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    Types of HRT Therapy
    katsmed posted:
    I am a 64 yr. old woman. When I was 47 I had a complete hysterectomy — by that I mean my ovaries/uterus were removed. The cause was extensive endometriosis. I had been on birth control long term prior to that. Immediately after surgery I was put on a pill form of hormone replacement then used a patch for several years with the dosage decreasing. I started to feel symptoms of fatigue, irritability, weight gain…general symptoms of menopause. I then started reading about types of hormone replacement. I started out with a cream that seemed to do the trick for some time and then felt it stopped working as it did previously. Instead of having it adjusted accordingly, I decided to try the "pellet" which was promoted by my OBGYN as the "latest and greatest." Aside from the cost (expensive) I immediately experienced problems — weight gain, excessive hair growth, irritability…had hormone tests done and found the testosterone was excessively high but what could I do? I had a pellet inserted inside of me and had to wait until it dissolved. My OBGYN Dr. said it was common to "overdo" the meds the first time but will have it right the 2nd time…after 2nd insertion found excessive levels…
    Went back to a low dose patch (Miniville) where I experienced fatigue, leg cramps, weight gain…Compounding pharmacist I know highly recommended the troches or lozenges. He said it was the "latest and greatest" method of hormone replacement. Simply place a troche between gum line and inner cheek and it instantly dissolves and comes in so many yummy flavors. In actuality, they tasted nasty, even with the flavors added. You had to keep refrigerated and take one twice a day. It took anywhere between 10 — 30 minutes for the troche to dissolve. I felt half of the medication was lost with saliva that went into my stomach, which caused upset. I stopped using them after three days, to the protests of my compounding Pharmacist. For the first time ever, I developed an abscess in the inner cheek area which I reported to him this morning, which he said had to have been caused by something else…I am back using the cream and so far, so good. I know the cream is the best for me and hope my previous experiences help to make some aware of what to expect…bottom line, do research...keep fighting to feel well!!

    Mary Jane Minkin, MD responded:
    Dear Katsmed,
    And there are several types of prescription bioidentical gels: Divigel, Elestrin, Estrogel, and more-that come in different concentrations-so lots of availability,
    Good luck,
    Mary Jane
    katsmed replied to Mary Jane Minkin, MD's response:
    Thank you for your response!
    Currently, I am applying a cream that has Bi-est/prog & test. I have been feeling better than I have in a long time and would highly recommend to those who are losing their quality of life due to menopause symptoms. Can the gel be a combination of hormones or just one?

    Thanks again
    Mary Jane Minkin, MD replied to katsmed's response:
    Dear katsmed,
    In general, I don't encourage estrogen creams from a compounding pharmacy (see the article in this month's More magazine about labs measuring levels of hormones in these compounds). There is no need for any estrogen cream other than estradiol,(your body actually converts one estrogen into another, without a problem) and dosages can be adjusted to amounts you would need. As far as the progesterone component, I would rely on your gynecologist who did the surgery many years ago. In general, we usually don't prescribe progesterone for most women with a history of endometriosis this many years after the surgery; most women do fine without it. Now the secret ingredient here for you may be the testoserone cream, and indeed I do prescribe testosterone creams from compounding pharmacies; unfortunately,, the FDA has not approved a commercial brand for women; so we need to obtain them from compounding pharmacies. So I would suggest to you a commercially available estrogen cream, and some testosterone from a compounding pharmacy. Hope you continue to do well,
    Good luck,
    Mary Jane
    katsmed replied to Mary Jane Minkin, MD's response:
    Hello Dr. Minkin,
    Thank you for informing me of the article in More magazine. It was quite interesting, much of which I have been previously told/experienced and as previously stated, I have tried many different methods to control menopausal symptoms. Since I no longer have ovaries/uterus or family history of breast cancer, the progesterone should not be an issue re endometriosis? As previously stated, I did use the patch for many years until it stopped working. I should have asked for an increased dosage but started on a long search for relief of symptoms using different methods (listed previously) Of all the replacement hormones I I have taken, testosterone was the one I had the most difficulty regulating. I was dismayed to read another magazine article stating the only real natural way to replace hormones was with the pellets but my testosterone level was extremely high after both pellet insertion tries and made my life miserable.
    I agree with your estrogen statement and will talk to my Dr. regarding that. My cream is compounded based upon tests done in a lab. I really do feel great at this point and wish every woman finds relief from her symptoms.
    Best regards,
    Anon_6061 replied to katsmed's response:
    I'm curious where you saw the article touting pellets as the "only real natural way to replace hormones." Was it an article or an ad (possibly disguised as an article)? I suspect it was written by someone who is in the pellet business (someone affiliated with a compounding pharmacy or a medical practice that provides pellet therapy). I don't think any studies have been done to prove that pellet therapy is more effective than other methods. The source of information can tell us a lot about its credibility.

    Another thing to consider is that HRT is very individual. So what works great for one woman may be awful for another (as you discovered with the testosterone pellets).

    Glad to hear the cream is working for you.
    katsmed replied to Anon_6061's response:
    Anon_6061, Yes, you are right! The article is in our local paper under "Ask The Health And Beauty Experts," and the article was written by a Dr. affiliated with a Medical Spa and Wellness Center! Upon close inspection, at the top of these "expert opinions," is the word "Advertisement."
    Seems there are many snake oil salesmen with an "MD" behind their names using hormone replacement as a "come on." One must be very careful and go by how one feels. After I told the compounding pharmacist I could not stand to take another lozenge after using them for 3 days, he became contentious and told me I had not given the lozenges enough chance! Hormone replacement can be very difficult but it is worth it to have energy, sleep, maintain a healthy weight and just generally feel well again!
    Thank you for your input

    Anon_6061 replied to katsmed's response:
    Yes, HRT is big business especially with so many women having hysterectomies. This isn't to say that pellets shouldn't be an option but I urge women to at least try a number of the commercially available HRT's before going to the expense (and surgical procedure) of pellets.

    I only wish I'd known the horrible effects of hysterectomy. It makes me sad to think that I probably would have had an uneventful menopause like my sisters. Now I'll probably have to be on HRT for the rest of my life - another reason not to go the pellet route! But long-term HRT beats the alternative of the hell I was in from an inadequate HRT after my surgery. NEVER want to go back there!
    katsmed replied to Anon_6061's response:
    Even if one does go through uneventful menopause your natural hormones are being depleted and to me, logically speaking, you will lose the ability to look/feel your best so, taking hormones the rest of my life is a benefit women before us were unable to have. The Dr. who inserted my pellets was an OBGYN Dr., highly qualified (Harvard) in his field but feel even the best OBGYN Dr. needs additional training for hormone replacement and it seems that now internist's as well as OBGYN Dr.'s fancy themselves hormone replacement experts. I too, feel so bad for those women suffering because their Dr. was unable/unwilling to help them. That is why I became a Dr. Dumper"026move on to another until you find the right one.
    Best to you! Stay as well as you can :!

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