Question to those of you on estrogen replacement

Do you take oral estrogen, or use estrogen cream or patches? If you have tried more than one form of estrogen, which one did you prefer and why? It would be interesting to know your doctor's reasons for prescribing one or the other.

I am asking because the Hertoghe doctors only work with dermal estrogen. They refuse to prescribe oral estrogen as they claim it overburdens the liver, among other things.

I have been to see my OB-Gyn and was given a prescription to go to the lab and have my estradiol levels measured, along with my FH and LH levels. She believes my recent symptoms (profuse night sweats and hot more and more frequent hot flushes during the day) will require estrogen replacement therapy. I got the impression from what she said that she prefers oral estrogen.

That is why I'd like to learn as much as possible about the experiences of others.

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  • I have an E implant, gps usually only offer tablets, I had these first, then patches, gel, and now implant every 6 -9 months, but have to get these done at a Meno clinic at a hospital in London

  • Did the pills help, or did you find the patches or gel more effective?

  • Pills didn’t agree with me at all, patches ok but kept falling off, gel definitely better, but I wanted something that didn’t fluctuate as much, hence why had the implant, as that’s quite steady.

  • Ok, thanks again! I don't think that will be an option in my case though...

  • You can get Oestrogel or Sandrena gel, I found the latter better, as it was stronger and didn’t need to put so much on 😊

    You really have to push for the gel tho, as they will always try the cheapest option first

  • Thanks:-)

  • Yw 👍😊

  • Sublingual oestrogen - creams didn't work. Also progesterone and DHEA. Quite a low dose of oestrogen (I think). I had vagifem pessaries initially for two weeks to cope with vaginal atrophy. Those worked well for the two weeks I was taking them (but were a higher dose than the amount of oestrogen I now have)

  • I'm on my 4th day taking synthetic HRT due to disturbed sleep, burning hot flushes, & breast tenderness after 3 weeks on bioidentical oestrogen gel & progesterone tablets. I'm havingr a mammogram next week & can't bear the thought of the extra pain. :(

    I was using the lower dose of gel, so may have had too high a ratio of progesterone. Off to the doctors later in the week to see what she says.

  • Something very strange happened...as the ultrasound showed an ovarian cyst, the gynecologist prescribed Duphaston 10 mg (dydrogesterone) to be taken twice daily for twelve days. I took two pills yesterday, and this night is the first night in weeks I did not wake up several times drenched in sweat...coincidence??? I have no idea. But it seems strange that I would feel better after starting a new drug (synthetic progesterone), especially since it's the only thing that's changed...

  • I have been on estrogen patches (Estradot 25, lowest dose) for five years and they have helped keep the sweating under control. I’ve done much research on my own and found that estrogen patches/creams are best because they don’t go through your digestive tract, so don’t affect your liver, digestion, or kidneys. They are simply absorbed directly through your skin quickly and efficiently with less side effects.

  • Thanks:-) Yes, I read about them. I have no idea what my OB-GYN thinks about them, but I like the idea of continuous supply of estrogen throughout the day. Sometimes, I wonder if the problem with the cream is that it does not deliver enough estrogen, or if its effects don't last long enough...

  • PS. Do you find that the patches remain in place even after taking a shower or exercising? I have read that you are supposed to apply a new patch every three or four days, meaning you use two patches weekly, but wonder what happens if they fall off more often than that, so that you may need four or five a week...? I do exercise a lot, and have been wondering if an estrogen patch could "survive" that...

  • Yes my patches stay in place after a shower and exercising. I do light exercise three times a week and go for a long brisk walk daily with my dog. Yes you do have to change the patch every 3 or 4 days. I actually change it every 4 days, although I have gone 5 days many times. I have personally never had problems with the patch coming off, except at the beginning when I was not placing them correctly. You should place them on your lower stomach, just above your pubic hairline, on either your right side or left, I rotate each time, so I don’t place it in exactly the same place every time, then press in place and hold for a few seconds so it firmly takes hold. The only time the patches came off is if you place them too high (too close to your belly button where they can get caught on your clothes, especially if the patch was not placed firmly and there is a loose sticky edge that gets caught on your clothes. I also like the patch because it does not irritate my skin as I did experience with the estrogen cream on my arm.

  • Thanks again for that useful info! It seems estrogen patches are available online (you do have to complete an online questionnaire and, if it's accepted, a doctor will issue the prescription). Unfortunately, that service does not (yet) seem available outside the UK...:-( I'm afraid my OB-GYN will only prescribe oral estrogen...

  • I use an estrogen patch, Minivelle 0.1 mg, twice weekly. I put the patch on my lower abdomen, switching locations. I cover the patch with a wide strip of Tegaderm (keeps the patch on thru exercising and showering). I buy the 2" wide roll and cut 1" strips off (yielding a 2" x 1" strip that I apply over the patch).

    To balance the estrogen, I'm also on oral Progesterone, 200mg, taken daily. (I have found oral progesterone to work better than the compounded transdermal cream). I was originally only taking the oral progesterone for 12 days out of the month but found that I suffered and symptoms returned the days I wasn't taking it.

    I was also on compounded transdermal testosterone cream but had to stop since I seem to be very sensitive to testosterone and my levels rose to high levels very quickly, making me irritable.

    Since being on HRT, my night sweats have stopped and my mood has evened out. I don't have any experience with oral estrogen or compounded transdermal estrogen cream so I can't say if those are better or worse. The twice weekly estrogen patch and oral progesterone are working well for me.

  • Thanks, that's very useful:-)

    When you say that symptoms returned the days you weren't taking progesterone, does that mean that you now take it daily, along with transdermal estrogen?

  • Yes, I take 200 mg oral progesterone daily (I take it around 9:00pm).

    (I realized I had some typos in my original response so I have edited to correct those and to clarify things).

  • Thanks again, that's very helpful, as it's something I think I would need to do as well for complete symptom relief. Which brand of progesterone are you on? Do you see a gynecologist?

  • I'm in the US. I do see a GYN but it is my endo who handles my HRT.

    Not sure of the brand as it is via prescription. The oval capsules are pale yellow color and imprinted with TV A19 on one side.

  • OK, I was wondering if it's natural (bioidentical) or synthetic progesterone...I have been on 200 mg of Utrogestan (bioidentical) from day 15-25 of cycle for a few years, along with Oestrogel from day 5-25 of cycle, but they have not stopped hot flashes or night sweats...after two days on Duphaston (Dydrogesterone), prescribed by OB-GYN for an ovarian cyst, they are almost gone. It's difficult to see another explanation as I have not changed anything else. But what I've read about the negative side effects of synthetic progesterone would make me hesitate to use it long-term...

  • You mentioned absorption issues with Oestrogel. Not sure what dose you were on though. I suspect that the bioidentical progesterone was / is stronger than dydrogesterone, and with its being stronger and its associated receptor activity, decreased the effects of your estrogen, causing you to have a recurrence of symptoms (hot flashes, etc.). Bioidentical progesterone opposes estrogen, so depending on the doses of the both, you could suffer those side effects due to a relative imbalance.

  • Wow, that's very interesting, thank you so much! I had absolutely no idea...I have been using two pumps of Oestrogel per day, twenty days a month, along with 200 mg of Utrogestan at bedtime, ten days a month. Unfortunately, the so called Hertoghe doctors won't hear of synthetic hormones, so I will raise this with my gynecologist. I know for a fact that Oestrogel and Utrogestan are not working optimally for me. What you say actually makes a lot of sense!

    Some take 100 mg of Utrogestan every day instead of 200 mg ten days a month, but I am not sure that would make much of a difference if bioidentical progesterone in itself is the problem...?

  • Ok, so what I mean is that, and similar to what milkwoman wrote, it's about the balance. The little that I know about dydrogesterone is that while it may be more bioavailable (believe it or not), it is also not as strong as bioidentical progesterone. It has a similar profile, but does not work the same as the bioidentical.

    If dydrogesterone was less strong, it did not lower your estrogen levels such that you experienced recurrent side effects like hot flashes typically associated with low estrogen. On the other hand, the bioidentical progesterone at 200 mg opposed your estrogen to the degree that it effectively lowered it, either by effect or level.

    So, if you want to take bioidentical, you have to balance via symptoms your dosages. For instance, you would have to increase your estrogen if you want to take the 200 mg of micronized progesterone capsules, or alternatively decrease your bio progesterone if you want to stay on your dose of Oestrogel. Of course, the balancing is the tricky part as well as method of application and success of absorption.

  • Yes, I am slowly beginning to realise that...! To me, there are several balances to strike here...first of all, I see a so called Hertoghe doctor who is really a GP (but is called a "hormone specialist" after working a couple of years in H's practice and regularly attending his seminars since) who charges 200€ per visit, of which 20€ is reimbursed by my health insurance...but I have told myself that was OK as long as this doctor could offer me help that more conventional doctor could not. If you go to see a Hertoghe doctor in Belgium, you have to be prepared to pay most of it (both doctor's fees, labs, and drugs) out of your own pocket. A GP is supposed to charge +/- 35€ per visit...NDT is never reimbursed in Belgium, and neither are many other drugs prescribed by the H doctors that I have never asked for (the most notable example being HGH which is only reimbursed in the case of children threatened by dwarfism, not as an anti-ageing drug). The main reason for seeing a Hertoghe doc in the first place was because I never did well on T4 only, no matter how doctors tried to tweak the dosage. I wanted NDT. All of a sudden, I ended up with a lot of diagnoses and prescriptions...

    I will raise these concerns with my hormone doctor at my next appointment in six months...but both you and Milkwoman are right; something seems off balance here. I rather reluctantly started taking Duphaston the other day after my gynecologist prescribed it, but never expected my hot flushes and night sweats to go away because that is not what the drug was prescribed for...so I cannot have imagined the improvement I feel after only 36 hours on Duphaston, compared to bio-identical hormones...

    These Belgian hormone doctors seem to pay so much attention to progesterone as estrogen is never supposed to dominate...I have to admit it never occurred to me either that progesterone dominance (if such a word even exists) could explain some of my symptoms...

  • That is interesting because, where I live, there is one product combining estradiol and dydrogesterone...each box contains 28 pills. You take estradiol only for the first 14 days of cycle, and then combined estradiol + dydrogesterone pills for the next 14 days...continually, so there would be no break from day 25 of current cycle to day 5 of next cycle as is currently the case. At the end of the 28 day period, a period usually occurs, even though you don't go off the meds.. I have been considering that drug lately, but maybe it would not be a good idea since it contains dydrogesterone and not micronized P...? It's called Femoston, and contains oral estradiol...something I've always been told to avoid...

  • I did a little research. From what I understand, the oral progesterone capsules I take are bio-identical. They appear to be the generic form of the brand name Prometrium. I have not experienced any negative side effects.

    As it's been explained to me, it's all about balance. When your hormones are in balance, everything works as it should. So, perhaps the Duphaston dose was high enough to balance out your estrogen levels while the Utrogestan was not? The ovarian cyst was also most likely wreaking havoc. The Duphaston may have shrunk it and that is the explanation?

    It would seem that you are not in balance with regards to sex hormones. It did take quite awhile for mine to become balanced and I was on different doses of the estrogen patch, testosterone and progesterone during the process of "figuring it all out". I seem to be doing well on my current protocol but will be tested again in January.

  • So true...! I have done some research on Duphaston, and it seems it can and is prescribed alongside estrogen to treat menopausal problems such as hot flushes and night sweats.

    Like I wrote in reply to Cleo26, maybe I would be better off on 100 mg of Utrogestan daily instead of 200 mg ten days a month...? I don't know if it's the drug as such (bio-identical P) or the dosage that's the problem...as far as I know, Utrogestan and Prometrium are the same thing.

    It's possible that synthetic hormones are less safe than bio-identical ones, at least if you use them long-term, but I have no idea how much the risk increases...besides, I do regular pap smears and mammographies. True, it won't prevent me from getting cancer, but I sometimes wonder if the risks have been blown out of proportion, given the considerable benefits of HRT when it really works and relieves you of all symptoms...?!

  • I have heard more negativity about medroxyprogesterone than dydrogesterone, particularly regarding blood clots, breast cancer, etc. However, it could just be that dydrogesterone has not be studied. It could also be that there hasn't been much study of bioidentical progesterone as well.

    Might give you some peace of mind in the short-term to stay with what works while you research and find someone experienced on bioidentical progesterone and hormonal balance.

  • To be honest, I've not researched things one way or the other. My endo was Dr. Kenneth Blanchard - he was a pioneer in using unconventional methods of treating hypothyroidism - and, also an expert in fertility and women's issues. I trusted him implicitly as 1,500 happy patients worldwide couldn't be wrong. :-)

    He passed away in April of this year, and the physician he mentored for 15 months took over his patients. I now trust her and we have the same relationship. She listens to her patients just as Dr. B did and I feel it is a real partnership to get me and keep me well.

    Whether it's thyroid hormones or sex hormones, it's all complicated! No one treatment works for everyone, unfortunately. My goal is to find what works for me.

    My advice is to keep track of what you take and how you are feeling. Also, trust your gut instincts. If your gut is saying to try 100 mg daily instead of the 200 mg for 10 days, then why not? There really is no harm.

    Have you had your sex hormones tested? It's all about the relationship of one to the other, rather than the numbers themselves (tho, yes, if one or all are way out of whack then, of course, that does come into play). As I said, it is a complicated system.

    I started out on 0.75 mg patch, a compounded transdermal cream containing a small amount of progesterone and testosterone and 200 mg oral progesterone on days 1-12 of the month. I was still having breakthrough bleeding so we upped the progesterone to daily and reduced the estrogen to 0.5 mg. Then, sweats reappeared. So another change (upped the patch to 0.1 mg). Then, my testosterone numbers soared so we reduced the % amount in the cream. When I was still feeling agitated, I stopped the testosterone completely and now feel much better. Will I need to use it again at some point? Perhaps. For right now, things seem to be balanced. I'm still in early menopause so naturally, my hormones levels are in constant state of flux.

    I'm having a full functional medicine profile done in January. I'm not quite sure yet what that will entail, but it is designed to look at the entire body and evaluate what still could not be quite right. In addition to HypoT and menopause, I also have lupus and Sjogren's as well as other positive autoimmune antibodies so I am a complicated case. Considering all this, I'm doing fairly well. The functional medicine consult is to look at whatever missing pieces there may be as I want to feel the best I can in spite of all my body is dealing with!

  • Thanks, this is a lot of info to digest and I will treat it like a gourmet dinner...nibbling rather than gorging...!

    I am slowly beginning to realise there is so much more to learn...I have been relying on my hormone expert (trained by Thierry Hertoghe) to do the thinking for me, but the realisation is slowly beginning to dawn on me that I need to educate myself.

    I never expected three pills of Duphaston to make me feel better than I have in a long time, so all of this feels quite overwhelming right now...

  • I understand completely! More than once my head has spun based upon info received here! I assure you, eventually things become clear. Patience is one thing I've had to learn! :-)

  • Tried the patch and found it didn’t adhere well when showering or exercising. Transdermal creams worked a bit better because I had more control over the amount and frequency of application. However, both posed efficacy problems either due to skin absorption, or specifically for creams, compounding (in)consistency. Couldn’t maintain a level dose on either. The pellet was the best and most effective for me.

  • Is that a common procedure in the UK?

  • Subcutaneous estradiol pellet (implant).

  • I don’t know how common the procedure is in the U.K., but would imagine it’s available. Perhaps it’s less common.

  • If you apply a strip of Tegaderm over the patch it stays put through exercising and showering. (I buy a 2" wide roll off Amazon and cut 1" strips yielding a 2" x 1" strip that I place over the patch).

  • Cleo26,

    Yes, I see what you mean...I have been wondering if the Oestrogel cream simply is not potent enough for me, or at least inconsistent, as I have not been having great results on it.

  • I also had that same problem, and it was very frustrating having to work with doctors to increase the dose. At one point I had even thought to go on the pill to try to maintain better levels. I was applying 8 mg of cream daily and still had low estradiol serum numbers, high lh and fsh. Finally went with the pellet and it is working for me.

  • I do a few drops of a compounded blended mix of different estrogens on my wrist- Standard protocol of functional doctors in US. I agree with the liver issues and preferred to take anything I can topically. Important not to take estrogen tablets with thyroid medications. It might affect your absorption of one or the other.

  • Thanks...! I am not sure the same options are available to European patients, but I note your comment about not mixing estrogen and thyroid medication!...!

  • Well, it's all very confusing because my latest labs (I went to lab on day 23 of cycle as OB-Gyn said the day didn't matter) showed high levels of estradiol. This means I I had labs done during the luteal phase. I had not used Oestrogel for 48 hours and, according to the info I've found online, that should be enough for any exogen estrogen to leave the body. But, even if it isn't, that must show that I don't really estrogen replacement as levels should not be seriously out of range (mine were 565 pg/mL; reference ranges for luteal phase 21-312).

    This makes me wonder if it was a good idea to put me on Oestrogel in the first place, five years ago, simply because I "was over 40 and every woman over 40 needs HRT"...I recently read a post by US doctor Christiane Northrup stating that a woman's estrogen levels won't drop significantly until after her last period (and I'm still having my periods, although slightly irregularly), so there is no reason to use estrogen (if at all) until after 12 consecutive months without a period...

    I have not used Oestrogel for nearly a week, while using Duphaston for the ovarian cyst my OB-Gyn found, and I have to say I feel much better already...sleeping through the night, no more tossing and turning and horrible night sweats, and hardly any hot flushes during the day. It may be too soon to say I know what the problem was, but I can say one thing for certain: almost a week after going off Oestrogel, while using progesterone (albeit a synthetic version of it), I'm already feeling so much better, and my perimenopausal problems - mainly intensive hot flushes and night sweats causing me to wake up every other hour or so - are practically gone.

    What I plan to do next is to stay off Oestrogel, and go back on Utrogestan 200 mg for ten days a month (as prescribed by Hertoghe doctor). Hopefully, Utrogestan will prove as effective as Duphaston, as I'd prefer to use bioidentical rather than synthetic progesterone....but, if nothing else proves as effective, I'd be willing to go back on Duphaston, provided my OB-Gyn would be willing to prescribe it long-term, that is...however, I've never used Utrogestan on its own, but always combined with Oestrogel, so I'd like to give Utrogestan a chance before deciding it's not for me...

    Like I said, I find this very confusing, as I have attributed all my recent symptoms to estrogen deficiency, not dominance...but I cannot deny the fact that I feel better than I have in a long time since going off Oestrogel...which I've been on since age 42. I'm now 48.

    I have been doing a lot of reading, and it seems far from all postmenopausal women need estrogen replacement as the body can make estrogen from fat...whereas progesterone levels will drop to practically 0 after menopause.

  • Have any of you had your hormones tested on the NHS? I asked my GP who refused point blank saying they never test after the menopause because they know they will be very low. I suggested getting them done privately and she said it was a waste of time.

  • I'm not in the UK. My hormone doctor is in Belgium and that is where I have my labs done as well.

  • I found this article very interesting:

    restartmed.com/shbg/

    In August, my SHBG levels came back out of range (136 nmol/L; ref 41-79) and, according to this article, the most likely reasons for that are estrogen dominance and/or taking too much thyroid hormone...strangely enough, my doctor never mentioned my elevated SHBG, and just renewed my prescription for estrogen...I have now stopped using it, and will see if it makes a difference.

  • Thank you Anna, most interesting article.

  • I have to admit I find it a bit strange - maybe even worrying - that my doctor, a so called hormone expert (trained by Hertoghe) neither mentioned my elevated SHBG levels nor the fact that my estradiol levels were out of range for someone in the luteal phase (I am always told to go to the lab on day 21 of cycle)...this coupled with the fact that I've read that a woman's estrogen levels won't drop significantly until after her last period, meaning most women still having periods are estrogen dominant and not deficient (I read that on the website of US doctor Christiane Northrup), I have decided not to go back on Estrogel, but to use progesterone only from day 15 to 25 of cycle...once I'm fully menopausal I'll see what happens to my estrogen levels but, for the time being, I don't think I need it. The fact is that, twice in the past six months, my estradiol levels have looked like I was in the ovulatory phase when I was in the luteal phase and estradiol levels should be much lower.

    I have started to ask myself...why pay 200€ for a consult with a "hormone expert" when you have to figure everything out yourself with the help of this great forum...?!

  • Ive been on premarin for 14yrs (surgical meno) and lve been fine started out on the patch but keeping that thing on my skin was terrible.

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