(sorry this is so long for a first post!!)

Hi, I'm glad I found this site. Okay, a little of my history. I am 45, still having periods regularly every 27 days, but for the past few years, they have only been one day long and very scanty. I have been undergoing intensive infertility treatments since age 39, with no luck, only a bunch of miscarriages and a few frozen embryos left over.

Anyway, because we have some frozen embryos from an IVF cycle years ago, we are going to use them up and then call it a day if they don't work. A couple of months ago I did a preparation for a frozen embryo transfer and my IVF doctor put me on 6mg of estradiol a day, plus 800 mg of prometrium! Oh my, even I know that's a lot of hormones. I felt "okay" that month, but when the pregnancy test came back negative, the doctor told me to stop all my hormones, so I did. Well!!! What followed was HELL. I completely crashed, crying all the time and feeling sad and anxious. I just assumed this was a normal emotional reaction to a failed cycle. I waited out that month, thinking that THIS month, my hormones would reset and I would go back to my normal, low-but-adequate-enough hormone state. This is the second month since my high hormone cycle, and I still have horrible symptoms: hot flashes, high anxiety, depression and crying jags, insomnia, urgent/frequent urination, etc. I went in for bloodwork and my estrogen was so low the lab couldn't measure it (my lab doesn't measure anything below 50), and my testosterone was zero!

What followed next was 10 straight days of nonstop crying, at which point I got very frightened and went to my family doc, who put me on antidepressants. After a week of that, which did stop the crying jag, I was able to think clearly enough to put it all together and figure out that I need hormone replacement, not an antidepressant (which I tapered off and stopped). I lived on Ativan for two weeks. For some reason, that high hormone cycle fried my ovaries and I have not had hormone production for two months. Perhaps it pushed me into full blown menopause -- I don't know. My family doctor and my reproductive endocrinologist are totally CLUELESS and are offering me standard HRT until I'm ready for another frozen embryo transfer and then I can repeat that high hormone cycle (um, no thanks.) I ended up taking some estrogen just as an emergency to control my emotions until I can find a longterm solution. When I take it, I FEEL NORMAL! When I don't take it, I start crying and can't stop. It freaks my poor husband out, though he is starting to understand this hormone thing.

I finally found a BHRT doctor and I am going to see him next week. I spoke to him over the phone and he said he is not surprised to hear my story and that I need steady, individualized hormone replacement for several months and that I can even do a frozen embryo transfer on a regular BHRT month because it will simulate a natural cycle, that I don't need these super high doses of hormones for an embryo to implant. My reproductive endocrinologist conceded that if I can get "normalized" cycle wise, then we can do an embryo transfer without all those heavy duty hormones (it would have been nice if he had thought of that on his own). I am encouraged but I am wondering what I should ask my BHRT doctor and what I should expect. The important thing for me is that I just want to get on a regimen and go with it, and not have to interrupt it to do any more high hormone fertility treatments. I just want slow and steady from here on out.

I need estrogen, progesterone, and testosterone for sure (I have NO libido). What other hormones are usually replaced with BHRT? At what points in the cycle do they draw blood and what are they testing? How long does it take for the doctor to figure out the dose for your compounded hormones? I am so eager to get started. I have had enough anxiety and crying for a lifetime.

I know I'm a little bit unusual here since I'm dealing simultaneously with menopause and fertility treatments, but I hope what I've written makes sense.

Bitter, I have no idea how to advise you. Just wanted to wish you luck. You must be one tough cookie to go through all this and still have the moxie to continue. I hope all goes well for you. Maybe somebody here at PS will be able to offer some good advice. Take care.

Hi and welcome to ps,

I'm sorry to read your story, I too had fertility treatment many years ago and also had IVF.
I'm younger than you and going through peri but I'm not trying for a child (I beleave all the fertility drugs have caused me to go through this early). I do beleave that the AD will help you as it does help with all the symptoms your having and will help you cope with the high dosage drugs that you will need for your egg transfer, But having said that the choice is yours and only yours...
I do wish you all the best and hope the egg transfer works,
Good luck and please let us know how your doing.

Hugs
Honeylicks

Hello Bitter,

Welcome!! I have never had fertility treatments so I cannot comment on that, but I'm sure it has been a stressful time for you and your husband, not to mention the hormone crash that you have experienced.

Taking BHRT is not an exact science. I have been on the bio's for over 2 years. I have read a lot of books and talked to many women who are using them. I guess for some it's easy, but for most of us it can be trial and error for the "right" dosage. Blood tests can help, but sometimes even these tests can not explain what is going on.

Bioidentical estrogen is called beta-17 estrodiol. It comes in several forms, pill, patch and gel's to name a few that I know of. Bioidentical progesterone can be prometrium, which is a pill. I think they also make compounded cream forms (but I have not had this). Testosterone need's to be done VERY carefully. The cream should be compounded (for a women) at about .2 (this is NOT 2%) it is .2%.

The range for what makes a women feel normal is often not the same for each. A good starting point would be (this is just my guess) 1mg per day. Some women take more and others take less. I am taking 1.5mg per day and feel it helps me at this level.

The progesterone is also tricky. Prometrium only comes in 100mg. Compounded creams are done to more specifications.

Testosterone is a great hormone, but you need to use caution!!! If you use to much, you can become aggressive and gain weight. I've read that the average amount for women is about 1-2 mg per day.

Some women use bio's and they cycle them. The aim of this is to produce a bleed each month. This can work, and sometimes does not work if the estrogen you are taking is not enough. It's very complicated, I don't fully understand exactly.

When things go like clock work, you are taking estrogen daily (every day) and then begin the progesterone at the last 10-14 days of the month. Upon ending the progesterone you should start a period within the next day or two. That's how it's suppose to work if you cycle them.

Otherwise, some women take both estrogen and progesterone together daily, it is called the continous method. My understanding of this method, is that it would probably not produce a period.

I hope this helps, I am not an expert but perhaps it give's you some idea of how these hormones are suppose to work.

Best wishes, Juliann

Thanks ChocolateWoman99 and Honeylicks for the support. By the way Honeylicks, I am not on AD and I am not planning to do any more high hormone treatments. My BHRT doctor said I shouldn't need to do that to prepare for an embryo transfer. I just wish I had found him years ago!

Julianna, thanks so much for all the information. I had read somewhere that some protocols involve gradually increasing estradiol doses as the menstrual cycle progresses, and then decreasing it in the luteal phase, to mimic a natural cycle. If the doses are the same every day of the month, then that is not really different from what I have done on my infertility treatment cycles -- I take estradiol daily and then add prometrium in the luteal phase. I guess the difference is that I would only do that on certain months, whereas with BHRT, it will be a steady monthly routine.

What an ordeal!!