Getting Ready and have questions pls.

Hi, I am going to have app to schedule the surgery in 2 weeks and doing my research on HRT.

After reading all I can read on the web and in the books, I have decided that I iwll go on "Vivelle - Dot" . I have few questions which i am very confused on , so if you ladies can help me a little...

1. I am 34 and will have everything removed, but cervix. Do I need to take progesterone as well since I will have no uterus?

2. Only estrogen usually prescribed? Estradiol, it is. What about Estriol?

3. For my age would you think I need to start on 0.075 or 0.1? What is your experience?

4. Will I need any testosterone as well?

Thank you very much!

Hello!

You're very smart to research hormone therapy prior to your surgery. It's good to know what's available so you can discuss your preferences with your doctor, if keeping your ovaries isn't an option.

Generally, estrogen only is prescribed at first. There are various types of estrogen, which you can read about in articles 8 - 11 in this resource: Hormone Jungle Articles. Bio-identical estrogen from the pharmaceutical companies is estradiol only. To get both estradiol and estriol, or estradiol, estriol and estrone, you would need to get a prescription for either biest or triest and have it filled at a compounding pharmacy. It's an option that you can keep in mind but I think estradiol is a good starting point.

Women without a uterus don't have to use progesterone to avoid the increased risk of uterine cancer associated with using unopposed estrogen with an intact uterus, but that's not to say that you won't find it beneficial. Whether you need it post-op or not will depend on if you're having symptoms that would be helped by using that hormone.

Doses of Vivelle Dot, from lowest to highest, are 0.025, 0.0375, 0.05, 0.075 and 0.1. Your doctor can suggest which dose is best suited for you. It really varies from woman to woman. The goal is to use the lowest dose that provides symptom control. I'm 54 and use the 0.1 dose.

Whether or not you'll need testosterone will depend on whether or not your levels of free and total testosterone indicate that you need it. Many women don't but if you do, make sure you balance first with the other hormones before adding another to your hormone therapy. If you make too many changes too quickly, it's going to be hard to figure out which hormone needs to be changed to control symptoms.

Expect to experience fluctuating levels early in recovery--it's common with or without ovaries, on or off hormone therapy. Your body will be depleting hormones your ovaries made while recovering from surgery and adjusting to a new source of hormones. Consider keeping a symptom journal so you have a written record you can share with your doctor. Your doctor can interpret that information and adjust your hormones accordingly.

I hope this helps you!

My best advice on the whole hrt thing is this...your bodies stores are used up within 3 months of surgery...the thinner
you are the quicker the stores are used up.

I felt the slide even being on the .075...I moved to .1, but still kept sliding...

For me (and I was 48 at time of surgery)...I needed a higher dose to compensate and refill storage I lost (I was heavier, so it took time to build back storage).

Test your hormones regularly then you will know if they are maintaining or slipping down. Keeping them at a stable level is a good thing...some people are very sensitive to fluctuations ( I am one...some are not).
Being younger you may need to be at a higher level initially...find a doc that will get on board with that (some won't) if you need it...I have heard women your age needing anywhere from 200-300 (some even 400) at first

Not all deliveries work for everyone...the vivelle dot didn't absorb for me...I had to have 8 patches just to maintain 200 level....for others it works like magic.
That's why to me monitoring your levels is key...especially, initially...but I would also encourage ongoing tests.
Vaginal works well for many.


Good luck on your surgery...and recovery...I hope its a smooth transition for you.