Dr Bruce Farnsworth

Pelvic Reconstructive Surgeon




Hormone Therapy


A Different Approach to Hormone Therapy

At different times in the life cycle women are liable to suffer symptoms due to relative imbalance in their hormones which can leave them severely affected by debilitating symptoms. Far to often women are dismissed as not knowing what is normal and reassured that blood tests have confirmed that there is no problem. In particular the Perimenopause is a difficult time with symptoms progressively becoming worse as the Menopause approaches.

Dr Farnsworth follows the following principles in treating hormone imbalance:

  • use the minimal amount of treatment necessary to control symptoms

  • avoiding oral medication to reduce side effects on the liver

  • use natural or bioidentical hormone sources where possible

  • safety first at all times in prescribing any hormonal preparation


Phytoestrogens and Alternative Products

Remifemin, Promensil and other products are thought  to be helpful in reducing symptoms, but recent evidence suggests that an excess of soy based products are a risk factor for breast cancer. The important principle is to avoid non-bioidentical hormones as they may have some components which are non biodegradable and may cause side effects.


Natural Progesterone Creams

Natural Progesterone is widely used by Dr Farnsworth in treating hormone imbalance in women at different ages. If you are using Natural Progesterone it is important that you are using pharmaceutical quality progesterone made up in a cream by a compounding pharmacist from a prescription written by a doctor. There are a number of natural progesterone creams available with no active ingredients in them.

Click here for information on:

Using Natural Progesterone

The Perimenopause

The Menopause

Read what other women have said about treatment with natural progesterone cream.

Natural hormone troches

Troches are an alternative way to use natural hormones as absorption through the mucosa of the mouth avoids the bowel and liver. In a troche preparation your dose can be individually adjusted to achieve maximum benefit. Troches also enable complex mixtures of different natural hormones to be prepared so that your therapy can be tailored exactly to your needs. 

Dr Farnsworth supports the principle that hormone preparations that are biologically identical to the hormones that are produced in the body enable supplementation rather than replacement. This approach is based on common sense and logic rather than research based evidence. Research based evidence is conflicting and fact is difficult to separate from vested interest and opinion. Patients need to assess as much information as possible from different sources about any treatment they may consider before assessing the differing opinions and then making their treatment choices.

Traditional HRT

Traditional HRT is still chosen by some women as their preferred mode of hormone supplementation. This can involve tablets, patches, gels or implants.


Livial or tibolone is not a traditional HRT but rather a selective estrogen receptor modulator. This medication can be thought of as enhancing the effect of remaining hormones after the menopause. This medication is taken once daily. It has been shown to be effective at controlling hot flushes and other symptoms, improving vaginal dryness.

Opinions and Facts

After initially using progesterone cream to treat patients who could not use traditional HRT for one reason or another good results, minimal complications and happy patients have led to a steady increase in the use of bioidentical preparations in my practice. 

The effects of various hormones are influenced by receptor sensitivity and other hormones. Progesterone increases the sensitivity of oestrogen receptors which means some patients will relieve their menopausal symptoms by using progesterone supplements without any oestrogen. Patients who are receiving supplemental oestrogen will need a lower dose when progesterone is also given.

When deciding what you wish to do, remember:

1. All hormone treatments can potentially change your symptoms and affect your risk of various cancers and other medical conditions.

2. there are a number of controversies regarding the use of different hormone preparations.

 Recently there have been a number of articles in the press criticising the use of bioidentical hormone therapy. These articles have raised some issues which have been used as arguments against the use of natural bioidentical hormones which are listed below.

Arguments against the use of natural bio-identical hormones:

 1. Patients may develop high levels of hormone and cause side effects. For this reason it is important to have regular blood tests to exclude excessively high levels.

2. Compounding chemists are not scrutinised adequately by the authorities. For this reason it is important to only use a chemist who has a reputation and experience going back over several years.

3. Testosterone and DHEA have not been approved for use in women in Australia . These medications are able to be legally used in prescription medications.

4. There has been little research into these preparations and women who take them are essentially guinea pigs experimenting with hormones. Unfortunately all hormones are experimental in the sense that natural and synthetic medications often are trialled and then rejected in favour of another preparation. Some patients have spent many years trying to find a pill or HRT that suits them.


Arguments used in support of treatment with bio-identical hormones:

 1. Bio-identical hormones are synthesised from plant hormones  identical in structure to the natural hormones produced by the body. These hormones are able to be used, processed and excreted normally by the body and have no toxic degradation by-products.

2. Bio-identical hormones can be used to supplement falling levels of the body's natural hormones.

3. Dosage can be adjusted and individualised for each patient based on the response to therapy and as a result of monitoring with blood tests.

4. Hormones can be provided in quantities that reflect the normal balance of hormones in the body.



Each patient has to assess the risks and benefits of the treatment they are considering  and then make an informed decision based on the available evidence. If in doubt undertake further research and seek a second opinion.