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Premarin vs. Estradial

I am a 62 year old woman G3P3 .  I had a total hysterectomy with BSO.  I have been on estrogen replacement since my surgery in 1998.  I still have moderate-severe hot flashes and they seem to be getting more intense with age.
I switched from oral Premarin which covered me pretty well but I didn't want to be taking pills the rest of my life. Since then I have tried a variety of patches that are really not very effective on a regular basis and very expensive.  At my age, what do you recommend.  Is Premarin dangerous (risk of DVT).  I tried to stop everything but didn't realize I was doing my body more damage than good , i.e. dry wrinkly skin, sleeplessness, hot flashes , memory and concentration issues not to mention low sex drive.  I would appreciate anything you could recommend.  
(Reg. Nurse)
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134578 tn?1614729226
I think the patches specifically say on the box that they don't do anything for hot flashes, though they supposedly keep the vagina pretty lubricated.  

I don't like Premarin because it comes from mare's urine.  Have you talked to your doctor about a light dose of oral estrogen and some compounded progesterone capsules that can be inserted vaginally?  Of course, this would mean taking the estrogen as a pill, but it could knock down the hot flashes.

I'd dig around until you find a sympathetic ob-gyn who is well versed on HRT and go over the whole issue with him or her.  (My IVF doctor gave me the word to the wise that every woman he knew over 52 was taking a light estrogen dose.  You never know where you'll find the advice.)  Just try to stay away from people who aren't up on the latest research.
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134578 tn?1614729226
Oh, also I read recently that Zoloft in a light dose is supposed to delete hot flashes.  Go figure!
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Avatar universal
I do use a separate estrogen cream for the vaginal issues. I tried Osphena which worked great but it causes HOT FLASHES and big ones at that!!
Yes, I will continue to research this .  I do have a new GYN who does seem to be up to speed.  Thanks!
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Avatar universal
Sorry you are suffering since stopping the Premarin. Did you know that the ovaries of women with all their parts produce hormones into their 80's?  So it is not unreasonable for women without parts to take hormones the rest of their lives. Estrogen deficiency resulting from ovary removal or premature natural menopause is associated with many increased health risks and reduced quality of life. And testosterone deficiency caused by ovary removal may also have negative health and quality of life effects.

I have read that the clotting risk of oral estrogen normalizes after the first year or two of taking it. So blood clots should not have been a concern since you had been on the Premarin so long.

The patch (at least Vivelle-Dot, never tried Climara) was a dismal failure for me. I was on the highest dose and about all it did was keep my vagina well lubricated so all the estrogen must have been going straight there and giving me no other benefits. I get much better results with the estradiol tablet (generic Estrace) which is a $4/$10 prescription in the U.S. If you want to go with transdermal delivery, gels or compounded creams are options. So is Femring but it is very expensive and seems like it seldom lasts the full 3 months.

Although hysterectomy is grossly overused, many gyns seem uneducated about hormone replacement. We have to do our own research and seek out doctors (not necessarily gyns) who are either knowledgeable about hormones or are at least willing to learn and work with us to maximize our health and quality of life.

Good luck in finding something that helps with all these symptoms! I know I was a basket case before finding a suitable HRT.
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Thank YOU!!!!
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