topical versus vaginal bioidentical hormones

Unfortunately I don't really know of any Pub Med studies that address saturation/absorption problems. In our practice we have found that changing the vehicle often improves absorption dramatically. Most women dislike vaginal administration for systemic usage. There is also increase incidence of infections associated with vaginal administration. Try to change the vehicle and possibly consider FDA approved Estrogel or Elestrin or Vivelle Dot to raise serum levels.