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Beyond Traditional Medicine

Dr. Mirela Cernaianu is a highly experienced, board-certified OB/GYN. She has extensive knowledge and understanding of the significant hormones produced in the body. Under her guidance, our team goes beyond simply replacing sex hormones like estrogen and testosterone for women or testosterone for men; we aim to optimize all hormones to work together harmoniously. In addition to addressing sex hormones, we take a holistic and functional approach to thyroid, adrenal, growth hormone, and insulin resistance issues. You can expect comprehensive care and wellness at Hera Healthcare.

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What is Hormone Replacement Therapy?

Hormone replacement therapy (HRT) is a treatment that involves replacing hormone deficiencies, particularly in relation to sex hormones.

The following sex hormones play crucial roles in regulating reproductive functions and influencing secondary sexual characteristics:

  • Estrogen is primarily responsible for the development and regulation of the female reproductive system and secondary sexual characteristics
  • Progesterone plays a crucial role in preparing the uterus for pregnancy and maintaining a healthy pregnancy
  • Testosterone is the primary male sex hormone, responsible for developing male reproductive tissues and promoting secondary sexual characteristics such as increased muscle mass and body hair growth

Dr. Mirela Cernaianu at Hera Health Care provides hormone replacement therapy to alleviate these symptoms by restoring normal hormone levels. If you believe you could benefit from hormone replacement therapy, you can get in touch with her office in the Westlake Village area of Thousand Oaks, California, or book an appointment online.

When Do Women Reach Menopause?

Levels of estrogen begin to decline during perimenopause, which occurs in the three to five years before menopause. During this time, menstrual periods often become irregular, with longer or shorter menstrual cycles and lighter or heavier blood flow. Menstrual periods stop when estrogen production finally drops to a permanently low level.

When you haven’t had a period for twelve consecutive months, you’re at menopause. The average age of menopause is 51, but the timing is different for each woman.

What Are Menopause Symptoms?

Menopause symptoms often begin during perimenopause and continue for years after menopause. You may experience any or all of these symptoms:

  • Hot flashes and night sweats.
  • Vaginal dryness.
  • Vaginal atrophy.
  • Painful intercourse.
  • Low sex drive.
  • Difficulty sleeping.
  • Fatigue.
  • Depression and irritability.
  • Poor memory and lack of focus.
  • Weight gain or difficulty losing weight.
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What Can I Expect During My Treatment for Hormones?

Your initial consultation involves a comprehensive interview with our physician to understand your symptoms, specific situation, associated medical conditions, and potential hormone deficiencies.

Next, Dr. Mirela Cernaianu or another qualified medical professional trained by her will order a series of tests. These tests will confirm baseline hormone levels and assess the following:

  • Inflammation
  • Vitamin deficiencies
  • Potential thyroid and adrenal imbalances

We anticipate seeing you and evaluating your response to initial treatment within eight weeks of starting any therapy. You will receive a test order to monitor hormone levels, which you should complete 1-2 weeks before your follow-up consultation.

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Once you have established a stable regimen, hormone replacement visits will occur three times a year. Our goal is hormone optimization, not just replacement. Therefore, simply providing a prescription for 12 months is not ideal and may not be beneficial.

We believe that regularly investing in your hormone wellness, like going to the gym, is essential as your body's needs and condition will change over time. What worked well six months ago may no longer be effective, leading to new, often subtle, and overlooked symptoms.

The bio-identical creams, gels, and patches are subject to bioavailability, and the amount absorbed by your skin can decrease over time, necessitating adjustments in dose or therapy.

It's important to note that testosterone is a controlled substance, and close monitoring is required no less than three times a year.

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Do I Need Blood Tests for My First Exam?

The more information we have, the better. If you have had blood tests before, please bring them to your first appointment. The doctor may be able to make a recommendation based on your previous results during this initial appointment. However, our hormone testing methods, timing, and reasoning may differ from your last doctor's. As a result, additional tests may be necessary for a comprehensive wellness approach, not just hormone replacement.

    What Type of Hormone Replacement Therapy Can I Expect?

    Doctor C. or our mid-level practitioner will thoroughly discuss all available options and alternatives with you. Ideally, you would have immediate access to knowledge and information by listening to our podcasts on hormones, particularly our October 2023 episodes focusing on hormone replacement therapy.

    Do You Offer Bio-Identical Hormone Replacement?

    We offer all available hormone replacement options, including bio-identical hormones:

    • Estrogen is available as oral, creams, gel, vaginal rings, patches, and pellet therapy
    • Testosterone is available as cream, gel, pellet, or injectable
    • Progesterone is available as oral or cream

    Is My Hormone Replacement Therapy Going to be Covered by My Insurance Company?

    We can provide information about pricing and insurance coverage for the selected therapy. However, the decision to cover a medication or hormone pellet procedure is ultimately up to your insurance company and may depend on the dosage. As a result, we can only determine the cost once the billing is submitted or the pharmacy informs you.

    Will My Insurance Cover a Consultation for Bio-Identical Hormone Replacement Therapy?

    The coverage depends on the type of therapy you choose. There are FDA-approved bio-identical options available, but the medication may be expensive and not covered by insurance, or it may not be available at your pharmacy. If this is the case, we can work with you to switch to a more affordable or covered option, which may require a follow-up consultation billable to insurance.

    If you opt for a compounded bio-identical daily cream made from Mexican yams to address your hormonal deficiency, the cost of the non-FDA-approved treatment consultation and any follow-up management cannot be billed to insurance and will be your financial responsibility.

    Does Insurance cover compounded Bio-Identical Treatments?

    Your insurance does not cover the compounded bio-identical hormone creams or consultation costs. As a general guideline, if you opt for a billable therapy, we will also bill your insurance for the consultation. However, if you opt for bio-identical cream therapy for Estrogen or Testosterone management, you will be responsible for paying for the consultation and the cost of the cream directly to the pharmacy.

    Are Hormone Pellets Covered by the Insurance Company?

    Some insurance companies and Medicare may cover the cost of the consultation and hormone pellets, but the amount covered can vary depending on your insurance and the dosage required. If you choose to bill your insurance, you will need to pay the full allowed amount until you meet your deductible. However, billing for the pellets, even if you are ultimately responsible for the cost, can help you reach your deductible.

    If you have a high deductible, over $3000, and do not expect to meet it by the end of the year, paying the cash cost upfront and declining billing is also an option. For pricing inquiries, please contact our office, and our staff will be happy to discuss costs or submit an inquiry through our website's online chat.

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    What are the Benefits of Replacing Estrogen for Women?

    Achieving hormone balance is ideal, but it's important to note that you cannot optimize or balance something you no longer produce. After menopause, the ovaries cease estrogen production entirely. Therefore, estrogen after menopause cannot be balanced; it can only be replaced. Once replaced, it can be optimized and balanced with other hormones to safely and effectively relieve symptoms, ultimately improving your quality of life.

    Replacing estrogen after its decline or cessation in the body can offer numerous benefits, including:

    • Enhanced mood and reduced anxiety
    • Increased energy and motivation
    • Improved sleep quality and quantity
    • Healthier, more youthful-looking skin
    • Reduced hair loss related to menopause
    • Better joint health and decreased joint pain, even for those with conditions like rheumatoid arthritis or fibromyalgia
    • Stronger muscles, bones, and joints, preserving mobility as you age
    • Enhanced metabolic rate and potential assistance with weight management
    • Improved mental clarity and reduced forgetfulness
    • Increased vaginal moisture and sensation, leading to improved sexual satisfaction
    • Resolution of painful sex caused by estrogen loss
    • Enhanced immune system function, potentially aiding in fighting off viruses, including COVID-19
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    What are the Benefits of Replacing Progesterone for Women?

    Progesterone is a crucial hormone that works with estrogen to maintain hormonal balance. While typically used together, estrogen can be taken without progesterone following a surgical removal of the uterus. However, there are several benefits to using progesterone, even in the absence of a uterus:

    1. Progesterone alleviates anxiety and contributes to a calmer nervous system.
    2. Progesterone promotes the formation of GABA in the brain, a neurotransmitter essential for falling and staying asleep.
    3. Progesterone has a stabilizing effect that counteracts the proliferative impact of estrogen, ensuring the health and balance of estrogen-dependent tissues such as the uterus and breast, thereby reducing the risk of cancer.
    4. Progesterone can enhance mood and boost libido.
    5. Progesterone can be beneficial in alleviating premenstrual syndrome (PMS).

    What are the Benefits of Replacing Testosterone for Women?

    Testosterone is a crucial sex hormone that plays a significant role in women's health. As women age, their production of testosterone typically decreases, leading to various potential benefits of testosterone replacement. These benefits include:

    • Improved energy, stamina, and recovery after exercise
    • The maintenance and building of muscle mass when combined with exercise and a high-quality protein intake
    • A positive impact on mood, serving as an antidepressant and stabilizing hormone that can alleviate irritability and depression
    • It contributes to mental clarity, drive, motivation, ambition, and libido, ultimately enhancing sexual satisfaction and intimacy with a partner for many women
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    Are There Any Side Effects With Hormone Replacement Therapy? 

    Each person's body responds uniquely to hormone replacement, with variations in how hormones are processed, metabolized, and eliminated. It is important to consider individual history, genetic predisposition, and any coexisting medical conditions, such as liver or gut health issues, to ensure the safe and effective use of hormone therapy in Thousand Oaks. By understanding these factors, we can optimize hormone replacement therapy to minimize potential side effects and maximize the benefits while supporting the body's natural processing and elimination pathways.

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    How is HERA Health Care Different from Other Practices That Offer HRT?

    We take the time to understand your unique needs and customize our hormone replacement and optimization approach to ensure it is tailored specifically for you. Our goal is to make your hormone replacement as safe and free of side effects as possible.

    What sets us apart is our unwavering support for whatever choice you make regarding hormone replacement therapy. We believe that having numerous options can be overwhelming, and we are committed to educating you about all available choices so that you can make an informed decision. During your initial consultation, we will provide information about non-FDA-approved compounded treatments, including pellet therapy, which is not widely available in other practices.

    We are flexible and supportive of changing treatment modalities to suit your individual needs and preferences best, offering all hormone modalities. Unlike many practices that bill insurance for only FDA-approved non-compounded HRT, we accept insurance for FDA-approved treatments and possibly pellet hormones, and we also offer compounded bioidentical HRT at cost to you if desired.

    For further information about hormone replacement therapy, we have released four podcast episodes in October 2023. You can access them through this link.

    Navigating hormone replacement therapy options can be challenging and intimidating, but our practice is dedicated to supporting you not only during consultations with our providers but also after the appointment with our knowledgeable staff.

    Hormone Replacement Therapy FAQ

    What are the risks associated with HRT?

    How is hormone replacement therapy administered?

    Can HRT interact with other medications?

    Can HRT affect fertility or reproductive function?

    What are the risks associated with HRT?

    Risks of Hormone Replacement Therapy can include an increased risk of blood clots, stroke, heart disease, breast cancer, and endometrial cancer (for women with an intact uterus using estrogen therapy alone). The risks and benefits of HRT should be carefully considered and discussed with a healthcare provider.

    How is hormone replacement therapy administered?

    HRT can be administered in various forms including pills, patches, creams, gels, injections, and implants. The choice of administration depends on factors such as individual preference, medical history, and the specific hormones being replaced.

    Can HRT interact with other medications?

    Yes, HRT can interact with other medications, including certain antibiotics, antifungal medications, seizure medications, and herbal supplements. It's important to inform your healthcare provider about all medications and supplements you are taking to avoid potentially harmful interactions.

    Can HRT affect fertility or reproductive function?

    HRT can affect fertility and reproductive function, particularly in women undergoing menopause. Hormone replacement therapy can suppress ovulation and menstruation, leading to temporary or permanent infertility. However, fertility may return after discontinuation of HRT, especially in younger women. In transgender individuals, HRT may also impact fertility depending on the specific hormones used and the duration of treatment.

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