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Power Surge Forums > Board Discussions > Synthetic Hormones - HRT
patsy
I am having trouble getting dosage for biest and my NP put me on patches.  They were a disaster.  I am beginning to think I must just be one of those people who need A LOT of estrogen. Would others mind sharing how much biest or other HRT they are using so I can see if I am staying in line.  I know my NP would have a fit if she knew I was taking so many but every two hours the symptoms seem to return.
boni
Patsy..

You need to get a blood test, sometimes when you have too much estrogen you get symptoms  as if you have too little.  You can't compare to other women as we are all different with different life styles.

You have lots of options, there are so many patches, Climara , Combi, the Dot, premarin,  etc.  

As with the Bi est are you taking the capsuls, pills, sub lingual??  Do you have progrestrone with it, testostrone, there are so many combinations, do you take it 1 x daily, 2 ? 3? 4?  and it goes on and on.  

I suggest as I alwasy do, give Pete at Bellvue a call .  The man is the greatest in getting you to a place where you can be happy.  It takes time .  You don't get there over night.

As for my self I take Bi est 3.2 ,3-4 times a day  along with 125 mg of progestrone broken up in to 4 times daily as I can not tolerate it.  I take this sub lingual to get it into the body quickly.  SO I hope that this is helpful.

Kalanie
Hi Patsy...

I take 2.5 mg of Biest a day (gel capsule), but I agree with Boni that you cannot compare yourself with others and should have your hormone levels checked.  I also agree that Pete is the greatest when it comes to getting the hormone balance right.   smile.gif

patsy
Have had my hormone levels checked and they are very low and am working with Pete.  Was simply asking where others are out of curiousity because I don't seem to be getting enough estrogen and my NP is pushing to stop working with Pete because the process is VERY frustrating.  I just need some hope and information, knowing it may not apply in my situation.

I had a very bad experience with Climara, Vivelle and Esclim patches where I have panic attacks, legs go numb and a whole bunch of other odd symptoms. It is very strange because I do not have the numb legs and other odd things (although I do get anxiety if not enough estrogen) from the biest.  I  want to stick with the biest but must have some level of comfort that I am doing the right thing.  Right now (after seven months) it is a bit hard to know what to do, especially with the NP saying that seven months is enough and we should try more traditional. sad.gif

It seems that the estrogen races in and back out of my body in about two hours and I am just looking for some comfort that perhaps others share the same problem and have found a solution.  It may not be applicable in my situation but I have often found comfort in just knowing I am "normal" on this site and being nosy about the estrogen amounts others are taking may help me!  Certainly there must be someone who needs a lot of estrogen and falls outside the normal range and I am desparately searching for this person so I can continue to feel optimistic that we are on the right path.

I know too much/too little can often mimic each other.  However, what everyone seems intrigued by is the fact no matter how much estrogen I have taken my breasts never get sore.  Other compounding pharmacists have recommended decreasing because they think the amount may be too much but since I still have symptoms of not enough and none of too much I am simply confused.

What happens with me is that I take (2) 2.5 biests at 8 AM.  About an hour/two later I feel good for an hour and then it starts to wax and wane and within four hours I feel lousy and must take more.  It is not so much that I feel a craving but begin itching, develop the beginnings of a migraine and have anxiety.  It has also taken the eight biest a day to stop me from spotting.  

zjsurfer
Patsy,

That sounds like when I took Premarin when first going on estrogen.  It would wear off in a couple of hrs. and I would feel sick.  I tried Climera, but needed to change in less than the recommended 7 days.  I probably would have kept working with it; but my insurance wouldn't pay.  They wanted congegated estrogens (Premarin) so we compromised on Estrace.  I orginally took 2 mg and had to use Estrace cream too to help and it took a while (months) for the symptoms to subside.   I eventually got off the cream and later reduced the Estrace to 1 mg; which worked pretty well except for libido--about a month ago I added testosterone cream (from Pete) and that helped with the libido & dryness.  It also helped with something difficult to explain.  Ever since I really got into peri and then menopause, it was like a inner strength of sorts was missing.  I would stand for things knowing I should or had to--but it wasn't easy or natural like before.  Sometimes felt like I had a "backbone-lectomy" and was holding it together by shear will power.  With the testosterone, it is easier--"backbone" is back.  Some sort of strenght--man, this isn't explaining very well.....anyway, back to the estrogen.  One of my friends can't take it orally--it doesn't work for her.  She has to get injections for it to work.  I hope it is just a matter of time and dose levels for you--but, if oral doesn't work, there are other options.

Zelma

patsy
thanks for the encouragement!
moonshadow123
Hi Patsy - i have been curious about this too - as to how much people take.  I am currently taking 5 mg of tri-est (capsules) a day, but definitely feel it is not enough.  My dr. does not recommend going any higher.  It's only been 1 1/2 months so I am giving it a bit more time.  I am 40, and had a total hysterectomy when i was 24, so it's not like my body produces ANY hormones.  The tri-est also has 2 mg of testosterone, and I use the progesterone cream.  This natural way is new to me, and is a zillion times better than the patches I have been on, even WITH flashes still continuing.  No more headaches, no depression anymore, I feel like I have my life back (although sometimes I wonder if the depression is creeping back).  
patsy
I think tri-est has even less estradiol in it (10%) than biest (20%) so maybe you want to consider switching.  Just for your information, I did have another talk with Pete yesterday and he okayed taking the eight 2.5 MG of biest a day after I assured him that I do not smoke, am not (terribly) overweight and that I exercised.  That converts to 4 MG of estradiol everyday.  He did point out that 4-5 biest would be a more "safe" range but that he is treating symptoms.  Because we are curious about where all this estrogen is going I am going to do saliva tests now despite the fact I am really clueless as to where I am in my cycle!  Should be interesting to see what it shows!
Framboise
Am I right that you've tried patches and oral forms, but that's all?

Patches rely on both skin permiability and adhesion, and if either of these aren't right, patches can fail to work--which it sounds like you demonstrated.

Oral, if your body is really diligent at getting rid of what it defines as a rush of foreign material, can also fail in the way that you describe. It doesn't matter how much you put in if your liver takes it back out before the rest of your body can make use of it.

I have heard of other women who seem to have a very short life of their hrt in their body have success by switching to a slow-release formulation of some kind.

I found, initially, that my Estrace didn't seem to last as long as I thought it should. When I switched to a sublingual route for it, I dropped from a barely-adequate twice a day to doing just fine on a single daily dose. That made me wonder whether you had tried the sublingual or cream/gel transdermal route, all of which often provide a more sustained effect.

All of these transdermal routes are available with the compounded estrogen blends, and would certainly be something worth looking at if you haven't already.

The amount you are taking would seem to me to be of little importance if your body is not demonstrating that you are getting it to use. But this seems terribly inefficient to keep slamming these increasing quantities in and stressing, at the very least, your liver in disposing of them. Maybe you should listen to your body's hunger for the hormones and look for an effective way to satisfy it, since you don't seem to be there at the moment.

And one other thought. There are women who metabolize the bio-identical hormones so well that they don't get to use them, period. If you have tried all the routes and still found no success, it might be worthwhile considering a trial of a synthetic, just because you might need hormones you can't put into the normal metabolic pathways. Some women just do, and there's no way to know. I agree that the bioidentical are philosphically preferable, but on the other hand, I would physically prefer to have hormones that work than take the moral high ground and live in hormone-dep meltdown. There are synthetics other than premarin, if you dislike the idea of how that is produced, so there remains a range of choices. Even though they may be well down on your preference list, it may be necessary to give them a try when you have exhausted your patience working with bioidentical.

moonshadow123
Framboise,Thanks for the great reply - and to others who replied, too! I love when I have a question and get a reply that just makes so much sense; happens a lot here!  I guess if nothing else, I am becoming an expert on HRT.  I have about 6 pills left of my 2nd month on this - I am giving it til then and then either get a sub-lingual, or see if I can take a 3 mg in the morning and the same at night - not sure if that makes sense though since I would just have 3 mg's at a time?  My problem is not hot flashes all day, I think I have figured it out that they start when the pill actually wears off after 8 hours.  Will the sub-lingual help then?
Framboise
I think I have figured it out that they start when the pill actually wears off after 8 hours.  Will the sub-lingual help then?

It could, if rapid disposal via the oral route and "first pass" dumping is indeed your problem. If it's that you are metabolizing it too quickly in other ways, it may not. For me, it did make a difference.

Sublingual is a route that is gaining in popularity, and the compounders are getting more accustomed to working with different sublingual forms and how women respond to them. If you are just trying the route out, I would suggest that not investing in a bunch of mixed-hormone prescription would save you money: if you keep each hormone separate, you can adjust them independently. And I'm guessing that if a route change makes a difference for you, adjust is one of the things in your future.

Andy
Does anyone use Estrace brand sublingually or is it a specific estradiol for sublingual use?  Also, are there many women out there who have had a TAH/BSO who DON'T take progesterone?  I have tried Pro-gest and Prometrium and haven't had much luck with either.  I'm now using Estrace orally and testosterone thick get from Pete H.  Thanks.
zjsurfer
That's just what I am using, Andy!  How are you doing?

Zelma

Framboise
Does anyone use Estrace brand sublingually or is it a specific estradiol for sublingual use?

Estrace brand works sublingually because it is "micronized"--which simply means it is in particles small enough to be absorbed through your skin. I don't know if the generic estradiol that is substituted for Estrace works this way, but I do know that it uses different binders, so I would be leery of trying to use it this way without explicit assurance from a pharmacist that it shares both the solubility and the micronized size of the Estrace.

You can also, of course, get all of the estrogens specially made up in forms appropriate for sublingual use. The other commercial brand estrogens (in the form of pills meant to be swallowed) are not micronized and do not work this way.

I have been using the Estrace sublingually for several years now, and the only reason I envision having to change for will be when I need to lower my dose over time and it is not something the tablet divides into handily and accurately.

Also, are there many women out there who have had a TAH/BSO who DON'T take progesterone?

Sure--some women have adrenal glands capable of making enough on their own, and trying to supplement only leads to symptoms of excess. If you feel that you are balanced on your estrogen alone, it's possible that you are one of them.

The major thing  in deciding that you don't need progesterone is to be sure that what you experience as "no luck" is not a result of either the inappropriate dose or is a route-related effect, and that you have taken at least several weeks to accommodate to the progesterone before reaching your decision.

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