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Rhythmic Hormone Restoration Protocols

Rhythmic Hormone Restoration Programs

What is Rhythmic Hormone Restoration?

Rhythmic hormone restoration therapies (like PHRT™) are designed to mimic the body’s natural monthly hormone cycles using bioidentical estradiol and progesterone, aiming to restore balance and improve long-term health.

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Getting Started

You should have received two distinct dosing cards—one for estradiol and one for progesterone.
Each card has a different color, depending on the hormone it represents.

Your pharmacy has marked the column that shows your personalized dosing instructions. These may be adjusted by your practitioner as your hormone levels begin to balance.

How to Read the Dosing Schedule

Read from left to right:

  • Dose (e.g., 8 Twists)
  • How often (e.g., Twice Daily)
  • Cycle days (e.g., Days 1–5)

What is an HRT Ticker?
The HRT Ticker is a hands-free dosing device that looks like a deodorant stick. It’s designed for precise and easy application of hormone creams, with each audible and tactile “tick” dispensing 0.05 mL of cream through a small opening at the top.

Tickers come in different colors to help you distinguish between multiple hormone formulations.

How to Use It:
Follow your Dosing Card to determine how many ticks to rotate for your prescribed dose.

Tip: For larger doses, it’s often easier to count in increments of 5 or 10.

Where to Apply

  • Your Doctor may have special instructions for area application - please follow your doctor's instructions*
  • Use hairless, thin-skinned areas with good blood flow:
    Inner thighs, back of knees, or upper inner arms (biceps/triceps area).
  • Apply each cream to a different area—don’t layer them on top of each other.

When to Apply

  • After a shower: Pores are more open
  • After a workout: Sweating may cause you to sweat ou the hormones
  • Once daily: Usually in the morning—but evening is okay if preferred. Just stay consistent.
  • Twice daily: Apply once in the morning and once at night, about 10–12 hours apart.

How to Apply

  • Spread over a large area of skin.
  • Rub in well until the skin is no longer sticky.
  • Wait 3–4 hours before showering, exercising, or swimming.
  • Apply after those activities—not before.

Maintenance Tips

  • Rotate application sites monthly to avoid buildup.
  • Gently exfoliate those areas once a month to prevent residue from blocking absorption.

When in doubt, reach out—we’re here to help!

Hormone creams can transfer through skin contact, so it’s important to be cautious—especially around children and pets.

How to Stay Safe

  • Avoid close contact with others for at least 1–2 hours after applying.
  • Cover the area with clothing to reduce the risk of transfer.
  • If you're often around people, avoid using your arms—instead, apply to inner thighs or behind the knees.
  • Always wash your hands well after applying the cream.

Staying mindful helps protect the people around you.

You doctor may have a prefernce to which calendar they want you to use. Please follow those instructions.*

Use the Lunar Calendar if:

  • You've had a hysterectomy
  • You are post-menopausal
  • You do not expect a period in the next 28 days

Use the Personal Calendar if:

  • You expect to have a period within the next 28 days
  • Or, you qualify for the Lunar Calendar but prefer to start your cycle right away

You’ll receive either a Lunar or Personal Calendar to guide your hormone schedule.
Use your dosing cards to fill in each day’s dose on the calendar.

Although the dosing cards show once-daily doses, remember to apply your hormones twice daily unless your provider tells you otherwise.

Be sure to track any symptoms or changes you experience by noting them on the calendar.
This will help your provider make more informed adjustments to your dosing, based on how you're responding.

Lunar Calendar

Begin on Day 1 of the Lunar Cycle as shown on the calendar—only start on this day.

Personal Calendar

Begin on Day 1 of your own menstrual cycle.
If you're eligible for the Lunar Calendar but choose to use the Personal Calendar instead, you may pick any day as your Day 1.

Assessing Your Progress

It typically takes 3 to 6 months to fully adjust to physiologic hormone levels. During this time, it’s normal to experience some temporary symptoms as your body adapts.

You may notice:

  • Headaches
  • Mild bloating or water retention
  • Breast tenderness

Your calendar also lists other possible symptoms, which may indicate too much or too little estrogen or progesterone.

If you experience more discomfort than expected, contact your doctor—your dose may need adjusting.

  • If you do not have a uterus, you will not have a period.
  • If you have a uterus, you can expect a period sometime between Cycle Day 25 and Cycle Day 2.

Keep in mind: a 28-day cycle is just an average—every woman’s cycle is different.

  • Your doctor should check your hormone levels between months 1 and 3, then at least every 3-6 months after that.
  • Estradiol should be tested on Cycle Days 12 and 21.
  • Progesterone should be tested on Cycle Day 21.

Before your blood draw, apply your hormone cream to an area away from the draw site (like the thighs or back of the knees).
Then, wait 3 to 4 hours after application to have your blood tested.

  • Common labs: Estradiol and/or Estrone, Progesterone, Testosterone, SHBG, FSH/LH

⚠️ Estrogen Black Box Warning

1. Endometrial Cancer

  • Using estrogen without a progestin in women with a uterus increases the risk of endometrial (uterine) cancer.
  • To reduce this risk, a progestin is typically prescribed alongside estrogen in women who still have a uterus.

2. Cardiovascular Risks

  • Estrogen therapy may increase the risk of stroke, deep vein thrombosis (DVT), pulmonary embolism, and heart attack, especially in postmenopausal women over 50.

3. Breast Cancer

  • Estrogen, especially when combined with a progestin, may increase the risk of invasive breast cancer.

4. Use for Shortest Duration

  • Hormone therapy should be used at the lowest effective dose for the shortest duration consistent with treatment goals and risks.

Note: These warnings are based primarily on oral, synthetic hormone therapies used in large studies like the Women’s Health Initiative (WHI). Bioidentical and transdermal therapies may carry different risk profiles, but are still subject to the same FDA labeling requirements.

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The information and videos found here are for educational purposes only and do not replace a consultation with a pharmacist. For personalized guidance, please contact us to speak directly with a pharmacist about your medication.

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Disclaimer:
The drug information provided is for informational and educational purposes only. The products or formulations discussed may not be approved by the U.S. Food and Drug Administration (FDA). This information is not intended to diagnose, treat, cure, or prevent any disease, nor does it replace a consultation with a qualified pharmacist or healthcare provider. Always seek the advice of your healthcare professional regarding any questions you may have about a medication or treatment.

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