Hello -

I started BHRT about a year ago with a triest cream 2.5 E/100P applied 1 x day with NO results after a month. Prescription was upped to 2E/50P 2 x day and again No results after a month (still having severe hot flashes, etc all day and night). Doc changed it to oral 2 E/ 50 P 2 x day and after 2 weeks I felt great and have continued with that dose without a problem.

I am wondering if this dose is considered high? I'm obviously concerned with taking a lot of estrogen, but at the same time I don't think I can decrease it without having symptoms return. I am also concerned with many people advocating cream/gel transdermal methods (which I really wanted to work) and having to resort to an oral delivery.

Any thoughts by others would be greatly appreciated. Thanks!

Hi DME,

I think you have not gotten an answer because it is unclear what your dose is. Can you write down everything on the tube/bottle as far as dosing goes and exactly how much and how often you are taking the triest.

Triest would have three different estrogen numbers (E1, E2, E3); triest is made with different amounts of the three different estrogens depending on how your doctor wrote the order. It looks like you may have some progesterone added in as well.

Is your oral triest or is it just a single estrogen like estradiol?

Kathy

Hi Kathy,

Thanks for your reply and I guess I can see the confusion, as you stated. I am taking oral triest 2 mg twice a day (10% estrone, 10% estradiol, 80% estriol). The capsule also has 50 mg progesterone mixed in. The total intake is 4 mg of the 3 estrogens and 100 mg progesterone. I'm just worried that the 4mg seems a lot compared to what many women take and am hoping some of the women taking tri-est, or the ones who know about it, can shed some light on this. I'm happy with the results, just concerned I had NO results with a lower dose or with the dermal cream.

Thanks for any insight - it's appreciated. DME

DME,

From what I have learned, the most important and helpful estrogen in your triest is the estradiol (the other estrogens probably are not providing much relief). You are taking 2 mg of 10% estradiol or 2 X 0.1 = 0.2 mg of estradiol twice a day. If you are in peri 0.2 mg of estradiol twice a day may or may not be enough, but if you are in menopause it is probably way too low. Your topical dose was probably just too low for you. Did you ever try doubling (or tripling) the dose to see if it helped? Sometimes my dose changes dramatically depending on what day of the month it is. I have read that women absorb topicals differently, you may just not absorb quite as much through the skin as others do so you would need a slightly higher dose. Also, it is possible that the formulation or base cream could have been changed for better absorption. You probably would have had better luck with plain estradiol gel/cream/oil rather than a mix of the three estrogens. I found that when I took biest it seemed like the estriol was competing with the estradiol and I still had my low estrogen symptoms. Dr. Vliet in her books recommends using estradiol rather than triest or biest. Biest was horrible for me but triest seemed to work OK. I am using plain estradiol in olive oil with good results now. The nice thing about the estradiol in olive oil is that you can use it topically, sublingually, or orally. I buy mine from the Women's International Pharmacy and it is very inexpensive even when you add in the priority mail shipping.

I do not want to try oral estrogen because I have read that because of the sex binding globulin that orals produce, you testosterone level can be reduced. I want all of my testosterone! I have such a low testosterone level that I supplement with a small topical dose every day and it has been very helpful.

Kathy

DME,

I forgot to mention in my last post... When I switched from triest to plain estradiol, my estradiol dose remained the same. What I did was figure out milligrams of estradiol that I was taking with my triest dose and then take that amount of estradiol for my plain estradiol dose. I found out that the extra estrogens were doing nothing for me; the only thing that was helping was the estradiol component of my triest. I hope I am explaining this so that it is clear.

Kathy

Thanks Kathy. I wonder why I was prescribed Tri-Est if the main estrogen is estriol and it is less important than esttradiol. I may ask my doctor when I see her in February, but am not hopeful as she doesn't seem very informed (I live in Connecticut and finding a doctor who is up on BHRT is extremely difficult). I didn't try increasing my cream dose beyond what I am now taking orally as that seemed (to me and my doctor) fairly high and she wanted me as low as possible. I think that's why she tried oral.

I wonder why some women have a prescription for bi-est, some for tri-est and some with just plain estradiol. If it is based solely on symptoms, I pretty much had them all (!!!!) that's why I thought she gave me the triple-whammy!

Thank you again for your response.

DME

Hi DME,

I think the reason why doctors use different estrogens is that they are just guessing about what to do! They are worried that too much estrogen can cause cancer and want to protect themselves from liability. They seem more concerned about the liability thing than making sure that their patients feel good. They do not seem to have a clue that if a woman takes too much estrogen she will get excess signs and symptoms and if the doctor and/or patient are paying attention, the dose can be easily lowered to an acceptable level. Estrogen is not like other drugs that doctors prescribe; there is not that one size fits all dose that doctors are used to. Women (especially in peri) make their own estrogen in varying amounts throughout the month and just need to supplement with the amount that they are lacking to make them feel good. It is not easy to get it right in peri because one day our estrogen is really low and the next day it is high.

If your doctor thought that your triest cream dose was high I think she was just misinformed. It sounds like she does not know what to do and guesses, but I think that many doctors do that. You need to take the dose that makes you feel well without taking so much that you get excess symptoms. I just don't get these doctors who want to keep everyone's dose so low that we feel lousy. I think the best thing to do is experiment with dosing and figure out what feels best for us and then tell the doctor that is what we need to take. We will not take too much (for very long) because our breasts will become sore and we will get bloated. I think Dr. Reiss has it right in his book about listing to our bodies and changing our dose accordingly. Do you have the Natural Hormone Balance book by Dr. Reiss? It is really worth the time and cost to read it. He will make you feel comfortable about tweaking your estrogen dose. Dr. Reiss uses triest by the way. Another good author to read is Dr. Vliet; she likes plain estradiol better but tends to like patches. I do not think patches are good for peri (me) because our estrogen fluctuates so dramatically during the month.

I do not think the choice of triest, biest, or estradiol is based on symptoms; I think it is based on a doctor's personal biases. My doctor said that biest is better than triest. I had been taking triest topical with good results for several months and we switched to the "better" biest and it was horrible. My triest was good but it wore off too soon; I had to use several applications/day. Even though I think I have one of the better doctors he really did not want to listen to my observations about how triest was working better than biest (he is set in his ways and only wants to hear what he agrees with). I was able to convince him to switch me to estradiol though so I was happy about that. From everything that I have read we do not need to take the other two estrogens because our bodies can make them from estradiol if necessary. The other two estrogens (estriol and estrone) have too much controversy surrounding them that I feel more comfortable with just estradiol. (Promotes or does not promote this and that kind of cancer, causes breast tenderness.....). Estrone is the "fat" estrogen, made from our fat; and estriol is the pregnancy estrogen, made in high amounts during pregnancy. I felt horrible when I was pregnant, I could not sleep and my breasts were sore, I decided that the last thing I needed was to take extra estrogen that mimicked my pregnancy state because when I took the biest I could not sleep and my breasts were sore just like when I was pregnant!!!

Kathy

I don't think taking progesterone every day is a good thing at all. That is not how nature intended it. Women produce progesterone in the latter half of the month, next to nothing in the first half. Maybe that's why you don't feel very well?

Thanks for the info, Kathy. My doctor is pretty set in her ways as well, and tri-est is her mode of choice. My search for another doctor continues as I don't think she'll budge on this, but I'll talk to her anyway. The tri-est is working, I was just concerned at the "high" dose, which it seems is not high, and the mode of delivery.

I am in menopause, so there are no fluctuating hormones, I'm pretty much sputtering at this point (at best), so I believe I need the progesterone every day as well (there is so much controversy over to cycle or not when you're not having periods anymore, but I opted for the latter).

I have the book by Vilet, but not by Reiss, so I'll definitely get that as it may pertain to me a little more at this point. I appreciate your knowledge and guidance with me, and with many others on this board.

Thanks again, DME

Hi DME,

When you go to your MD you should bring your new hormone book by Dr. Reiss. On page 54 Dr. Reiss talks about the strength of the basic triest gel that he prescribes--0.25 mg Estrone, 0.75 mg estradiol, and 2.5 mg estriol per gram of gel. Maybe you can convince her with the help of the book that she gave you a very weak triest, since Dr. Reiss adds 0.75mg of estradiol to each gram. I believe 10% estradiol per gram would be only 0.1 mg/gram. I know that the ratio you indicated above was for the pills but I am assuming that she gave you the same ratio with the topical.

Kathy

almost 4 years ago I started with tri-est; troche, 2.5mg(80-10-10), 1mg testosterone, 200mg progesterone.
It hit me like a freight train. I feel i was so depleted my system went nuts. Had hair loss. From the testosterone, I feel.
I cut the dosage in half. Things were better.
I was totally ignorant about bhrt, did research and after a few months started on 1mg estradiol and 100 progesterone. After a short time decreased the estradiol to .5mg, 1mg was too much.
Six months ago I started getting dry and cold(thyroid is 1.67).
I then was confused because my doc was prescribing tri-est with prog. to my friends. I did more research on triest. Read Dr. Reiss's book and started his combo. It was too much.
Dr. Jonathon Wright now suggests 3.5mg tri-est(90%, 7%, 3%). So had a talk with my doc. Started the 90-7-3 triest (troche) plus 100mg progesterone(capsule). In the past I had trouble tolerating progesterone.
3.5mg is too much( breast pain). Now I take half and may need less.
A happy benefit- depression and anxiety have diminished. I was elated. I even have more of my confidence back.
This is the best I have felt for years. Remember, we are all different.
I take the progesterone at night and triest in the morning.
deb

should clarify something.
90% estriol
7% estradiol
3% estrone

HI DME

I'm taking 1/5 oral tri-est 2s per day and 100 mg progesterone, orally 1x per day. I'm just getting started on this and had to go from 1x per day of tri-est because my symptoms would return in the evening. I had to take another dose at about 5;00 p.m. to carry me through the evening. I take the estrogen and progesterone at night then another dose of tri-est in the a.m.

Hope this helps

Mary

I am trying to find out in what form you ladies take your bio-identicals. I take mine in capsule form.I get mine through my Dr. who was a compounding pharmacist for 15 years then went back to med school and became a dr. She does not prescribe cream so it is either in capsule form of troches. Also I dont think she ever puts testosterone in it and I always thought that was to help with low sex drive. This whole ordeal is really frustrating!