Hormone Therapy for Menopause: A Guide to Doses, Levels, and Delivery Methods | Dr. Susan
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- เผยแพร่เมื่อ 20 ก.ย. 2024
- While the safety and benefits of menopausal hormone therapy (MHT) are becoming widely accepted, hot debate continues around dosing, delivery methods and how to monitor levels.
Advisory boards including the American College of Ob/Gyn and the Menopause Society support the use of (MHT), but much confusion continues regarding ideal blood levels, whether to check blood levels at all, and optimal route of delivery.
The dosing of both estradiol and testosterone varies 5-10 fold between methods such as patches, gels, sublingual methods or pellets. Both doctors and patients need to understand the dose that they are prescribing to make an educated decision.
Today I will help to shed light on the differences between these options, and why my strong opinion is that blood levels are critical to ensure that levels are not too high or low for your optimal health.
Dr. Susan Hardwick-Smith is a Board-Certified Gynecologist and Certified Menopause Practitioner specializing in women's midlife wellness, hormone optimization, and sexual wellness. She is the founder of Complete Midlife Wellness Center in Houston, TX, and the best-selling author of "Sexually Woke- Awaken the Secrets to Your Best Sex Life in Midlife and Beyond." She also hosts the popular podcast "Empowering Midlife Wellness."
Dr. Susan is the recipient of the Texas Super Doctor award over a dozen times, as well as a multiple-time recipient of H-Texas magazine's Top Doctor and Top Doctor for Women awards. She also has been chosen as one of Houston's "3 best-rated" gynecologists for several consecutive years. Dr. Susan is also an ICF-certified life and leadership coach, multiple-time marathoner and Ironman triathlete, and mother of 3 teenagers.
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To keep mentioning pellets in such a positive way and not talking about the risks or factors that women should weigh in on, as a Dr, I find that really surprising.
1. Pellets are not FDA approved, which means your insurance will not cover the cost
2. It can be difficult to find compounding pharmacies.
3. The higher cost
4. Finding a Dr that will be willing to prescribe and insert them, and Drs who do insert them, make a lot of money off of recommending this method to women.
5. There isn’t a guarantee that the dose they tell you is really the dose that you are getting, again, no regulations
6. It can be painful and uncomfortable for several weeks after insertion
7. You can’t take them out if you don’t like it or you have an adverse reaction to them, even at a low dose, women have bad reactions.
8. You are stuck with them for 3 months
9. Not all compounding pharmacies are the same and can use ingredients that are not safe or are contaminated by other ingredients they are compounding.
10. You will have the same high cost and possible pain and discomfort every 3 months
Some women really do like this method and that is great, but if you’re not also talking about the downsides of pellets, you’re not giving women the full picture.
100 % agree with you, thank you
It is a high cost, you’re right there but it’s not painful at all. Myself, my husband and 4 of my girlfriends all get the pellets and haven’t experienced pain at all and the three years we’ve been doing it, nor did any of us experience any adverse reactions. Because they run labs six weeks after the pellets you do know how much you’re getting. It’s an option for sure. Expensive? Yes. But for some it’s worth it. I have rheumatoid arthritis, so I take many supplements and medications so for me the pellet is one and done at least for four months. Anything I don’t have to take daily I’m on board with.
I think the main issue that people have with the pellets is, if there is an issue with the dose, you're literally stuck with it for 3 months before you can make any changes.
Agree. That’s why I won’t use pellets.
And it's not consistent as to when it wears off and how fast it wears off. I feel much better on daily T cream.
That would be a wrong assumption. Your Doctor will prescribe a medication to lower your estrogen if it is too high. This happened to me once. During my one month post check-up my estrogen levels were way to high.
@@sheilamccurley7084 yeah but testosterone is another animal. If it's too high, you can't lower it. If it's too high, it can cause irreversible virilization in women.
@@sunnievictoria9917 It would take the same amount as men and if you have a good doctor who knows his stuff, then that will never happen. I 300 to stay just above the 200 estrogen. You are checked a month later to see if you need a booster of either and then checked again 3 months later to determine your next full dose.
Dr. Susan, you make everything so easy to understand. YOUR AWESOME!!!
Australian here, I am big advocate of bio identical HT and I do agree that everyone has different absorption and different dosage requirements specific to your body. The best would be to test yourself when you are feeling great and still ovulating and once menopausal then you will know your limit and dosage you need to be on feeling great. otherwise it is a lot of ups and downs till you start feeling balanced. In Au the Dr test your hormones first besides your symptoms then the dosage ( normally they all start with low E 0.5mg which is hardly enough specially if you are still young in your 30ties or 40ties and your body is hungry for higher dosage!) so it takes for ever to level up and balance it with progesterone (the good ratio is somewhere 1:10 ) (so if your E is around 100 your P should be around 10).
Also with the progesterone ,bio identical Prometrium capsules are better to take vaginal administration for better absorption and it also helps to reduce systemic side effects such as drowsiness and dizziness by passing the liver! Also when you are taking the Testosterone make sure you have good E levels of Estrogen not too high because T is converted to E via the aromatase enzyme ) so taking lower dosage is safer. Then just monitor your symptoms like: breast fullness or headaches are usually indicator of too high Estrogen or high anxiety levels and not able to get to sleep is low progesterone levels , waking up at night time and hard to go to sleep is low Estrogen, no libido and no energy is low Testosterone, getting hair on bizarre spots like your chin is too high aromatase levels = PCOS...I hope this helps ❣
Very helpful comment
Dr. Susan thank you so much for putting information out. I came across your channel about a year ago, I educated myself in this subject and then I searched for a gyn specialist in menoupause, she is wonderful. And I've been using pellets since September and the benefits from it blew my mind away. My mind and my body feels like in my 30s....actually I feel MUCH MUCH BETTER than when I was in my 30s. Thanks again for showing us the way❤
Wow, I been going through the M, thank u for ur information.
I have been using bioidentical progesterone cream for 3 years and one of the biggest improvements has been sleeping. I put it on 20 min before falling asleep because it helps tremendously and I live that I can spread it out in 2-4 times a day that way I can keep it more stable during the last 10 days of my cycle. The info you presented is very valuable and appreciated but I do need to correct you about progesterone cream not helping you fall annd stay asleep because it does.
Pellets were also a bad experience for me. I had testosterone inserted when I started menopause and I got a huge lump in my breast b/c my estrogen skyrocketed! It was stage 1 and I decided for mastectomy since I had already lost one breast via stage 0 cancer so now I am on estrogen patch and I have been for 5 years and it’s been great! Of course all doctors think I should not be on hormones but I don’t care I have a gene for heart attack and I feel amazing! Plus on testosterone via cream and oral progesterone:)
i too had a terrible experience. thank you for sharing yours. Sore right buttock, prolonged, from insertion. And then right sided pain ensued.
Where can I get testosterone cream ? I HAD a really bad experience with the pellets they gave me a high dose that sent me into another dimension it's was horrible I'm on estraidol patch 0.25 lowest dose
Thank you for the valuable information. You have no idea how your video helped me understand so much about hormone therapy, there is so much negative information that keeps us from getting the right help. Thank you so much!!
Finding the right personal balance is so important. I developed endometrial hyperplasia and a large uterine polyp after being on HRT for a few years (a transdermal body-identical estradiol gel on my arm and a progesterone capsule in the evening), which meant I needed a D&C procedure. It seemed just one pump of estradiol gel on my arm was too much and made my uterus lining grow too thick (good thing I asked for an ultrasound scan to check, as I was getting jabbing pains!). Now I'm on one pump of _Lenzetto_ spray on my forearm skin once a day and still on the 200mg of progesterone (Femenita) in the evening. So far my uterus lining is fine, just 2mm, but I'll ask my gynaecologist for another ultrasound in 9 months to check it's okay. I think women on HRT should get an ultrasound of the uterus at least once a year to check for hyperplasia, adjusting their HRT dose if necessary. As for blood tests for hormone levels, both my gynaecologist and family doctor said they're pointless, since it's not the same for everyone and hormones are constantly fluctuating, and I would imagine women would know from any symptoms they're having. Regarding testosterone pellets for postmenopausal women, some studies have raised concerns. E.g. pubmed.ncbi.nlm.nih.gov/33518182/
Agree it's very personal ! Dose is critical
FDA will never approve pellets bc they're not a pharmaceutical product. Same with the NIH. They get their funding from Pharma. So guess what they're going to say....
A Mirena coil really helps mitigate that problem and keeps your uterine lining thin. My Meno specialist does not prescribe testosterone and I am good with her decision for me personally.
@@jennieoh8543 My daughter had the Mirena coil and could feel it when she sat down. Also, there are many cases of the coil embedding itself into the uterine wall and, even worse, migrating to other organs. When this happens, surgery is required and damage such as lesions can occur. It's actually not that uncommon. I'd prefer to stay away from it.
@@ShazWag Oh my I have no problems thank goodness!!!!!! So sorry she had to go through that :*( I have had one for years.
we definitely need help from the bloodwork interpretation to the actual integration (dosage, how to apply) of these products. i'm getting exhausted by the industry before even finding the right balance of these hormones (estradiol, dhea, etc) Thank you for your work in this area!
I know what you are saying but as women with hormaones pre menopause are hormones are unstable in fact too unstable to check it
It’s different say to day and hour to hour -
It’s true
You would see if you tried it
Like me
Checked my bloods but always changing so untill in menopause when it’s more stable with hrt
It doesn’t really help as to what levels of hrt you need !
I went with trial and error
Estogel 2,5 was to high had lower back ache swollen
So went down to 1.5 !
Wish it was easier but it’s very complex
Fingers crossed my doctor offers me any form of testosterone and checks my blood levels for estradiol patch! She didn’t want to do any of those things my last visit😳 🙏🏼 🤞🏻
find another doctor.
What @Lbb789 said! Life is too short to deal with indifferent, uncaring, unequiped doctors or providers! I have been on pellets for less than 2 weeks and my knees quit hurting, my ankle quit hurting, I have some libido again (!!!!!) and I feel SO much better. It was hard for me to find an MD/gynecologist who was also an HRT specialist and was super knowledgeable (and she also was forced into menopause early due to chemo herself) and fabulous! It was not easy finding her, but I did! Often providers don't advertise that they are HRT specialist because insurances poo-poo this (even though they should not). DEFINITELY find a better doctor. You are worth it!
Thank you and you’re entirely right! I was able to find a new doctor who I believe will be a lots more helpful and have an appointment in June. I will still see my other doctor on Friday since I already have the appointment but my expectations are low. I too have really bad joint pain lately even though I eat a very healthy diet and am very active. Do you think your pain has been helped by the testosterone? Have a wonderful day!🌻
Same here you might live in canada
@@cheylou1no but right near the Canadian Border in Blaine, WA. 😊
This spring, I started HRT by weekly injection for T and E and pills for P. Levels are getting to where you suggest. Any comments on injections? Just curious. So glad for Dr. Susan. I spent my 40s having no one listen to me or even suggest any help. Finally, I have someone that will listen and excited to help, but pellets aren't an option.
The male 5gr t-gel can easily be drawn up in BD syringes (I use two 2ml syringes and then you dispense very accurately from those. I put the gel in a sterile contact lens container first and then draw the gel up with the syringes.
Also you can you place the gel into 10 ml syringe. And then put on the dose you want every day.
Thank you for all the valuable information. I’m currently trying to decide on the best course of action regarding hormone replacement therapy during perimenopause. From what I’ve understood:
1. Estrogen Options: You recommend estrogen in the form of patches, cream, or pellets. However, you expressed concern about the variation in the levels of hormones like estrogen, progesterone, and testosterone in the blood. You mentioned that these fluctuations are normal, but at the same time, you seemed concerned about the effects of these variations. This is a bit confusing - should I be worried about these hormone fluctuations or not?
2. Measuring Hormone Levels: It seems that measuring hormone levels is quite complex. How is this done accurately? If hormone levels vary throughout the day, how do you ensure that the measurements taken represent an accurate picture over other days? It seems challenging to get a clear understanding of the hormone balance with these fluctuations.
3. Progesterone: I learned that progesterone is better taken orally as a pill because it isn’t well absorbed through the skin. Plus, taking it by mouth provides the added benefit of helping with sleep, which is especially valuable during perimenopause.
4. Testosterone: For testosterone, you recommended taking about one-tenth of the male dosage. However, you mentioned it’s difficult to divide those doses properly. Could you clarify more about this?
5. Timing: You didn’t mention what time of day is best for taking each hormone. I’d really appreciate it if you could provide advice on the best timings for taking estrogen, progesterone, and testosterone.
I found this class very informative, and I’m still in the process of choosing what to do, but these are the key points I’m considering.
Your description of this video says that it discusses level, which it did not! Why is it so hard to find a chart that shows optimum levels for post-menopausal women on BHRT?
optimal test levels for women is 50-70. Optimal estrogen levels are 100-300
its also about how you are feeling and symptoms, every woman is unique
A level less than 60 means that you’re losing bone. So to stop or prevent bone loss, your estradiol blood work level should be at least 60. So, optimal post menopausal blood work levels are considered to be in the 60-80 range .
The problem with compounding pharmacies is that you are really trusting that the pharmacist and pharmacy is reputable and delivering the same dose with each prescription. This has been shown time and time again not to be the case. For example, and this goes for any drug - say your prescription is for 5 mg. dose. When they looked at prescriptions issued over a six month period, On a 30 day refill schedule, all six prescriptions had widely varying strengths from a quarter as much to three times as much. So until this is FDA approved and you can buy it that way like you can buy estrogen, it’s a crap shoot what you are getting month to month from a compounding pharmacy. Also, you do not mention that there are patients where the pellet dose is too much where they get side effects and you are stuck if that happens for as long as those pellets are in you because they cannot be removed. If you’re using a patch or a cream and the dose is too high for you, you simply stop using it and don’t take the next dose. That’s a huge difference and I don’t understand why you don’t mention that.
Yeah I have a hard time trusting anyone now because I worked as a clipper in the legal cannabis industry in washington state. I am also a curious person so I got close with the managers and learned about the process, and I found out they were selling stuff under the same name so people think it is always the same product but it wasn't. It varied from plant to plant, harvest to harvest, the levels of all the phenols and flavonoids and stuff they market it for were changing in every single batch. The whole year I worked there they never figured out how to get consistency in the product but they kept selling it and they were meeting all legal requirements because they only make them monitor things like the thc amount.
That is not correct information. There are very good studies showing that non-oral estradiol does not increase the risk of blood clotting events so a patch or a cream or anything not in pill form would not increase your risk of a stroke.
Numerous studies support that statement
Possibly your mis understanding her. Because from what I understand from her is that the non oral versions she is all for.
Seems liver doesn't mind taking progesterone every night, but not a good option for your liver taking estrogen orally.... That doesn't make any sense! If it's a pill its a pill, no matter of what it labeled. Progesterone IUD is a much better option.
Yes I use T gel as well. Can get is prescribed and decant 1 packet into a clean container then apply amount recommended by health professional. When that amount runs out, decant another little packet into container. A bit of a pain, yet it works for me.
I agree to get our bloodwork to know where the hormone levels are at BUT the pellets are waaaay more expensive compared to the patches 😌
I can see that you really like the pellets. I have to let you know that I had a bad experience with these.
On my third
Injection of the pellets I had 2 issues. The pellet was inserted incorrectly, and not only was it very painful for a couple of weeks but, I started bleeding as in having a period when I was 65. The doctor told me that I should just have a hysterectomy. Keep in mind that when I started these. I had no issues. Needless to say, I never went back to that doctor. I am estrogen sensitive, and she wasn't willing to work with me. All that she wanted to do was surgery. This would have been a money maker for her.
So I have had no help with hormones and now I am 70 with osteoporosis.
Dear Patricia - so sorry you went through all that ! Please continue to seek expert doctors on TH-cam - there are several that have made it their mission to help educate woman of their options. Some do consults.
Women's International Pharmacy offers Testosterone in a cream and it's VERY easy to order and use, once you have a prescription from a doctor. The key is to FIND a doctor that will actually prescribe it!
In the USA, for women, testosterone is considered a “controlled substance “ and must be created through a compound pharmacy ( expensive), unlike for men who can go to CVS or any other pharmacy and get a testosterone script filled easily and inexpensively. I learned that fact from Dr Shawn Tassone, a gynecologist who is licensed in 34 states and does virtual appointments and actually accepts new patients.
I wish someone would invent a hormone meter similar to a glucometer. I’m fearful of pellets because once inserted it can’t be taken out until it runs out.
Really important to get the right dose ! And yes that would be an awesome invention !😊
Wouldn’t THAT be amazing?!
I was overdosed (testosterone) with the first and only pellet I had inserted! I was miserable until it finally was all gone.
Don't be afraid! Mine are a godsend!
Everyone is different my daughter had the pellets and her hair started falling out
With patches, if you swim, one should get water proof bandaides to cover the patch……wondering about baths.
So ridiculous they approve pellets for men and not for women. I'm on pellets for Estradiol and Testosterone, love them. So easy to deal with, don't even have to think about it. I was on Progesterone cream and creams just don't work very well. I'm taking 200mg pill now, game changer. Pellets are great, just have to find the right level. Yes, blood work is so important. Thank you so much, great video!
I love these sessions. So informative. ❤❤❤
I have been on pellets for ten years, before and after hysterectomy. No problems and no adverse effects. I tried shots and patches and both were much more problematic.
Dr. Susan, I began my perimenopause journey with a dark green estradiol/ testosterone pill. Within months realized there was way too much testosterone here. Then moved to pellets. Wonderful… until it wasn’t. Engorged clitoris, growing hairs on my chin, raging anger… My blood felt like it was fizzing or vibrating. Totally a cowboy experiment, to use your own words. I ended up in the emergency room in tachycardia. Went back to estradiol 1 mg, then adjusted up to 2 mg. Felt great again, initially, after the upgrade to 2 mg but now on a rollercoaster again. I simply am at a loss. My bloodwork shows testosterone at 0. Absolutely no libido. At this point my only goal is to just have energy and be positive. I know that I can do better but just do not know where to adjust.
Dear Kimberly- so sorry to hear all that you went through. Please think about a private consultation with a meno doctor such as: Dr Louise Newson, and Dr Mary Claire Haver (i think), Dr Barbi Taylor. You should be able to do them via phone or Zoom. Best of luck!! The first one I listed I have followed for 5 years now.
I've had something similar happen with the T and vibration sensation. Since the pellet is now gone and your level at zero maybe try the cream in a super low dose?
Do you have a naturopathic doc? They make testosterone creams that can compound exactly what you need 😊
I purchased T gel last week in Mexico. I’m using 1/20th the men’s dose to start. Let’s see how I feel.
is it over the counter in Mexico or did you have to get a prescription?
Over the counter.
So how is it going with the gel?
It’s going great. Increased dosage slightly after 2-3 weeks. Starting to feel like when I had the T via pellets.
Ridiculous you had to go to Mexico for it. This is crazy.
If we had testicles, you better believe all this would be solid science by now.
I have to use the infrared sauna for mycotoxins. I have very sensitive receptors in my breasts & lymphnode. Going to try a cream next
Thank you for all of the great information.❤
I work in a clinic where we provide timing sheets for blood draws. For example, we instruct our patients to take estradiol 6 hours prior to their lab appointment (if it’s oral).
It's great to have protocols, but I would definitely tell your providers not to take any estradiol orally that is not standard of care and increases the risk of blood clotting events!
Why does prempo stop working after a period of time? I have been on prempro for almost a year now. Started on a low dose. It was the best 3 months of my life, and then it stopped working. So I went to the next level of dose. Same thing. Had 3 great months, and then it stopped working. Again, it happened on the highest dose of prempro. It seems that no matter how many times the doctor increases my rx for prempro, the cycle will repeat. Can you explain why this is happening? After watching your video, i now know there are other options out there that are better and safer. I scheduled an appointment with a menopause specialist who is more informed with the latest treatment. Can't wait. Thank you for giving me the tool.
A question for you if you would be so kind. I asked for progesterone to help me sleep and it did but I felt pretty rubbish the next day / I commented on one of Dominique’s videos and Dr Taylor said of course you felt terrible you don’t need it (because I have had a hysterectomy and still have my ovaries) so I am confused and still sleepless 👀👀
I do see a prominent OBGYN bashing
‘Pellet farms’ and I do think it’s unnecessary as you can clearly see you and others that promote them are so genuine and want to help women so don’t condone that attitude
Thank you for all of your hard work 🙏🏻
I love my Estrodial gel and am waiting the three months to see a specialist to get testosterone in Australia / I’ll be sticking to the lowest dose after your comment thank you for that 🇦🇺
Barbie Taylor is correct that you don't need progesterone for uterine cancer prevention but it does help many women sleep but everybody is different so there are lots of other wonderful products I can help with sleep like magnesium 5HTP melatonin and gaba. I would make sure that you're taking bioidentical progesterone that does help most people sleep, but everybody is different and I've made a lot of videos about sleep. I hope you find them helpful.
I was told you still need progesterone. Our ovaries still make it and Estradiol. Why would you replace one and not the other? I have also learned that lack of progesterone can cause thyroid problems. Sure nuff, went to have labs done and my thyroid is low. I will be starting progesterone next week. I too had a complete hysterectomy(still have ovaries). I am on the pellets now, but still have depression, anxiety and some panic attacks. I’ve never in my life had these problems. The pellets do help a good bit, but I am going to add progesterone to see if it helps me more. I hope you get better soon
@@tesiemarie8942 and you 🙏🏻💛💛
First appt next week. In zoom pre-appt meeting she said she doesn’t check hormones because post menopausal there are none. She just puts patients on very low level. All women have some levels of hormones at different times in life right? Considering canceling and looking further for a doc. This one was in another state. Aren’t many close by for this type treatment.
Lots of information. Thank you. It would be very helpful to include what the desired levels are for estradiol and testosterone if it is so important to check levels.
I think for estradiol it should be around 400; 800 is high
I feel like a second class citizen .. when the FDA doesn’t approve & test HRT and have to fight this uphill battle without any tools 🤯!
Thank you for so much information ❤️
I’m on BIO identical HRT. I’m not comfortable with synthetic HRT.
Dr. Susan,
Thank you for the invaluable education. I will appreciate your perspective for my question.
I have been on estradiol, Mylan patches, .05mg/twice/wk. I thought the patches are synthetic, made in the lab. I don’t know where it was sourced? Should I be concerned that it is not a plant based? I think the compounding ones are plant based.
Is the plant based, bio-indentical products better than the synthetic, bio-indentical products?
Thank you for your kind perspective and all you do❤️.
My GYN doctor would never agree to prescribe testosterone made for males. I had to cry in her office to let me have some compounded cream T for libido. She gave me 1% cream.
Do you feel like the cream is working? i just had my bloodwork drawn for T. No libido for me, i'm foggy and very moody so i'm hoping the T will give me the last of the missing puzzle piece.
Maybe a 1% placebo.
1 percent is meaningless- you need to ask how many mg you are getting .
5 mg daily would be standard (at least in Australia !)
1% = 2.5mg is fine, just use more.
2% = 5mg is the standard, which is 10 times less then what men mostly get/want.
How do you feel about taking progesterone for 21 days and off for 7 days? Any advantage/disadvantages?
I'm very nterested in this too.
@@anne-louisegoldie My gynaeloclogst suggested I do this to try and encourage a bleed, as my endometrial lignin was becoming too thick from the estradiol, but I didn't bleed and eventually needed a D&C. I've since been on just one pump of _Lenzetto_ transdermal spray, instead of an estradiol gel, and I still take my progesterone every day - both continuously, without any breaks.
@@anne-louisegoldieWhat is the benefit to this?
Would love to know this too
@@bbjonas4233 I need to know more about it, but I've heard that a few days break from progesterone may be beneficial for the receptors. From another menopause specialist on TH-cam 😊xx
Estrogen patch. Progesterone pill at night b/c helps you sleep. Testosterone pellet, compounding pharmacy.
This came at a good time. I'm currently switching off the patch because I started having an allergy to it.
Same here. Started on a patch but my skin gets red bumps every single time
Don’t go off it… just switch the patch to a different ones your probably allergic to the adhesive.
The NIH did a study on contact dermatitis from estrogen patches and the conclusion suggested site rotation of the patch and/or a small amount of clobetasol (topical steroid), prior to patch application to ward off allergic skin reactions.
All the doctors say no, no, no.They don't do hormone.Where do you get the prescription from?I don't understand this
There are many doctors fully embracing HRT now. Just do a search for HRT doctors in your area 😊
Doctors who have training are not saying -this the standard of care is to provide menopausal hormone therapy. This is supported by the American College of OB gynecologists, the menopause Society, and everybody else -so any Doctor who is educated would support hormone replacement for the great majority of women . You could look at the menopause Society website and find somebody in your area. Their website is menopause.org.
I am 66 and been on HRT for 15 years. When I first started I was taking .037 patch and 100 mg progesterone daily. After a few years I had numerous breast biopsies because of suspicious areas. I got tired of it and switched to taking progesterone the first 10 days of the month only. I was told progesterone keeps your breasts in an agitated state. I would like to go back to daily dosage but cautious. What do you recommend?
Why not talk about injections? I did fine on pellets for 13 years... until I didn't. Patches, gels, creams did not work for me. I have been doing twice weekly injections at home, and feel very stable. I do not have crazy high numbers either, my E is 115 and T is 54.
I’m wondering if the same options and FDA approvals are in Canada?
Thank you so much!!
Doctors who use pellets make a huge amount of money, with the cost of insertion. And if the dose is too high or too low you’re stuck with it. Patch is so much better, but doctors don’t make money on it like they do with pellet inserts.
Do you have in your practice postmenopausal patients on testosterone only without supplemental estrogen and progesterone? And if yes, do you see them converting testosterone into estrogen in blood work?
I am missing something , not sure. You say to get blood work done to check your levels, for estrogen & progestrone, but then say how can they be accurate if you levels go up & down, depending on time of day you apply gel , or have a patch ? So, this is confusing and contradicting ? I am 61, 4 years on HRT, 1 pump Gel, and 100mg progestrone. FYI.
No, it's not contradictory. I explained it as well as possible. It's important to time the blood draw. I mentioned in detail if you're wearing a patch, it doesn't much matter when you draw it however, it will fluctuate during the week and we want to be not excessively high or low with progesterone and we don't need to draw the blood level and with cream or gel you want to draw it 6 hours later. As I mentioned the reason to do this is to make sure your level is not excessively high or zero which is possible, even with a patch. The alternative is not drawing your blood at all and you would have absolutely no idea what's going on so we need to understand that levels to fluctuate, but we want to rule out having excessively high or close to zero absorption.
I have been on pellets for 7 years. My doctor gives me a slightly higher dose of testosterone than estrogen. I have found that my BHRT has stopped night time incontinence.
I finally got hrt after 10 years of trying. Been on for a month and a half. I now have severe osteoporosis. I'm on estrogel 0.06 progesterone 100mg. Still have hot flashes brain fog poor sleep and extremely exhausted day and night. I've asked for the estrogen to be increased but I'm being ignored. I'm low income so I won't be going to a compounded pharmacy. I live in Canada.
My PCP gave me the name of a Menopause Specialist because I was having trouble sleeping. She said I could either get sleeping pills or try HRT. I took the name of the Menopause Specialist and made an appointment 2 months ago.
Menopause.Org is a great resource and we would be happy to see you here either in person or remotely
Can you provide healthy ranges of estradiol, testosterone and progesterone for post menopausal women on HRT?
There is no consensus on this and there is hot debate about it, but in general Estradiol levels in the 40 to 100 pg/ml range reduce symptoms and also provide protect protection for all of the health benefits that we want without any adverse side effects
The highest levels of testosterone that we achieve as women in our 20's are approximately 50 to 100 ng/dL
So my personal opinion is, we should stay somewhere within that range and at levels over 150 we start to see side effects
I started my estradiol patch at .025 dose and my symptoms abated. The things I noticed the most were that hot flashes, heart palpitations, insomnia and lack of coordination went away. However, another OBGYN I follow on TH-cam mentioned .025 is too low of a dose to have an impact on the main reason I am taking estradiol: long term bone, brain, and cardiovascular health. That made me try .05 dosage which made my breasts incredibly sore. It was intolerable. So I went back down to .025 dose which feels like it's the dose that eliminates my symptoms and yet I'm still wondering whether It is enough to protect my bones, brain, and heart. I'm hoping it will. Because of this video I just reached out to my doctor to ask if I can get a blood panel to check my hormone levels, but I'm wondering if it is possible for some people that .025 is in fact enough?
I'm not on testosterone and I'm still confused as to why I would want to be on it other than libido? Beyond the libido aspect of it, is there any other reason to be on it?
Health benefits are not dependent on your dose. It’s your blood levels. You want a mininum of 60 to protect bones for estradiol. I keep my levels at least 250. That’s where I feel best.
You could have a consultation with _Menopause Taylor_ , who also has a You Tube channel. She really knows her stuff!
I believe it can help build muscle.
Blood levels would be helpful in your case. Happy to see you in person or virtually!
@@ShazWag Thank you. But a Menopause Taylor video was the reason I went up to .05 dose. She mentioned that the minimally effective dose for long term health benefits was a .05 patch. It really was too high for me though. I was very uncomfortable.
I am 5'8" and weigh 123 pounds. I wonder what role BMI plays in dosage.
Hello, thank you for this video. Have you seen anyone using the estradiol patch and experience bleeding?
Great episode! I appreciate the dosing suggestion for the testosterone pellet; I believe I got too much when I got mine originally. What is your feeling on the dosage for estrogen calculation for the pellet? Thank you!
I think my dosage was too high too because the tri-est cream made my skin blotch terribly. I just quit. It was just too much but they said it was the lowest dosage.
6-10 mg for E in pellet - I start almost everyone on 6 mg unless they are over 200 pounds
@@drsusan Thanks so much - this is helpful as I see my practitioner today!
@@drsusan Thank you. My OBGYN provider was trained by Rebecca Glaser and we worked on the right T dose for about a year and I was OK on 100, but then in 2021 I chose to increase to 112.5 to better protect my bones. I am on 112.5 T and 25 E. Next time I will try lower E, but I have had trouble thinking on a lower dose. Theoretically, is 6mg equivalent to .05 patch? I was on a patch for years at .1, then .075, until I stopped making any testosterone. I've been on pellets since 2010.
@@drsusanis 125 for testosterone dosage good for 132 lbs is my weight and 5.2 height.
What about sublingual or buccal method of estradiol tablets?
Took oral progesterone for a couple of months (100mg). Yea, great fof sleep, but I was SO moody/irritable...I couldn't tolerate it. Doctor told me to insert vaginally...no more side effects. Haven't checked blood levels yet.
I'm new to your channel. You look amazing!! As far as your teachings, Menopause Barbie could learn a thing or two from you. For years I used a 20% compounded progesterone cream only to find out that I should have been using a 3% or 5% cream for much better absorption.
Did she ever talk about injections? She mentioned it in the wording on the screen but never discussed it. I have not ever done the pellets and the reason why is once you do it your stuck with it for months. I agree with some of the other people on here finding the right balance is definitely the key. Going to talk to my FMDr about injections, which gives me more control. I had to have a complete hyster at 23 and 55 now so I have tried alot of things that have just been meh.
All of the nonoral options are pretty damned expensive aren't they?
Is the Divigel bio identical ? If not, it's not the horse urine, right? Just making sure 🙏🏼💕
Could you please explain how the results vary from a saliva test compared to a blood test.
The idea is that saliva measures free levels of T - we can also check that in blood now. So usually more difficult and expensive to do salivary testing and no additional benefit
No one seems to talk about the fact that our hormones cycle even after menopause. My hormones cycle weekly (the same way as in monthly menstrual cycle only shorter ) . I thought having a patch and progesterone would smooth it up but nope! The same cycle happens , and I still go through severe mood dips, bone pain and sleeplessness during my ‘period’ two days a week ( sometimes even cramping and spotting). It drives me nuts because I’m very unstable. 🤪
What level of testosterone do you like to see your patients at?
I would think it would B unethical to NOT test blood levels of a person's hormones! thinking about Insulin for example.
I am trying to find a doctor who would B able to make wise decisions for my hormone replacement since I am over 80ty yrs. old. I have however, been taking wild yam, pregnenolone & DHEA for many yrs. However I don't think it is working well enough for me to not have bad sleep, frequent urination nightly, daily, bone issues, pain issues, brain fog, etc..
What do u think about estriol? It's hardly mentioned....
BHRT solves that night time incontinence that happens with menopause.
Where are your recommendations for proper/ideal estradiol serum levels?
Hello if my estradiol levels are high and my progesterone is low I take hormones.Should I increase my progesterone? I take 1 mg estradiol pill and prometrium 100 I have anxiety and insomnia. Any advice? My doctor says I don’t need to test my hormones.
I am on .05mg estradiol patch & 200mg micronized progesterone. My serum estradiol is 54 while my serum progesterone is 0.3 so my NP wants me to increase progesterone. The 200mg progesterone makes me sleepy even the next day & I actually felt better on 100mg progesterone so I don’t know what to do!
Why don’t they have time release version of these hormone pills? Is it really difficult to get one done?
Great idea to me
I use lavender oil. It has really helped and no prescription.
For what?
Sleep?
When do you draw blood after pellet insertion Dr Susan? And what are optimal levels?
Does the transdermal dose reflect the actual absorption rate? Transdermal applications are not 100% absorbed.
Thank you so much for all the helpful info! But, what is a compound pharmacy and how does one find one?
google
This video spends all its time defending pellets. Nothing against pellets….but not everyone can afford them.
What about splitting up the cream dose into 2 doses. One on am second at 5pm?
This was very interesting - I was wondering what your thoughts on trouches (not sure if we have the pellets in Australia).
They work well too. Just make sure the base isnt polyethylene glycol❤
I’ve done estradiol gel and patch. My body did not absorb it.
I'm 66 yrs old and have been on bio identical hormones for about ten yrs. Originally I used capsules which took my hot flashes away. I switched drs and she prescribed creams. Ever since I've used the cream my hot flashes are back. It's been two year now. My dr says my levels are good, as of saliva trsting. Do you have any idea why I'm having hot flahes since stopping the capsules?
Hot flashes mean your estradiol level is too low. I would suggest trying a patch. There's no science supporting using saliva testing and if you're having hot flashes, then your levels are too low no matter what your doctor tells you.
Dear Dr. Susan, how do you feel about pulse-dose 1st 12 calendar days of month only for a post-menopausal woman? I am concerned that my better since Progesterone-sleep will be affected and this will also cause a "bleed" 😢
Unfortunately health insurance doesn't cover compounded creams, pellets or sprays.
I’ve heard it’s important to cover the estrogen patch with a water proof Band-Aid if you’re going to be in water for a while so you don’t wash away all the goodness
It was determined back in January that at some point I had had a subacute stroke. I am 63yo and previously took Estradiol .05mg for the past 10-12 years. I was told to stop that medication since it can cause strokes. Now I am not sleeping well and have terrible night sweats. I can't get Veozah because my insurance doesn't cover and it would cost me $500. Now I am taking Paxil but it's not helping much. What are my options?
Non oral estrogen does not increase risk of stroke. That's misinformation:)
I’m sorry, several things you mentioned is why so many women don’t have any desire to do HRT.
1. Even though my testo is rock bottom, even using the lowest dose immediately causes hair thinning and loss. 2. The .25 patch cause high symptoms with swelling pain in legs and headache, in spite of very low blood levels. 3. You didn’t mention the weekly patch, only 4 day. Do you find twice weekly better? I’m low in all hormones but react to even low doses.
My preference is the twice weekly patch but there are other products available. My experience with the weekly patches that the levels drop off to towards the end of the week and patients feel symptomatic.
Very good information, thank you. Just started climara 0.025mg patch once a week and prometrium 100mg daily, 2 weeks now. Feeling bodyache, sinus congestion, sore throat and headache. It was also showing under adverse reactions in the package insert. Should I try it for few more weeks? Will it go away? Other options? Thanks
If you check the blood level and it's a crazy high or crazy low level, what are you going to do? It could be a different level when you check again later the same day
Also, I had a primary tell me oral estrogen was the only way to get heart protective benefits! I stopped b/c my estrogen plummeted into post menopause I couldn’t keep my estrogen levels up with a pill.
You can also get Testosterone for injections at a regular pharmacy and use a tiny dose... because of the dosage being for men.
My doctor put me on an estradiol compound (the highest I could get), but my body would just suck it up, so she put me back on a patch. Walgreens changed manufacturers, and these current patches aren't good at staying on. They fall off during intercourse - we sometimes find it attached to my BF's leg... LOL
I was given Estrogen, progesterone, testosterone, cream after ONLY A SALIVA TEST... JUST STARTED THE CREAMS, ON A WEEK AND ITS NOT TOO HIGH OF A DOSE, BUT I did not get blood test...
Is SALIVA TEST GOOD ENOUGH? IM CONCERNED!!!
THKS MUCH
Pellets are horrible…..you get the full dose when they insert it & at the end you have none.
I had b😅leeding when i started pellets with estrodial and testosterone pellets and oral progesterone, i discontinued it because it was so annoying,twice i did that. Then my gyn told me i could just get testosterone pellets, it was wonderful i had my sex drive back. But because of all the literature that any hormone replacement was harmfull to women over 60 i stopped. I am miserable, im 63 and hubby is 68 with an enormous sex drive. Its effecting my 38 year marriage. I plan to start the testosterobe pellets alone again when i see my gyn again.
Your video is confusing regarding blood tests. You recommend blood tests, but say they aren't accurate because hormone levels fluctuate. So what's the point of a blood test if they can't accurate measure your hormone levels? Very confusing.
New subscriber here....I'm so frustrated because my Dr. will not give me a prescription because I have a history of breast cancer in my FAMILY!...There's so many new researches that state that it's ok to use. My biggest concern is Vaginal Dystrophy, everything else I can live with. Any suggestions would be much appreciated!!!
Estrodiol cream. Twice a week.
Taking estradiol patch . O5 testosterone crème by compounding and 100 mg progesterone by mouth, curious as to how I would know if I need more progesterone since you said 100-200 mg/it’s hard in Mi to get a menopause specialist, went to 2 drs and one stopped answering the phone, who prescribed these but told me to stop preglanone and dhea, the other dr said no don’t stop them. Who do you think is correct?
100 mg is the minimum dose that has been studied to prevent uterine cancer but some people take more than that if they need it for sleep or moods or anxiety I personally take 200 mg but anything over 100 mg is safe
Would be happy to see you remotely or in person to discuss
@@drsusan I would like that but when I called your office some months ago they said no because I lived in Michigan. Is it possible? I asked my combination naturopath/MD office for the doses you recommended and they agreed to give the prescription. So far I feel fantastic.I don’t know if can put my email here since not sure who will view it. I’m
Carol Ann