HRT & Bioidentical Hormones compared

Hi there:

I had a TAH in 1997 at the age of 41. I had noticed some symptoms over the years - tension was the most prominent symptom that I had noticed, but my doctor didn't seem to be too concerned. My hormone levels were still ok. I started having some additional symptoms like, some dry eyes only on awakening, tiredness, low lobido, hot flushes, weight gain, memory loss - most of the symptoms seemed to point towards the thyroid. My thyroid levels were tested over and over each year. In 2003 I had a thyroid test and I was told I was borderline hyperthyroid I thought this unusual since I had gained weight - not lost it. Oh, and by-the-way, I was post menopause (the doctor told me after my blood tests came in). Nothing was done about my thyroid only monitoring my bloodwork every 6 months. After 6 months, my thyroid levels were back to normal. Still nothing was done about my hormones.

After a year of my thyroid being stable, I decided it was safe to get laser eye surgery. Since having the surgery, my dry eye symptom worstened significantly to being dry all the time. It eases up for a short time with drops.

In 2006 - after turning 50, my doctor recommended I finally see a gynecologist who checked me out. By this time, I was having painful sex (which by this time only occured about 5-6 times/year), dryness, hot flushes, headaches on top of my other symptoms. Upon examination, the doctor could tell that my vagina had shortened and the usual thinning of the walls was the cause of this discomfort.

I was prescribed Premarin .5 mg vaginal cream as well as Premarin .065 mg pill taken orally. This seemed to help with the hot flushes and allowed me to sleep a little better, but the vaginal dryness/tenderness, dry eyes, low lobido still were a problem.

I talked to my doctor about bioidentical hormone therapy and she prescribed 200 mg prometrium, increased the amount of Premarin vaginal cream 1.0 mg 3X week, 1.25 mg EstroGel daily as well as (2 lines) testosterone cream from the compounding pharmacy rubbed into the thighs daily.

I have been on this for 60 days now and have noticed the following. I am sleeping worse than before, my eyes are still dry, I still have painful sex and lobido hasn't changed much. On top of this - my breasts have increased in tenderness and enlarged, I have gained weight, I have suffered on/off with constipation and my hair seems to be greasy, I am constantly washing myself as my body odour has increased, my urine seems stronger smelling. I'm not sure if this is a common effect.

My doctor has now increased my Prometrium to 300 mg, my testosterone to 3 lines, my EstroGel has been replaced again to Premarin .065 daily pill. I have concerns over increasing progesterone in somebody who has no uterus. From what I have read, this is the hormone used most commonly for endometriosis in women without hysterectomies. I am almost reluctant to increase these doses as prescribed.

I am wondering if my doctor is correct in increasing my HRT dose. I felt better when I was just taking the pill and cream than I do now. I even told her so.

Hi Swelloos, sorry you're having these problems. I have been doing a lot of research on the subject of surgical menopause, not so much on natural menopause, but what I learned I think can be applied in your case. Basically I think your doctor, while she meant well, may have been a bit hasty in initially adding prometrium, testosterone, and switching you from Premarin to Estrogel all at once. From what I have read it is better to make only one change at a time, that way if you develop symptoms or side effects it will be easier to tell what is causing it. However doctors sometimes have a tendency to want to fix all our problems in one fell swoop.
I am not a doctor and this is just my personal opinion as well some info I have picked up along the way from reading about other women's experiences on boards like this. I am in a different situation than you because I still have my uterus and part of one ovary, but that little part doesn't seem to be functioning any longer. When I developed issues with vaginal dryness and atropy as well as low libido, my doctor prescribed a product called Estring, it is a flexible plastic ring you insert in the vagina and leave there for 3 months. It releases a very low dose of estrogen that stays in the vaginal tissues where you need it. It is very comfortable and I don't feel it all. It really helped my tissues get back to normal. I leave it in during intercourse as well. I also use a patch for systemic HRT but apparently it's common for systemic HRT such as patches and pill not to work as well on vaginal tissues as it does for things like hot flashes. I have also used Estrogel in the past and I found it to be too weak, I was using 2 pumps/day and all my symptoms of low estrogen such as joint pain, hot flashes, etc. returned and did not go away until I switched to the bio-identical patch. I use Combipatch because I still have my uterus, but the company that makes it also make the Vivelle Dot which does not contain a progestin. This is a very popular option for bio-identical estrogen with the sisters around here. It's very possible that once you get your vaginal and systemic estrogen levels to where they need to be, your libido will return and you won't need the testosterone, or at least not as much of it. The 300mg doseage of prometrium seems awfully high, I can barely tolerate 100 mg./day, I would be psychotic and fat as a house on 300 mg! I suspect that is what is causing your weight gain and breast swelling. The testosterone also should be dealt with very carefully, did you have your levels checked by blood test before starting it? It is strongly recommended to do that since it can have some nasty non-reversible side effects if you get too much. For me the 1st symptoms of testosterone excess are greasy hair and acne. Maybe you should ask for a blood test for free and total testosterone before increasing that doseage. And if, after finding the optimum dosage and delivery method of estrogen, you still feel like you need some progesterone, I know many women here just use a dab of a USP progesterone cream such as Pro-Gest, which is available over-the-counter. Just some things to think about and discuss with your doctor. Good luck, I hope you feel better soon. s, Andrea

You sure have been through a lot!! I also had Lasik and after when I had very dry eyes my eye doc thought I might be hyperthyroid. I got it tested many times as well and it has never shown up on the thyroid panels. Now since surgery my eyes are very dry except for the couple of times I've tried estrogen alone. I'm not quite ready for the estrogen though as I was swelling, and bloating on it. I know omega 3 fatty acids are fantastic for dry eye. I would take them now as they have helped in the past, but my face is very zitty lately and after 3 months on fish oil I got zits too. My eyes were great though. Is everything a catch 22?? Anyway something to try if you need too. I used Prometrium before my surgery and it worked to keep my uterus smaller, but I felt like crap on it after awhile. I realized now it really lowers your estrogen levels, but if you need that for balancing it might be good. Maybe you can ask your doc for a lower dose though. 300mg is usually used to retain a pregnancy. A bit too high for us after a hyst.
Take care,
Tara