Need advice about Premarin

Hello, Sisters:

I need some advice about Premarin. I had a TAH BOS and a bowel resection on February 14th because of severe endometriosis. All visible endo was removed, but my doctor delayed ERT for three months in an effort to eradicate any microscopic disease. Instant menopause was a most unpleasant adventure, but fortunately he started me on ERT two weeks ago. Hallelujah. I am currently taking .625 mg of Premarin daily.

He told me to increase the dose in a couple of weeks if I needed to. The problem is I’m not quite sure what I should be expecting. My hot flashes have greatly improved although I still get a few each day. Sleeping is still very, very difficult, however. Is this as good as it gets or is it reasonable to expect more? Should I give it more time at this dose? If I do increase the dose, should I take an extra pill every day or every other day? Is this stuff cumulative? I know its best to take the lowest dose possible, but I haven’t had a good night’s sleep since January and the novelty has worn off. What have your experiences been? I would appreciate your advice.

Thanks.

Annaleigh:

I can understand your reluctance to increase the Premarin -- and your desire for !!

Is your doctor also giving you any progesterone source? Many doctors prefer not to use estrogen "unopposed" in their endo patients. Any residual endo could continue to proliferate without the counterbalance of progesterone inhibition. And many women find that progesterone helps with that elusive sleep cycle.

That being said, a number of women around here have been pretty happy on Premarin alone. However, you've been off ALL estrogen for the last three months...it's going to take a bit more than two weeks to "fill up the well" so to speak, and to know if this dose is the right dose for you or not.

What I found is that my needs continued to shift within the first year, and they continue to shift for me a bit. I did increase the dose, but I gave it a few months at each dose before increasing. And I take Prometrium with my estrogen.

Journalling your symptoms is a good idea...it takes no more than a line or two a day. For example, you may find that the sleep thing is improving a bit, but the changes are too subtle to be noticeable until you look at a trend over a few weeks. It took me nearly a year to get my sleep cycles to where they used to be.

You'll get there. But it's an ongoing, fluid process. And you may find, as some women have, that Premarin isn't the "right" estrogen choice for you. But you won't know that until a few weeks -- depending upon the symptom, I give an HRT change at least three weeks to see if it's working. Sometimes it's not a matter of increasing the dose but perhaps using a different formulation or delivery system. For example, I tried Estrace cream for the vaginal dryness for three weeks. It didn't work for me, and I went back to my Estring. We're all different, and one size really doesn't fit all (although the drug companies would like to have the doctors believe that!).

So, don't give up...keep documenting...and if you don't see a real improvement on this dose within a month total, then it's time to either evaluate the dose, the delivery system, or the overall strategy. And don't give up. Many of us have found balance...I, for one, feel like I'm doing so much better with HRT than I ever did with my unpredictable, traitorous, native hormonal "soup"!



Audrey

Hi Annaleigh --

Audrey gave you great advice, the only reason I thought I'd reply to your post is that I'm on Premarin also. And like you I had a lot of endo. My doc had me on 0.3 mg Premarin daily for the first 6 months post-op and then increased it to .625 mg. It took quite a while for things to settle down and for me to figure out that this is the dosage that I feel best on. I tried some of the bio-identical hrts at one point (I felt pretty good on the Premarin and wanted to see if I would feel even better on something else!) but they didn't work for me and I went back to the Premarin. At one point the dose was increased to 1.25 per day (a .625 in the a.m. and in the p.m.) but it proved to be too much for me. I went back to one tablet of .625 Premarin per day, and I use progesterone cream about 3 weeks out of the month. It seems to help balance me.

I had a rough time with insomnia too. My doc gave me Bellamine-S tablets to get me thru that, and when I started sleeping better I weaned myself off of them. I sleep well now without taking anything to help so hang in there..........it does get better with time.

Just my opinion but I think you should give it at least another week or two before you increase your dosage. Any time you change hrt's or add something new like progesterone cream it really takes a while to know if it's going to work for you. On the other hand, when I tried changing to the bio-identicals (I tried the Climara Patch and than two other synthetics Cenestin and Estratest) I felt so lousy within a week that I couldn't continue to take them. When I increased my Premarin dosage from 0.3 to .625 I felt better within about 4 days but that is just me. But what Audrey said about the first year being a lot of shifts and changes was totally correct............so many ups & downs........if you change things too rapidly you won't know what's working.

Please feel free to email me or PM me if I can be of any more help!

Good luck!

Ann
TAH/BSO 1/5/01