January 2011

Q. I have a question about Estradiol blood levels. I am on Vivelle 0.1mg patch the highest dose but my blood work has constantly came back with an estradiol level of around 50pg/ml. I have read that you need at least 100pg/ml. Do you think 50pg/ml is to low for effective HRT and should I ask my Dr about increasing my dosage of Estradiol.

A. The dose of Vivelle is actually on the high side for most women (0.05 or less is more typical). I presume you are younger? just had surgery? Most postmenopausal women don't require that much. In addition, we don't usually rely on estradiol levels to manage the dose - but we do rely on how you feel, sleep, hot flashes, dry vaginal symptoms? You didn't mention progesterone so I am assuming that you may have had a hysterectomy. Women who have their ovaries removed and are younger often require a bit higher estrogen dose.

Q. I ran across your site while searching menopause sites, which I do way too often these days. I am 48 years old and experiencing perimenopause for 8 years, the last two pretty significantly with the last 6 months extremely difficult with depression,anxiety,mood swings,night sweats. I was on Activella for 18 months and went off cold turkey 7 weeks ago. During that time I went 5 months on two separate occasions without a period. Six weeks ago I began bioidentical Biest cream .5 mg once a day, and Progesterone 4%, 20 mg twice a day. I have had two regular, normal periods since then. My prescriber has advised me to cycle the progesterone days 14-25 while continuously taking the biest. I'm just concerned about having a period forever doing it this way? Will my periods eventually stop while I am cycling the hormones? I do not want a period every month, but want to get through menopause finally. I am having trouble getting a clear answer on how to relieve my symptoms without having monthly periods. Help! Thank you.

A. As you may have read in my writings, I am committed to women using both transdermal estrogen (cream, patch, or gel) as you are doing and using cyclic natural progesterone. Although taking progesterone every day will minimize the chances that you will have any bleeding because it thins the lining of the uterus so much, there is some concern that taking progesterone continuously (that is, every day) could be more harmful to the breast. So although we don't have enough research to know for certain, I agree with your practitioner who suggests you take progesterone for 10 days each month. I have found that for most women their monthly "withdrawal" bleeding will be minimal and often disappear altogether. It really depends on how much estrogen your uterus is getting - the more estrogen - the greater the uterine buildup and therefore the more you may bleed.

Taking estrogen is a balancing act for each woman - the right regimen you need to find that makes the most sense for your body.