Question on HRT

I had a total (uterus, cervix, tubes & ovaries removed) hysterectomy 6 weeks ago.  I amnow in full surgical menopause.

Two weeks ago, I asked my doctor to put me on HRT because of terrible mood swigns and, of course, hot flashes.  She put me on Premarin 0.3mg, daily.

I am still having the hot flashes (even worse than before) and the terrible mood swings.  Is there a different type of HRT that works better?  Also, do I only need to have estrogen replaced - or should I be getting progesterone and testosterone as well?

Thank you for any advise you can offer.

[Machelle Seibel, MD]

If a woman is still menstruating and her ovaries are removed, this causes a big drop in estrogen that happens quickly. The effect is a real withdrawal. Usually, the estrogen needs are greatest in the first 12 months or so. Often, initial dosages are higher than 0.3 mg of Premarin and may be 0.625mg or if that doesn't work, 1.25mg daily.  The goal is to get enough to make the symptoms tolerable in the short run and to taper that dose down over the first 6-12 months or 12 to 18 months. One might end up quite satisfied on O.3mg but it might be a year or so later. One doesn't need progesterone if one's uterus is removed. Many women do not need testosterone and are fine on estrogen alone.


Premarin is a very good estrogen, but any will do if the dose is high enough for the person's symptoms.
Machelle Seibel, MD

[bev62]

I am 44 and after a hystorectomy 4 months ago I am doing the bio-identical hormones. They have been a life saver. I was determined that I would not use synthetic HRT due to breast cancer and heart disease being in my family. They first did a saliva test which tested all my hormones and then they compounded the hormones that I needed in the dosage that I needed. They are a cream that you just rub into your skin on your arms or thighs. I live in Tn, I go to a pharmacy in my town and a nurse there explains everything and give you the saliva test. The pharmasist then compounds the hormones based on your test results. I have no more hot flashes or night sweats and I have lost about ten pounds without even trying. I never realized the effect your hormones could have on you. I also read Suzanne Somers book Ageless, it is all about bio-identical hormones and explains everything very well. Good luck