Three ways to know that your hormone replacement therapy is working
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- Опубліковано 4 сер 2024
- Three ways to know that your hormone replacement therapy is working // Have you started hormone replacement therapy for menopause or perimenopause, only to feel like it is not working? In this video, I break down the three rules I have for my patients to ensure that we have found the right doses, route, and formulation of menopausal hormone replacement therapy.
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• Three ways to know tha...
What did you find most helpful about this video? Let me know below!
That it’s ok to change dosages. I was on 50mcg patch. I was feeling worse and ready to give up, but I won’t give up. Now I’m on 25mcg (Dotti patch) and I’m feeling so much better. I have your book and I’m going to do the 12(?) days of progesterone at 100mg. I have it in my calendar.
For anyone that has the itchy skin, my derm friend Dr. Dustin Portella, told me to use Sarna. I got it on Amazon and it is a life saver 🛟
Thank you. Everything in this video is helpful. I'm in peri and have been on HRT and have been having tons of bleeding and went anemic. I use midi, but I can't see my midi person as much as I want.
There is so much info on the internet and I'm feeling so overwhelmed! I truly wish my mother was apart of my life so I could have someone to turn to. I'm 36. Finally diagnosed with PCOS when I was 33. Last year have been experiencing night sweats, brain fog and low libido. Went to. Wellness clinc because pcp wasn't interested in hear me. I've been on HRT(the pellet) since July. I feel awful. I don't know what to do. I'll keep watching your videos in hopes I'll keep learning.
This was great video
I really have been with 8 months since my biopsy ruling out my bleed
Started HRT but then got off it in Jan
I don’t know I get extreme dizziness
Is that normal ?
The progesterone is at 2.5 I’m usually taking it late at night
I was shocked when I had to change doctors recently that HRT is viewed so negatively! I feel like I'm in a battle with him to continue my therapy. I would like to be confidant when speaking with him about why I know this is right for me. Thank you for helping build that confidence.
Feels like you are talking straight to me - thank you for answering these important questions that help me feel more confident in my menopause management
Love the information! I want to tell you I am on compounded form of HRT, orally. I am also on GLP (ozempic). I noticed right away with break through bleeding (Still have my uterus). It came down to the absorption as the GI tract empties slower. My Dr dispelled my concerns. I’m willing to continue both meds as I’m feeling wonderful
I have seen Dr Hirsch twice, she's wonderful
Thank you so much! You are the only Dr. I have found that doesn’t cause fear and anxiety regarding HRT. I turn to you to feel confident and empowered and that is a gift. So thank you again. The doctors I have seen (many) are very uninformed. Sad for so many women suffering.
Thank you! I hope you’ll be able to do telemedicine in Arizona, I’d love to switch my care to you 😊
Thank you so much for the specialized information! I'm wondering if you could talk about or refer me to a video talking about perimenopause: post-menopause HRT treatment. Also, any advice on how to ask for this from a doctor prescribing OCP. Gratitude!
Yes ! I feel like telling women I am on HRT now was like telling others I was going to give my baby some formula back in the day . 😐 They are shocked and appalled 🤷♀️ Meanwhile I’m feeling pretty good . Just have to figure out the dryness situation then all will be great .
Premarin way to go😊
I use estrogen cream on vulva and just inside vagina. Works really well.
A lot of women don't need vaginal estrogen in addition to taking it systematically. I'm in perimenopause, I take systemic HRT, but I also use vaginal estrogen three times a week. It makes a big difference.
Hi Dr Hirsch. Any chance you might one day extend your online practice to Louisiana? I don't have confidence in my HRT. I was happy on elestrin gel but then it was discontinued. The other estrogen gels didn't seem to work as well for me so now I'm on Evamist but I don't love it. My doctor also added Premarin but I didn't know it came from horses and that there is a bioidentical estradiol available. I'm 57 and my doctor's office still holds with that "least amount possible" adage. I really love my doctor but her nurse is quick to tell me I should be tapering down and I feel just the opposite! I would love to have a consultation with a doctor like you who has dedicated their practice to menopause.
Please do more perimenopause content…..its so confusing…. Still getting periods but feeling not right
I totally agree💯
THIS!
Thank you so much doctor for all the knowledge you share. I started last November on the estradiol patch 0,375 and 100mh progesterone pill vaginally. I experienced some blood spotting after a month which went away.Last week I had to take a different brand of estradiol (due to shortage) but same dose, yesterday i had some blood as did I today . Is that normal? When i did an ultrasound last year my doctor said I do have polyps, can that be the cause? Thank you so much , you are God send
Thank you for this information. I have been struggling with doctors for years who have been telling me that I need to taper down on my estrogen dose. As time has gone in my symptoms have worsened. My doctor has me splitting my oral dose to 1 T an the am and 1 in evenings. Is this what you would do?
What should your estrogen level be while on HRT? What is the range?
Many years ago Alan Hamels cousin a GP in Canada advised me to take Evista and now I realise how good his advice was. I flew for AC for over 35 years and when I asked him I had Osteo Pina. Two years ago at 76 years old I broke my ankle and when they gave me a bone scan it showed my bones were comparable to a forty year old woman. In the greater scheme of things stick with the winners and chuck the rubbish of trying to stay young away. We age like it or not just like car we need regular services. Good food and exercise and a good down to earth doctor.
This is amazing!!!
Dr. Hirsch ❤ Thank you.
Could you please help with the timing to do the blood test. I use gel in the morning so my Dr said not to put the gel until I return from the lab. Results were really low so she changed the dose and I started to feel really bad, breast tenderness, bleeding etc. I found on my research that you should put the gel and then wait 4 hours and then go to the lab for more accurate results 😮
Please please please help
When should you check your estrogen level? How many months/weeks after starting??
Thank you.
Can bleeding occur if my combo patch is barely sticking for prescribed duration? I usually have to change it before the 7 days and the last day it’s using barely on.
Hi there. My question in how do you know it’s working is the length of time it takes. I have read 3-6 months.
I was put on the 75 patch just recently. I’m feeling better but I have a lot of discomfort with soreness in the Breast. Do I have to inform my Dctr right away. Or should I wait for a couple of weeks to see if it settles ?
is this course also good for peri menopause people?
Thank you for your amazing channel! I am 47 and had the hysterectomy 2 weeks ago but kept my ovaries. Wondering if I can tell at this point if my ovaries are actually working.
I had the same surgery but states to experience menopause symptoms soon afterwards. Now on HRT.
I am using torche hrt and I hate it. The taste I can't allow it to fully disolve and I need to drink something to get the taste out of mouth. I would rather do injections or anything. Is the troche the best way ? I am post menpausal. I love listening to your videos I learn so much. Thank you!
Obviously you are new to her channel.
im now 1mg est pill,.12.5 prog, 60mg biweekly T inj (tot T 164)... idk, been on est patch didnt absorb. do u prescribe T for pts?
how do i know if its working i just started using patches irl and idk how to know if i feel better plz help advice
hi doctor my gynecologist just prescribed me with duavee .45 because of a lot of bleeding during menopause I wear glasses, so my question is does this medicine causes vision loss?
What about the high blood pressure and blood clot risks?
Transdermals don't have the same risk as orals
Wondering your thoughts on Dr Louise Newson's paper about dosage. She writes that for health benefits of estrogen replacement, estradiol blood levels need to be over 250 pmol/L. As I have osteoporosis, I am curious to hear what you think of this. Thank you for your very informative videos!!
Good question! It's so confusing as some docs don't believe in blood levels/test.
That's a really high level. I'd love to know Dr. Hirsch's opinion too.
@@annemarieedwards68If you’re in the U.S., different units for measuring estradiol are used - pg/ml, and the value will be lower. The 250 would be close to 70 pg/ml in the U.S. There are converters online that you can use.
It’s an excellent question, and one that is not focused on enough, in my opinion. There is great variability in estradiol absorption through the skin, so you’re not necessarily getting the intended amount. I had this issue with the standard dose patch that is supposed to be sufficient for disease prevention (osteoporosis, etc). My noticeable menopause symptoms were gone, but my 24-hr urine calcium level did not normalize until I asked for a higher dose of estradiol! My blood level had only been 25-30 pg/ml on the standard dose (0.05) patch.
I had been diagnosed with beginning osteoporosis at age 56 after educating myself about menopause and insisting on a bone scan.
Symptom relief is important and the reason why most women start HRT. But if we’re talking about disease prevention, I think there needs to be more diligence on an individual level, instead of just “hoping” our dose is enough.
I LOVE Dr Newson, BTW! She’s a true hero for fighting to improve women’s health and lives worldwide. She’s my favorite! 🥰
I’ve noticed that my estradiol level lab value was reported in pg/mL. So when we listen to doctors from UK and USA there can be a confusion in lab value’s numbers. For example, 250 pmol/L = 72 pg/mL.
So if we have breast tenderness and bloating, is it too much of one of the hormones? Or too little? I’ll ask my doc in my follow up but curious what you typically see.
I only get four patches for a month evorol Conti patches neausa and vertigo please thank you ♥️
I’m not a doctor, but the nausea and vertigo sound like your estrogen is still too low. Also the Conti patch has a progestin on it. Progestin is not progesterone. It’s synthetic. That could also be why you might be feeling poorly. You could have your levels checked first and then also ask for the Estradiol patch by itself and the oral Progesterone instead if the progestin on the patch is causing you problems. Unfortunately, they don’t make patches with progesterone yet. I wish you well!
No HRT is working for me in perimenopause. Even though I’m 54, I’m still in early perimenopause. I’m gonna have to start low dose BCPs as my quality of life issues are PMDD 10-14 days before my period. I am so miserable and desperate, I hope I get some relief! Thanks for the info.
Get a Mirena IUD!!! Saved me from the misery of PMDD!!!
BCPs are a form of HRT as they contain both estradiol and a progestin.
Because of you, my doctor prescribed Vagifem tab. 10 UG. Thanks so much for all you do for women. .For the first time in my life I got 2 urinary infections within 7 months. I got irritation for a couple days every time I had intercourse. I had no idea of all this. I have questions I hope you can help. Can I start slowly?, meaning not every day for 2 weeks but every other day? The box says lots of side effects. Nausea ,vomiting, abdominal pain, bleeding, sever headaches even HAIR LOSS with vagifem etc etc. It scared me but I will nonetheless start tonight. If is not systemic like taking orally, why are there side effects? and will it help with hot flashes or hair loss? I am very interested in knowing more. Please educate me. Thanks soooooo very much!
The manufactures mark the boxes with the same warnings that they put on systemic estrogen. Another doctor I follow Kelly Casperson talks about how they scare women by doing this. The side effects are not the same.
You mentioned that in order to establish the cause of HRT bleeding, ‘separating’ the oestrogen and progesterone dosages in order to establish the cause of the bleeding.
How is this done in the case of those who still have a uterus when progesterone is taken to protect the uterus from cancer? In other words is it safe to be able to take one without the other for a few weeks whilst establishing which one is the one causing the problem?
She has stated in other videos that she sometimes has women go one to two cycles without progesterone if they are still having regular periods. But after that, the progesterone has to be added. It just allows you to differentiate between estrogen alone, and estrogen plus progesterone in terms of the effect on your symptoms.
I’m in UK. I recently changed from patch to Mirena Coil/IUD. I really thought I needed more oestrogel to stop the breakthrough bleeding and upped my dose but it was actually the opposite , I reduced the gel out of curiosity to one pump instead of two and the bleeding stopped pretty quickly 👍.
I have done 2 months ago done the exact same thing as you had the Mirena IUD fitted (for progesterone) and one pump oestrogen gel daily and it seems finally the breakthrough bleeding has stopped. @@nikkim4016
Dr. Hirsch, I am 55 years old and 5 years post menopause. 3 months ago i began HRT (.5mg oral estadiol and 100 mg oral progesterone). Most of my menopause symptoms have improved, with the exception of my worst symptom which is low libido. So, my doctor increased just my estradiol to 1mg which I will begin today. One huge complaint I have is that I have gained two full inches in my waist. Will this pass? I went from having a flat belly to looking 6 months pregnant in 3 months. And it's not like normal bloating that goes up and down through the day. Even first thing in the morning my belly is huge.
i saw that besides the estro/prog we also need a small bit of testoterone for libido. ask your doc. but theres a bunch of vids about the microdose test
Did the increase in estrogen help?
@@shellyb988 with the libido? No😩 however, my body has adjusted to the hormones so I'm not quite as bloated anymore.
What do I do about loss of libido after radical hysterectomy?
Radical hysterectomy usually means that your ovaries have been removed as well. Most menopause specialists would recommend that you start systemic and vaginal estrogen replacement. But they would want to do a health screening first.
I just started the estrogen patch. How soon before I notice full benefits?
I'd say about 2 weeks to a month?
Up to 3 months!
A few weeks.
I saw a major change in urinary symptoms in week 6.
Does HRT help with tendon health?
As I know ,estrogen has antiinflamatory effect on body so the tendons
It’s frustrating to hear about something I can’t get.
Hello, what can one do to ease digestive side effects of vaginal estrogen? I experience stomach upset every time I use it.
I’m using the progesterone capsule vaginally instead of orally and wondering if that’s as effective. Using with patches I change every 3 days but after 10 days I don’t feel any changes in symptoms yet
I am putting the contents of my progesterone capsules on my skin since they really bother my digestive system ( progesterone relaxes the smooth muscles of the large intestine). I think vaginally would be even better since it's closer to your uterus, but i don't care for the additional discharge.
I’ve heard the oral progesterone is best
I also use my progesterone 100mg capsules vaginally. It's not really accepted here, but is recommended in other countries if you can't tolerate them orally.
@deborahjean8026 There’s one way to know for sure - get a pelvic ultrasound ( done in the office) that measures thickness of your endometrium and that’s your data!
She has stated in other videos that using prometrium vaginally is fine.
The girl who mentioned squeezing the prometrium and rubbing it on her skin is setting herself up for endometrial cancer. It does not absorb well through the skin and was not designed for that. Either take it orally or vaginally, or talk to your doctor about an alternative.
I took HRT capsules for years, which took care of my hot flashes. I switched drs who only uses creams. My hot flashes have now returned. My hormone levels are are good, though. I'm thinking that the cream doesn't work for me.
Do you recommend using progesteron capsules into vagina ? Which way is more bioavailable, vsginal or oral ? Thank you❤
Different routes affect different symptoms
I’d say I’m there. Around 75% better. I could still use some help with my energy level and libido.
I think I’m going to try going up to the highest patch and see if that helps. I’m on the .075 E patch that I change twice a week and the oral 100 mgs. P pill.
My biggest concern is my breasts getting bigger. When I started on HRT, I was a 36GG. I’m spilling out of my bras now. I don’t want to get any bigger if I go up on the patch.
I wish I had your problem😂
@@user-xs9835, they are so heavy. I’m looking at a reduction because I have severe arthritis in my lower back. I look at flatter women and would love that! I guess we always want something different. 😊
@@crh251
True! 😊
My breasts also get bigger on estrogen.
That is the exact regimen I just started... tried the 0.05 (too low) and the 0.1 (too high). Sounds like you need testosterone for the other symptoms. I will be trying this after seeing how well I respond to the new dose and tweak again if needed. Best of luck! It's so individual.
Is it true that a low dose of HRT doesn't benefit you as far as heart disease, bones and brain? That you should take at least a 0.5.
Estradiol 40-80
Testosterone 100-150
I started on perimenopausal hrt. still on now a few years later. I want good sexual health. felt like glass for a long while.
What is perimenopause hrt? Birth control pills?
She has said in many videos that she also prescribes HRT for perimenopause
I read up on you, and your reviews could be better. Nurses are working for you, no doctors. Ladies, read reviews.
Why would doctors work for her and not with her?
I would never want you as my HRT doctor why be satisfied with 80 percent symptom relief why not 100 percent you sound scared of hormones. I wear 2 of the 0.1 patches my estradiol runs 200 40-70 level of estradiol barely offers any bone brain heart protection. You would be a terrible dr to dose my HRT protocol
I read bad reviews about her. She's only in it for the money. She's a saleswoman.
My levels are 350 pg and I still have anxiety issues. Acc to doc newson levels upto 900 are acceptable. My doc is from the UK.ty v much.
Yet you watch her??