Good morning, my P-S ladies,

My dear neighbor came over yesterday and was a meno-mess! She has been having weird meno symptoms.
Recently she was rushed to the hospital with heart paps. She thought she was having a heart attack.

...and then a few days ago she couldn't breathe (panic attack),
had tingling & numb feeling up and down her body (hot flash)
and went to the emergency room again . They could not find anything wrong.
~~~ They knew she had had a hyster. and not on hormones.


....THEY tested her for Bird Flu (LOL!) and gave her an anti-biotic, which she did not need or want. Basically, they gave her a Sugar Pill to get rid of her.


She had a hyster. 2 years ago and was put on premarin.
She stayed on for a short while and stopped it.



She is having many meno symptoms due to lack of hormones.

She called her doc, who is not versed on BHRT, but was willing to call in a script. Her doc was so nice and told me thank you so much. I am going to send her a lot of information. (She probably needs bios, too! LOL!)



Because it was the least expensive, I suggested estrace (sp?) or another bio E, ...and progest. (I know....many don't think that a woman who has had a hyster. needs this one, but research seems to point otherwise) and testosterone.

Estrace can be bought for $4.00 for a 30 day supply at Walmarts. Since she is on a limited budget, it seemed most economical.

...and by taking the Estrogen separately, she would be able to adjust her dose. Due to budget constraints, she needs to take the Progest & Test. compounded together at this time.




I had her doc call the compounding pharmacy.

After her doc talked with the pharmacy, she gave a script for .625 Estrogen, 100mg progesterone, and 1mg of testosterone...in sublingual form.



The Progesterone seems OK and testosterone seems low, but a good place to start....

Her E seems very low for that amount of Progest.

According to dosing guidelines for Hyster women, it looks like her Estrogen should be higher than .625....?????? But I am not sure about the sublingual coverstion? ~My doc uses 5mg of Biest when using is sublingually.


I am also concerned that the sublingual tabs will cause her to peak and then drop out of her system too quickly.
Has anyone tried them and had good sucess?



THERE is Still Time for her to Change her Script.

I wonder why that Pharmacy wanted to do sublinguals and compounded all together? Just to confuse us Power-Surge Sisters?????



She needs to have a good experience with the bios. She is in real trouble right now. HELP!


I know next to nothing about sublingal tables.

Please HELP her out, Ladies....
What do you think?
Shebee

Sublingual BHRT is the worst thing ever, they don't dissolve completely and part end up as oral meds. They peak too fast and then drop even faster, leaving you on worse hormonal roller coster than before.
The 0.625 estrogen is it estradiol or bip-est? if so, it is toooo low for 100 mg progesterone sublingual, which had really horrible side effect, well, at least, on me.
If it is pure estradiol, 0.625 seems to be ok. Mine was 1.25 Bi-Est, estriol/estradiol 80/20 ratio, with 0.25 mg estradiol only, and 1 mg estriol. I was Rx twice a day, with 1 mg testosterone once a day, and 100 mg progesterone twice a day!
Long story short, very bad experience!!!!

Having said this, I would imagine your friend needs to make sure she had hot flashes and anxiety, and not a a serious heart related issues, as the symptoms can overlap.

I am not sure who she managed menopause when she stopped Premarin, but if she did and did not have many symptoms for 2 years, assuming her chest pain and tingling, etc. was just due to lack of Estrogen, is dangerous.

She needs to have a comprehensive evaluation, if she did not have it before. Some women, after they have been without hormones post hysterectomy for some time, simply can't tolerate estrogen when they start using it again.

It is not the same as giving BHRT to a women that either just had procedure or still has her ovaries and cycling, but just needs a little of boost, her body most likely lost majority of the estrogen receptors, so giving her high dose of estrogen would be quite a shock.
If you friend is sure her symptoms are due to lack of hormones, this is what I would do. I believe your friend would be much better on Estrace and Progest ( not sure why she needs P), but I would start her with just estrogen and at a lowest available dose, and see how she will feel.
If her symptoms improve, then she can introduce Progesterone cream, again, at a very low dose, if she gets too anxious from estrogen alone.

Pharmacies love sublinguals for few reasons: they are "better" than "bad" oral pills, associated with Premarin and also, oral route is sort of out of style now, it has been proved to be the most liver burdening and linked to blood clots.
Also, subs they compound with estriol for the most parts, that make compounded hormones "unique" and "safe" compare to commercial products widely available and cheaper.
I believe there is Vivell dot patch that starts at very low dose, estrace can be used, estradiol gel, etc. Why she needs compounds if she is on a budget, normally separate compounded subs come at around $50 a month for each: E, P, and T. It will cost her about $150 a months, if she can afford it.
Sorry, I could not be more helpful, I suggest you read through the posts, I recall many posts with good information on subs.
Best,
I.

Are you kidding? Your information was very helpful. Here is a big thank you from me!
Shebee

I agree with Ira. Good advice Since she is on a limited budget and no uterus then maybe she can start on the estradiol tablets from Walmart (they are not compouded but are still bios). But, I thought they only come in the .1 dosage? Perhaps she could take 1/2 tab per day and see how she feels (especially since being without hrt for past 2 years.) Once an oral dose is established she could see if she has "peaks and valleys" of symptoms during the day. If so, then she could split her oral dose (part am and pm). I'd definitely wait for the P and T. I tend to adhere to the school of thought to only add or subtract one thing at a time. That way its easier to figure out what is causing any benefits or detriments. Hope she feels better soon and it's good she could turn to you. Regards, JZZ

btw - how did she do on the Premarin? Did she feel well all day? Maybe oral is an ok route of delivery for her. And, if she did well on the Premarin, but now wants bio's, why not just go back on Premarin for a short term relief?

Thanks for your post. She was only on Premarin for about 4-5 months. She did not do well on it at all, so she just quit. (She is in her late 30's) She does have one ovary. She has been off of premarin for at least 2 years and having terrible symptoms. NO wonder! For the last 2 years she has been running to the doctor or sometimes emergency room. They run test, but can not find anything wrong with her. The symptoms have been very real. Poor baby...eh?

Shebee

Ok...everything is better. For now, her doc is giving her bi-est cream...progest. in cream....and testosterone in cream...not sublingual. After she finished up this month, if she wants, her doc will switch her to estrace. (sp?)

Thanks so much...you gave enough information to be able to get her started on the right path. I bet she will start to feel better before the week is out!

Shebee