levels that occurs during perimenopause and menopause. When your body produces less estrogen, progesterone or testosterone, you may experience a range of uncomfortable symptoms that affect your quality of life, which can be alleviated through the use of bioidentical hormone therapy.

BHRT works by supplementing these hormones to:

Relieve hot flashes and night sweats
Improve sleep quality and insomnia
Stabilize mood fluctuations
Address vaginal dryness and discomfort
Prevent bone loss that can lead to osteoporosis
Potentially reduce risk of heart disease and dementia when hormone replacement therapy is started at the appropriate time.

Recent research has significantly changed our understanding of Menopause Hormone Therapy (MHT). The benefits and risks of bioidentical hormones now appear to favor treatment for most women when started before age 60 or within 10 years of menopause.

The Four Pillars of Hormonal Health

Personalized Hormone Optimization

Evidence based hormone therapy recommendations tailored to your symptoms, goals, medical history, and laboratory findings.

Nutrition and Metabolic Health

Personalized nutrition strategies to support hormone production, blood sugar regulation, body composition, and overall wellness.

Exercise and Physical Resilience

Strength training, cardiovascular fitness, mobility, and movement recommendations designed to support muscle health, bone density, metabolic function, and healthy aging.

Sleep and Stress Recovery

Strategies to improve sleep quality and manage stress, helping to optimize cortisol balance, recovery, energy, and hormone function.

Our Bioidentical Hormone
Replacement Approach

At SPOKEmed, we take a thoughtful, evidence based approach to hormone therapy. We prioritize FDA approved bioidentical hormone options whenever appropriate, providing treatments that have undergone rigorous testing for safety, quality, and efficacy.

These options are also often more affordable than compounded alternatives and are typically covered by insurance. Our recommendations are personalized to your symptoms, goals, health history, and laboratory findings to help you feel your best while supporting long term health.

Benefits and Risks of BHRT

Benefits

Bioidentical hormones are made to be chemically identical to the hormones your body naturally produces. As hormone levels decline during menopause, bioidentical hormone therapy can help restore levels closer to what your body once produced. Similar to how you might supplement vitamin D when levels are low, hormone therapy replaces hormones that have decreased over time. Because bioidentical hormones have the same molecular structure as the body's natural hormones, they are recognized and utilized by the body in the same way as endogenous hormones, meaning the hormones naturally made by your own body, such as estrogen and progesterone.

Potential benefits include:

Weight management and metabolic health support
Relief from hot flashes and night sweats
Improved sleep quality and reduced insomnia
Enhanced mood stability and emotional well being
Better cognitive function and mental clarity
Increased energy levels and vitality
Improved sexual function and vaginal comfort
Support for cardiovascular health, which often begins to decline during the perimenopausal transition
Protection against bone loss and osteoporosis risk

Risks of BHRT

Breast Cancer

The relationship between hormone therapy and breast cancer risk is often misunderstood. Risk depends on the type of hormones used, duration of treatment, and individual risk factors. In the Women's Health Initiative, the increased risk of breast cancer associated with estrogen plus a synthetic progestin was approximately 1 additional case per 1,000 women per year (0.1%). Research suggests that bioidentical micronized progesterone may have a more favorable breast safety profile than older synthetic progestins, although ongoing research continues to evaluate long term outcomes.

Cardiovascular Effects

The cardiovascular effects of hormone therapy depend on factors such as age, existing cardiovascular health, timing of initiation, dose, route of administration, and type of hormone therapy used. For healthy women who begin hormone therapy before age 60 or within 10 years of menopause, current evidence suggests the benefit-risk profile is generally favorable. Starting hormone therapy later, particularly after age 60 or more than 10 years after menopause, may be associated with greater cardiovascular risk and requires a more individualized assessment.

Blood Clots

Hormone therapy can increase the risk of blood clots in some individuals, particularly with oral estrogen. Route of administration matters. Transdermal estrogen, such as a patch or gel, bypasses first pass liver metabolism and is associated with a lower risk of clotting compared with oral estrogen. Risk can be further minimized through appropriate patient selection, regular monitoring, and maintaining hormone levels within physiologic ranges rather than exceeding levels naturally seen in healthy before the perimenopausal transition.

Liver Disease

Hormone therapy may not be appropriate for individuals with active liver disease or significantly impaired liver function. Because the liver plays an important role in hormone metabolism, underlying liver conditions can affect both the safety and effectiveness of treatment. A thorough medical evaluation is necessary to determine whether hormone therapy is appropriate and which route of administration may be safest.

Bioidentical Hormone Delivery Methods

At SPOKEmed, we offer several FDA-approved delivery methods for bioidentical hormones:

Transdermal (Skin)
These methods allow hormones to be absorbed through the skin directly into the bloodstream, bypassing first pass liver metabolism. Transdermal estrogen is often preferred because it may offer a more favorable safety profile for some women.
- Patches: often the preferred transdermal option due to consistent absorption
- Gels
- Creams*
*While creams and gels can be effective options, absorption may be more variable depending on factors such as application technique, skin characteristics, and individual response.
Oral
Oral medications are convenient and effective for many women. Oral micronized progesterone is often a first line option when progesterone is needed. Oral estrogen undergoes first pass liver metabolism, which may influence hormone processing and certain risks.
- Oral micronized progesterone
- Estrogen tablets
Other Methods
Additional delivery methods may be appropriate depending on symptoms, goals, and individual needs.
- Vaginal estrogen for localized genitourinary symptoms such as dryness, irritation, recurrent urinary tract infections, and discomfort with intercourse
- Testosterone injections when clinically indicated
- Compounded hormone preparations, such as troches and creams may be considered in select situations when commercially available FDA approved options do not adequately meet a patient's needs, but they are generally not the first line approach

We do NOT use pellet therapy due to concerns about inconsistent hormone levels and inability to adjust or remove if side effects occur.

Hormone Replacement Therapy Success Stories

Weight frustration

Weight Frustration

"I wasn’t doing the wrong things. I just needed a plan that was personalized for my body" - Susan

When She First Came to SPOKEmed

Susan came to SPOKEmed just a few months before her 60th birthday with one goal: to lose weight and feel confident celebrating this milestone.

She had been working with a personal trainer for over a year, strength training several days a week, doing regular cardio, and meticulously tracking everything she ate. Despite all of her hard work, she continued gaining weight, especially around her midsection. Her trainer believed her metabolism had adapted and encouraged her to increase her calorie intake, but the weight continued to climb.

She was exhausted, discouraged, and beginning to wonder if her body was simply changing because of age. She told us, “I’ve never worked this hard and seen so little progress.”

What We Did Together

Rather than recommending another diet, we took a comprehensive look at what was happening beneath the surface. We reviewed her hormones, metabolic health, body composition, nutrition, exercise routine, and lifestyle.

We optimized her existing hormone replacement therapy to better support her symptoms and metabolic health. Because insulin resistance appeared to be contributing to her inability to lose weight, we added a GLP-1 medication and adjusted her macronutrient goals to support fat loss while preserving lean muscle. We also started her on a continuous glucose monitor (CGM), which helped identify how different foods affected her blood sugar and allowed us to personalize her nutrition even further.

Throughout the process, we met regularly to review her CGM data, monitor her progress, and make adjustments based on her body’s response.

After About 3 Weeks

Within a few weeks, Susan noticed she had more consistent energy throughout the day and found it much easier to follow a lower-carbohydrate nutrition plan because her blood sugar was becoming more stable. Seeing her glucose patterns in real time helped her make small dietary changes that significantly improved her metabolic health and insulin resistance. Most exciting of all, for the first time in years, the scale finally started moving in the right direction.

After 2–3 Months

By her 60th birthday, Susan had lost weight, reduced body fat while preserving muscle, and was finally seeing results that reflected the effort she had been putting in all along. Her clothes fit comfortably again, she felt stronger during her workouts, had more energy, and regained confidence in her body.

"I Was Doing Everything Right but Kept Gaining Weight." - SUSAN

Hormonal Fog

“I finally feel like my brain is starting to wake up." - Lisa

When She First Came to SPOKEmed

Lisa, 48, came to SPOKEmed feeling overwhelmed and frustrated. She had been hesitant to start hormone replacement therapy because she wanted to take a more “natural” approach first. Over the past few years, she had tried numerous supplements, worked with different providers, and spent countless hours researching her symptoms online. Despite her best efforts, she continued to struggle with hot flashes, night sweats, vaginal dryness, midsection weight gain, poor sleep, and brain fog. Eventually, she stopped everything because she wanted to start over with a clear, personalized plan.

She told us, “I used to be sharp. Now I walk into a room and forget why I’m there.”

Her energy was low, she had no motivation to exercise, and her primary care provider told her her hormone levels were “normal,” but she knew something wasn’t right.

What We Did Together

Rather than focusing on a single lab value, we took a comprehensive look at Lisa’s health. We reviewed her symptoms, medical history, lifestyle, goals, DUTCH test results, and 3X4 Genetics report to better understand how her hormones, metabolism, inflammation, and genetics were contributing to her symptoms.

Together, we developed a personalized treatment plan that included bioidentical hormone replacement therapy (estradiol patch, oral micronized progesterone, vaginal estrogen, and testosterone gel), targeted nutritional support, anti-inflammatory strategies, strength training, sleep optimization, and supplements to support recovery and reduce joint aches. We followed her closely, making adjustments based on her progress.

After About 3 Weeks

Lisa was sleeping more soundly, waking less often during the night, experiencing fewer hot flashes, and noticing more energy and mental clarity.

After 2–3 Months

By the three-month mark, Lisa’s hot flashes had nearly disappeared, she was sleeping through the night, exercising again, and feeling more like herself. Her mood was more stable, her joint discomfort had improved, and she had the energy to enjoy life again.

She smiled and said, “I finally feel like myself again.”

Looking back, Lisa said her biggest regret was waiting so long to seek help. She had spent years trying to manage her symptoms naturally because she was hesitant about hormone therapy. She wished she had known sooner that hormone therapy could be safely combined with healthy lifestyle habits as part of a personalized treatment plan. Today, she continues to prioritize nutrition, exercise, stress management, and sleep while feeling like the best version of herself again.

"I Just Didn’t Feel Like Myself." - LISA

Painful intimacy

Painful Intimacy

“I wish someone had told me years ago that I didn’t have to live like this." - Linda

When She First Came to SPOKEmed

Linda, 70, admitted she had been avoiding intimacy because intercourse had become painful. She was also experiencing vaginal dryness, irritation, and several urinary tract infections over the previous year. She felt embarrassed discussing these symptoms and assumed they were simply part of getting older.

Linda had previously been told she was not a candidate for systemic hormone replacement therapy, but no one had discussed local vaginal estrogen or explained that it was different from systemic hormone therapy.

What We Did Together

We explained Genitourinary Syndrome of Menopause (GSM) and reassured Linda that her symptoms were common, highly treatable, and not something she simply had to live with.

We also explained that low-dose vaginal estrogen works primarily in the vaginal and urinary tissues with minimal absorption into the bloodstream. Together, we created a personalized treatment plan that included local vaginal hormone therapy, education about vaginal and urinary health, and ongoing follow-up. We also helped her make nutritional and lifestyle changes that allowed her to lose a few pounds and feel healthier overall.

After About 3 Weeks

Linda noticed less dryness and irritation. Walking and exercising became more comfortable, and she was beginning to feel more confident and less anxious about intimacy.

After 2–3 Months

Intercourse was comfortable again, and her urinary symptoms became much less frequent.

A few months later, Linda celebrated her 70th birthday feeling healthier, more confident, and full of joy. She even shared photos from her birthday celebration with us because she was so excited about how she looked and felt after losing fat, regaining her confidence, and finally enjoying life without the discomfort she had silently accepted for years.

Linda also learned that not being a candidate for systemic hormone therapy does not necessarily mean vaginal hormone therapy isn’t an option. For many women, including some with a history of breast cancer, low-dose vaginal estrogen may still be considered after an individualized discussion with their healthcare team.

"I Thought Painful Sex Was Just Part of Getting Older." - LINDA

Perimenopausal And Postmenopausal Conditions We Commonly Treat

Primarily Perimenopause

Both Perimenopause & Menopause

Primarily Menopause / Post-Menopause

Women’s Health Concerns

We Also Help Women Who…

Hormonal & Metabolic Health

Estrogen deficiency
Progesterone deficiency
Testosterone deficiency
Insulin resistance
Prediabetes and elevated A1C
Difficulty managing blood sugar
Elevated cholesterol
Increased cardiovascular risk after menopause
Elevated blood pressure
Menopause-related metabolic changes
Increased visceral fat
Bone loss and osteopenia prevention
Increased stress response associated with menopause
Healthy aging and longevity optimization

Advanced Testing for a More Personalized Approach

While many women can be successfully treated based on their symptoms and medical history alone, some benefit from advanced testing to uncover additional factors contributing to their symptoms. At SPOKEmed, we offer comprehensive testing when clinically appropriate to create a truly personalized treatment plan.

DUTCH Test

DUTCH Test (Dried Urine Test for Comprehensive Hormones)

The DUTCH Test provides a deeper look at hormone balance than standard blood work by evaluating hormone production, metabolism, and adrenal function.

It may help identify:

Estrogen metabolism patterns
Low progesterone or testosterone
Cortisol patterns related to stress and fatigue
Sleep disturbances
Persistent fatigue
Mood changes, anxiety, and brain fog
Low libido
Hormonal imbalances that may contribute to weight gain
Whether hormones are being metabolized efficiently

Why It Matters

Two women can have similar hormone levels but experience very different symptoms. The DUTCH Test helps us understand how your body produces and metabolizes hormones, including estrogen metabolism pathways that may influence symptoms, inflammation, and hormone balance. While most women can begin hormone therapy based on their symptoms and medical history alone, this test can be especially helpful when symptoms are complex, persistent, or not responding as expected, allowing us to further personalize your treatment plan.

3X4 Genetics

Your genes don’t determine your future, but they can help explain why you respond differently to hormones, nutrition, exercise, and stress.

Our 3X4 Genetics assessment may provide insights into:

Hormone metabolism
Detoxification pathways
Inflammation
Oxidative stress
Insulin resistance and metabolic health
Cardiovascular risk
Bone health
Brain health and cognitive aging
Nutrient needs
Response to exercise
Healthy aging and longevity strategies

Why It Matters

Menopause often brings increased inflammation, insulin resistance, changes in body composition, and a decline in muscle mass, making it harder to lose weight and maintain energy. Your genetic blueprint helps us personalize nutrition, exercise, supplements, and lifestyle recommendations based on how your body is designed to function, allowing for a more targeted approach to metabolic health, healthy aging, and sustainable weight management.

GI MAP Comprehensive Stool Analysis

The health of your gut plays a significant role in hormone balance, inflammation, metabolism, and overall well-being.

GI MAP testing may help identify:

Gut bacteria imbalances (dysbiosis)
Intestinal inflammation
Digestive dysfunction
H. pylori
Intestinal infections and parasites
Yeast overgrowth
Gut barrier dysfunction (“leaky gut”)
Causes of bloating, constipation, or diarrhea
Factors that may contribute to autoimmune conditions and chronic inflammation
Gut health issues that can influence estrogen metabolism through the estrobolome

Why It Matters

Your gut contains a collection of bacteria known as the estrobolome, which helps regulate how estrogen is metabolized and eliminated. When the estrobolome is out of balance, it may contribute to persistent menopausal symptoms, inflammation, and difficulty achieving optimal results with hormone therapy. Improving gut health can support healthy estrogen metabolism, reduce inflammation, improve nutrient absorption, and enhance your response to treatment.

How It Works

STEP 1 : Initial Consultation
Comprehensive evaluation of your symptoms, medical history, current medications, lifestyle factors, and health goals. We will discuss whether hormone therapy may be appropriate for you and order any necessary laboratory testing to help guide personalized treatment recommendations.
STEP 2 : Targeted Testing
Lab work is used to evaluate hormone levels, metabolic markers, and other key imbalances. If you complete a DUTCH test, we can also assess how your body is metabolizing hormones, along with your cortisol rhythm and cortisol awakening response.
STEP 3 : Personalized Treatment Plan
A customized treatment plan is developed based on your symptoms, goals, laboratory findings, lifestyle, and personal preferences. Recommendations may include hormone therapy, nutrition and lifestyle interventions, targeted supplementation, peptides, weight management strategies, or additional testing to address the root causes of your symptoms and optimize long term health.
STEP 4 : Ongoing Monitoring
Regular follow up appointments are used to assess your response to treatment, review progress, and make any necessary adjustments to your plan. We also focus on implementing sustainable nutrition, movement, sleep, stress management, and lifestyle habits to support long term success, symptom improvement, and optimal health outcomes.

Why Choose SPOKEmed for Bioidentical Hormone Therapy

At SPOKEmed, we offer several FDA-approved delivery methods for bioidentical hormones:

Medical Expertise

Michelle Middleton, PA-C, MSCP (Menopause Society Certified Practitioner), brings extensive clinical experience and specialized training in hormone optimization, menopause management, metabolic health, and precision medicine. Treatment recommendations are guided by evidence based medicine, comprehensive testing, and an individualized approach to care.

Evidence-Based Approach

Treatment recommendations are guided by current clinical data and evidence based guidelines from The Menopause Society, while considering each patient's unique symptoms, medical history, risk factors, and personal goals.

No Pellet Therapy

Avoided due to inconsistent delivery and inability to adjust dosing.

Comprehensive Care

Addressing lifestyle factors including nutrition, stress, exercise, mindset, and sleep.

Direct Access

Direct communication with Michelle between appointments.

For optimal results, we recommend you retest after 4-6 months to track improvements and make necessary adjustments to your plan.

Real Patients. Real Hormone Balance. Real Life Improvements.

Through personalized hormone replacement therapy and bioidentical hormone therapy programs,
patients often share how treatment has helped restore balance,improve energy,
support healthy weight management, and enhance overall quality of life.

      
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   Katrina Eggertsson 
 14 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is amazing!  Super knowledgeable and helpful! If you’re looking for help to a healthy lifestyle she is the one you want help from.
  
 
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   Greta Lambert 
 30 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Dr. Michelle Middleton has been such a blessing in my life.  She has helped me learn good habits not only for meals, but for living a happy, life of joy.  I am so grateful for her guidance and tips.  She is amazing!  Her guidance has helped me emotionally and physically.  She has helped me lose weight and to love myself again!
  
 
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   Michelle Chavers 
 30 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle helped me with my crazy hormones when others told me I just needed to ride the perimenopause rollercoaster. That answer wasn’t good enough for me. I wanted to feel better. When I found Michelle she got me on the correct HRT and supplements I needed to feel better. It’s made a big difference in my mood and daily routine. I would highly recommend her as a woman trying to understand our complex body in midlife!
  
 
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   Celeste Mikes 
 68 days ago
 
 
 Trustindex verifies that the original source of the review is Google. SPOKEmed is a very knowledgeable with weight loss.  They take the time to speak with you directly and walk you through the process.
  
 
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   danielle cruz 
 170 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is a wealth of knowledge and has done so much to help me dig into root causes - both physiologically as well as mentally.  I appreciate her comprehensive approach to wellness, her patience and her ongoing coaching!
  
 
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   Lisa B 
 184 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is lovely to work with. She takes adequate time to listen and has useful and practical solutions.
  
 
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   Judith Rosbrook 
 186 days ago
 
 
 Trustindex verifies that the original source of the review is Google. I’ve been counseling with Michelle for almost a year. She has your best interest at heart! She’s very knowledgeable and recommends what’s best for your health! Thank you for everything Michelle!!! JR
  
 
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   ilissa siegel 
 191 days ago
 
 
 Trustindex verifies that the original source of the review is Google. SpokeMED/Michelle is very knowledgeable and always accessible/helpful. She looks at your health and wellbeing holistically and has helped me feel like the best version of myself.
  
 
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   Ali Loomis 
 193 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Working with Michelle has been wonderful! She is clear, informative, and makes sure all of my questions have been answered. She is personable, supportive, and easy to talk to. I highly recommend her!
  
 
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   Nancy Hortman 
 193 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle, is absolutely wonderful! She is beyond helpful and wise and cares   woud recommend !!
  
 
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   Joni House 
 199 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Working with SPOKEmed has truly transformed my health and focus. The guidance, accountability, and encouragement is helping me build better habits and gain clarity. I am thankful for the positive impact they have had on my life.
  
 
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   Rhina Mendoza 
 200 days ago
 
 
 Trustindex verifies that the original source of the review is Google. I have nothing but excellent reviews with this service, very friendly and knowledgeable people, love it , thanks
  
 
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   Rolanda Montenegro 
 201 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Love working with Michelle! She answers all my questions and shows extreme understanding and care with her clients. I felt very good knowing she was there to walk me through this process. Highly recommend her services!
  
 
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   Katie Norman 
 205 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is wonderful!  Michelle is so supportive, responsive and encouraging.  She truly listens to your concerns and provides sound solutions and guidance.   She truly cares for her patients.
  
 
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 210 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is wonderful to work with and provides exceptional advice!
  
 
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 214 days ago
 
 
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 220 days ago
 
 
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 228 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is very knowledagble, kind and is always willing to help if I have a question about something. She makes sure she gives enough info on the glp1 shot for her clients to be successful.
  
 
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   Katie Sefton 
 234 days ago
 
 
 Trustindex verifies that the original source of the review is Google. I’ve been working with Michelle for several months and have lost over 50 lbs at a healthy pace. It is easy to arrange appointments and she is flexible with the need to reschedule. She listens well and offers on point advice without judgement. She seems to love helping people on their journey to better health and is very knowledgeable about current best practices. I highly recommend SPOKEmed.
  
 
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   Jenna 
 494 days ago
 
 
 Trustindex verifies that the original source of the review is Google. I can’t say enough positive things about working with Michelle! She has been instrumental in my weight loss journey with GLP-1 and Lipomino injections. She is so supportive, incredibly knowledgeable, and always willing to answer my questions. She truly listens and takes the time to understand my needs and goals. Her availability and accommodating nature have made this process smooth and reassuring. I’m so grateful to have her guidance and expertise!
  
 
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   Sumner Lane 
 497 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is knowledgeable, attentive, and takes the time to explain her treatments clearly, making me feel comfortable and informed. I appreciate how easy it is to communicate with her and efficiency of visits. She truly cares for her clients and their health.
  
 
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   Natalie Crain 
 519 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Very engaging, cares about my progress, extremely knowledgeable and supportive of my journey.
  
 
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 542 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Thank you for your health education and expertise on my weight loss journey.
  
 
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   Michele Sabin 
 543 days ago
 
 
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 617 days ago
 
 
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   Melissa Staelens 
 631 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle has provided amazing support as I continue in my journey towards better health. She helps provide tools that make getting healthy easier and attainable! So thankful to have found her!
  
 
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   MM 
 634 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is just amazing! From our very first conversation she listens to what I am looking for, addresses all my concerns and she patiently answers all my questions.  She is also an incredible positive force and a fantastic cheerleader as I continue my journey of growing and learning in regards to my health and happiness!
  
 
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   Arden Ellis 
 638 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is just the best. She helps you look at the WHOLE picture not just one aspect of your health. It's so important to take the time to really understand each patient's specific needs, issues our health goals, and Michelle does this like no one I've ever met. I am so grateful for her expertise and commitment to her patients.
  
 
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   Susan Martin 
 657 days ago
 
 
 Trustindex verifies that the original source of the review is Google. When one comes across something or someone of exceptional quality, you want to share it. That is what I would like to do w/ Michele Middleton. Michelle reached out to me with a suggestion of treatment and course of action to repair and restore my destructive behavior and thinking the program she believes in is good very good but her skills in repairing and Restoration are exceptional. Never judgmental always viewing it from let’s redirect it. Bottom line always with love the heart of hers is full and giving all the time I find her a gift from above
  
 
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   Jennifer Riggs 
 659 days ago
 
 
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Michelle- has been there for my health journey every step of the way. She turns a negative into a positive and at times when I wanted to give in, she was right there for me. She is a big part of my success and continues to support me.
  
 
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   Shannon Perry 
 660 days ago
 
 
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 683 days ago
 
 
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   Troy M 
 689 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle has been absolutely amazing. She is thorough, professional and takes the time to not just listen to my health concerns, but addresses them in a way that is easy to understand.  Very pleased with the journey so far and am looking forward to continue  my health journey with her. Crystal F.
  
 
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   Karla McCoy 
 689 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle has been an essential part of my health journey. She is knowledgeable, always available to answer my questions when needed, and always ready to help and encourage me. I highly recommend her to anyone ready to start their health journey.
  
 
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   Marty McCravy 
 689 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is a fantastic coach.  She is so knowledgeable and helpful.  I highly recommend Michelle for your weight loss journey
  
 
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   Charlin Burdick 
 696 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Michelle is absolutely amazing!!! She is beyond professional and listens to her patients needs and concerns. She has been my guide in this journey answering questions, addressing concerns and helping me bridge the gap in achieving my health & nutrition goals. She is incredibly intelligent & respectful and so easy to connect with as well! Do yourself a favor and schedule a consultation and see for yourself. You’ll thank me later!!
  
 
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   Gerry Gerrard 
 736 days ago
 
 
 Trustindex verifies that the original source of the review is Google. My friend lost 8 pounds in 2 weeks through this program of a healthy lifestyle and healthy eating. She stopped drinking alcohol (which is miraculous) and eats regularly but healthy all day long and feels GREAT! shes in it to win it and can't wait to get to her ideal weight!
  
 
 
  
 
 
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Traditional Hormone Therapy vs. Bioidentical Hormones

Many women wonder about the difference between traditional hormone therapy and bioidentical hormone replacement therapy. Here's a simple comparison:


FEATURE	TRADITIONAL HRT	BIODENTICAL HRT (BHRT)
SOURCE	Synthetic or animal-derived hormones	Usually plant-derived and processed to be structurally identical to human hormones.
COMMON FORM	Oral tablet/pills, patches, creams, gels, troches, rings, injections, pellets	Creams, gels, troches, tablets/pills, injections, pellets
FDA APPROVAL	Many forms FDA-approved	Many FDA-approved; compounded versions are not FDA approved
HORMONE USED	May include conjugated estrogens, medroxyprogesterone	Estradiol, micronized progesterone, testosterone
MONITORING	Varies by provider	Varies by provider

At SPOKEmed, we focus on FDA-approved bioidentical options that provide the benefits of molecular matching with the safety assurance of regulatory oversight.

BHRT Frequently Asked Questions

What are bioidentical hormones? Are they natural hormones?

How do I know if my hormones or hormone levels are out of balance?

Is compounded bioidentical hormone therapy better than FDA-approved options?

How long does it take to see results when using bioidentical hormones?

What is the difference between compounded bioidentical hormones and FDA-approved bioidentical hormones?

Do you use hormone pellets at SPOKEmed?

No, we do not use pellet therapy at SPOKEmed. While some providers offer hormone pellets as a delivery method, we have concerns about:

The inability to adjust hormone dosing once the pellet is inserted
Inconsistent hormone levels over time
The inability to remove the pellet if side effects occur

Because hormone balance is complex, especially when multiple hormones are involved. We prioritize delivery methods that allow precise, flexible dosing and easy adjustments to ensure your safety and optimal results.

How does the U.S. Food and Drug Administration view bioidentical hormone replacement therapy products?

The U.S. FDA has approved several bioidentical hormone therapy products for treating menopausal symptoms. These products have undergone rigorous clinical trials confirming their safety and effectiveness.
However, the FDA has expressed concerns about custom-compounded bioidentical hormones, as these preparations have not undergone the same level of testing or regulation.
Despite marketing claims that bioidentical hormones are more effective than synthetic hormones, the National Academies of Sciences states that all hormones; bioidentical or conventional, carry similar benefits and risks.
When considering hormone therapy, it’s important to choose FDA-approved products whenever possible to ensure safety and quality.

What possible side effects should I be aware of when taking bioidentical hormones?

While bioidentical hormones can effectively manage menopausal symptoms, it’s important to be aware that they may cause side effects similar to traditional hormone therapy:

Common side effects:
- Breast tenderness
- Spotting or irregular bleeding
- Headaches
- Mood changes
Rare but serious risks:
- Increased risk of certain hormone-sensitive cancers in women
- Blood clots
- Cardiovascular issues

Bioidentical hormones come in various delivery methods; such as creams, patches, and pills, each carrying its own side effect profile.

During your consultation, we will:
- Review your medical history
- Discuss how different hormone products affect your body
- Determine the safest and most effective estrogen replacement therapy plan tailored to your needs

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Business Facts:
SPOKEmed

Bioidentical hormone replacement therapy is provided when clinically appropriate
Services include hormone evaluation, laboratory review, and treatment planning
Prescription management is included if clinically indicated
Ongoing monitoring and dosage adjustments are part of care delivery
Services are provided via telemedicine to eligible patients
Care is delivered by a board-certified Physician Assistant
Availability is limited to states where providers are licensed

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Bioidentical Hormone Replacement Therapy