Hormone Therapy for Menopause: A Guide to Doses, Levels, and Delivery Methods | Dr. Susan

While the safety and benefits of menopausal hormone therapy (MHT) are becoming widely accepted, hot debate continues around dosing, delivery methods and how to monitor levels.
Advisory boards including the American College of Ob/Gyn and the Menopause Society support the use of (MHT), but much confusion continues regarding ideal blood levels, whether to check blood levels at all, and optimal route of delivery.
The dosing of both estradiol and testosterone varies 5-10 fold between methods such as patches, gels, sublingual methods or pellets. Both doctors and patients need to understand the dose that they are prescribing to make an educated decision.
Today I will help to shed light on the differences between these options, and why my strong opinion is that blood levels are critical to ensure that levels are not too high or low for your optimal health.
Dr. Susan Hardwick-Smith is a Board-Certified Gynecologist and Certified Menopause Practitioner specializing in women's midlife wellness, hormone optimization, and sexual wellness. She is the founder of Complete Midlife Wellness Center in Houston, TX, and the best-selling author of "Sexually Woke- Awaken the Secrets to Your Best Sex Life in Midlife and Beyond." She also hosts the popular podcast "Empowering Midlife Wellness."
Dr. Susan is the recipient of the Texas Super Doctor award over a dozen times, as well as a multiple-time recipient of H-Texas magazine's Top Doctor and Top Doctor for Women awards. She also has been chosen as one of Houston's "3 best-rated" gynecologists for several consecutive years. Dr. Susan is also an ICF-certified life and leadership coach, multiple-time marathoner and Ironman triathlete, and mother of 3 teenagers.
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[@peacepocket]

I think the main issue that people have with the pellets is, if there is an issue with the dose, you're literally stuck with it for 3 months before you can make any changes.

[@MaryBethMcCoy]

Agree. That’s why I won’t use pellets.

[@drsusan]

That is not correct information. There are very good studies showing that non-oral estradiol does not increase the risk of blood clotting events so a patch or a cream or anything not in pill form would not increase your risk of a stroke. Numerous studies support that statement

[@denisepeter7050]

I love these sessions. So informative. ❤❤❤

[@natusha_andrade]

Dr. Susan thank you so much for putting information out. I came across your channel about a year ago, I educated myself in this subject and then I searched for a gyn specialist in menoupause, she is wonderful. And I've been using pellets since September and the benefits from it blew my mind away. My mind and my body feels like in my 30s....actually I feel MUCH MUCH BETTER than when I was in my 30s. Thanks again for showing us the way❤

[@susanvanputten492]

Pellets were also a bad experience for me. I had testosterone inserted when I started menopause and I got a huge lump in my breast b/c my estrogen skyrocketed! It was stage 1 and I decided for mastectomy since I had already lost one breast via stage 0 cancer so now I am on estrogen patch and I have been for 5 years and it’s been great! Of course all doctors think I should not be on hormones but I don’t care I have a gene for heart attack and I feel amazing! Plus on testosterone via cream and oral progesterone:)

[@christyhelferich2325]

Thank you for all of the great information.❤

[@ShazWag]

Finding the right personal balance is so important. I developed endometrial hyperplasia and a large uterine polyp after being on HRT for a few years (a transdermal body-identical estradiol gel on my arm and a progesterone capsule in the evening), which meant I needed a D&C procedure. It seemed just one pump of estradiol gel on my arm was too much and made my uterus lining grow too thick (good thing I asked for an ultrasound scan to check, as I was getting jabbing pains!). Now I'm on one pump of _Lenzetto_ spray on my forearm skin once a day and still on the 200mg of progesterone (Femenita) in the evening. So far my uterus lining is fine, just 2mm, but I'll ask my gynaecologist for another ultrasound in 9 months to check it's okay. I think women on HRT should get an ultrasound of the uterus at least once a year to check for hyperplasia, adjusting their HRT dose if necessary. As for blood tests for hormone levels, both my gynaecologist and family doctor said they're pointless, since it's not the same for everyone and hormones are constantly fluctuating, and I would imagine women would know from any symptoms they're having. Regarding testosterone pellets for postmenopausal women, some studies have raised concerns. E.g. pubmed.ncbi.nlm.nih.gov/33518182/

[@drsusan]

Agree it's very personal ! Dose is critical

[@Lbb789]

FDA will never approve pellets bc they're not a pharmaceutical product. Same with the NIH. They get their funding from Pharma. So guess what they're going to say....

[@jennieoh8543]

A Mirena coil really helps mitigate that problem and keeps your uterine lining thin. My Meno specialist does not prescribe testosterone and I am good with her decision for me personally.

[@ShazWag]

@@jennieoh8543 My daughter had the Mirena coil and could feel it when she sat down. Also, there are many cases of the coil embedding itself into the uterine wall and, even worse, migrating to other organs. When this happens, surgery is required and damage such as lesions can occur. It's actually not that uncommon. I'd prefer to stay away from it.

[@jennieoh8543]

@@ShazWag Oh my I have no problems thank goodness!!!!!! So sorry she had to go through that :*( I have had one for years.

[@kimberlypotts8922]

Dr. Susan, I began my perimenopause journey with a dark green estradiol/ testosterone pill. Within months realized there was way too much testosterone here. Then moved to pellets. Wonderful… until it wasn’t. Engorged clitoris, growing hairs on my chin, raging anger… My blood felt like it was fizzing or vibrating. Totally a cowboy experiment, to use your own words. I ended up in the emergency room in tachycardia. Went back to estradiol 1 mg, then adjusted up to 2 mg. Felt great again, initially, after the upgrade to 2 mg but now on a rollercoaster again. I simply am at a loss. My bloodwork shows testosterone at 0. Absolutely no libido. At this point my only goal is to just have energy and be positive. I know that I can do better but just do not know where to adjust.

[@MarianneWilkinson0312]

Dear Kimberly- so sorry to hear all that you went through. Please think about a private consultation with a meno doctor such as: Dr Louise Newson, and Dr Mary Claire Haver (i think), Dr Barbi Taylor. You should be able to do them via phone or Zoom. Best of luck!! The first one I listed I have followed for 5 years now.

[@3hotspuds]

I've had something similar happen with the T and vibration sensation. Since the pellet is now gone and your level at zero maybe try the cream in a super low dose?

[@jisbell6308]

Lots of information. Thank you. It would be very helpful to include what the desired levels are for estradiol and testosterone if it is so important to check levels.

[@user-or2ml8cz5y]

Go Susan! Come over to Aussie you are most welcome. I have just started The AndroFeme so your feed back on that was awesome. Yes the Govt makes the GP test 3 weeks and then every 3 months to see whats happening with levels. The testing is all free covered by Medicare so we are lucky. I am struggling though how do you know when you have correct doses for all hormones is it a symptom thing or more of just feeling like you have your mojo back.

[@larayne]

The male 5gr t-gel can easily be drawn up in BD syringes (I use two 2ml syringes and then you dispense very accurately from those. I put the gel in a sterile contact lens container first and then draw the gel up with the syringes.

[@russvet]

Also you can you place the gel into 10 ml syringe. And then put on the dose you want every day.

[@lifetothefull4861]

Thank you so much!!

[@faithf5846]

I wish someone would invent a hormone meter similar to a glucometer. I’m fearful of pellets because once inserted it can’t be taken out until it runs out.

[@drsusan]

Really important to get the right dose ! And yes that would be an awesome invention !😊

[@imaniwilson1848]

Wouldn’t THAT be amazing?!

[@robinstewart6820]

I was overdosed (testosterone) with the first and only pellet I had inserted! I was miserable until it finally was all gone.

[@angelao1953]

Don't be afraid! Mine are a godsend!

[@sherylmorgan4802]

Everyone is different my daughter had the pellets and her hair started falling out

[@leanandmean55]

This spring, I started HRT by weekly injection for T and E and pills for P. Levels are getting to where you suggest. Any comments on injections? Just curious. So glad for Dr. Susan. I spent my 40s having no one listen to me or even suggest any help. Finally, I have someone that will listen and excited to help, but pellets aren't an option.

[@RBeck-uz6kg]

Yes I use T gel as well. Can get is prescribed and decant 1 packet into a clean container then apply amount recommended by health professional. When that amount runs out, decant another little packet into container. A bit of a pain, yet it works for me.

[@b.f.2581]

Dr. Susan, Thank you for the invaluable education. I will appreciate your perspective for my question. I have been on estradiol, Mylan patches, .05mg/twice/wk. I thought the patches are synthetic, made in the lab. I don’t know where it was sourced? Should I be concerned that it is not a plant based? I think the compounding ones are plant based. Is the plant based, bio-indentical products better than the synthetic, bio-indentical products? Thank you for your kind perspective and all you do❤️.

[@lisaaudy352]

I work in a clinic where we provide timing sheets for blood draws. For example, we instruct our patients to take estradiol 6 hours prior to their lab appointment (if it’s oral).

[@drsusan]

It's great to have protocols, but I would definitely tell your providers not to take any estradiol orally that is not standard of care and increases the risk of blood clotting events!

[@pamelajean1968]

I'm new to your channel. You look amazing!! As far as your teachings, Menopause Barbie could learn a thing or two from you. For years I used a 20% compounded progesterone cream only to find out that I should have been using a 3% or 5% cream for much better absorption.

[@aubreylowe1361]

Fingers crossed my doctor offers me any form of testosterone and checks my blood levels for estradiol patch! She didn’t want to do any of those things my last visit😳 🙏🏼 🤞🏻

[@Lbb789]

find another doctor.

[@angelao1953]

What @Lbb789 said! Life is too short to deal with indifferent, uncaring, unequiped doctors or providers! I have been on pellets for less than 2 weeks and my knees quit hurting, my ankle quit hurting, I have some libido again (!!!!!) and I feel SO much better. It was hard for me to find an MD/gynecologist who was also an HRT specialist and was super knowledgeable (and she also was forced into menopause early due to chemo herself) and fabulous! It was not easy finding her, but I did! Often providers don't advertise that they are HRT specialist because insurances poo-poo this (even though they should not). DEFINITELY find a better doctor. You are worth it!

[@aubreylowe1361]

Thank you and you’re entirely right! I was able to find a new doctor who I believe will be a lots more helpful and have an appointment in June. I will still see my other doctor on Friday since I already have the appointment but my expectations are low. I too have really bad joint pain lately even though I eat a very healthy diet and am very active. Do you think your pain has been helped by the testosterone? Have a wonderful day!🌻

[@cheylou1]

Same here you might live in canada

[@aubreylowe1361]

@@cheylou1no but right near the Canadian Border in Blaine, WA. 😊

[@Ann-MD]

Hello, thank you for this video. Have you seen anyone using the estradiol patch and experience bleeding?

[@patriciadrank6543]

I can see that you really like the pellets. I have to let you know that I had a bad experience with these. On my third Injection of the pellets I had 2 issues. The pellet was inserted incorrectly, and not only was it very painful for a couple of weeks but, I started bleeding as in having a period when I was 65. The doctor told me that I should just have a hysterectomy. Keep in mind that when I started these. I had no issues. Needless to say, I never went back to that doctor. I am estrogen sensitive, and she wasn't willing to work with me. All that she wanted to do was surgery. This would have been a money maker for her. So I have had no help with hormones and now I am 70 with osteoporosis.

[@MarianneWilkinson0312]

Dear Patricia - so sorry you went through all that ! Please continue to seek expert doctors on KZbin - there are several that have made it their mission to help educate woman of their options. Some do consults.

[@marlenede-abel1336]

This was very interesting - I was wondering what your thoughts on trouches (not sure if we have the pellets in Australia).

[@jennysiepka9900]

They work well too. Just make sure the base isnt polyethylene glycol❤

[@bethfrasher]

When do you draw blood after pellet insertion Dr Susan? And what are optimal levels?

[@katc9405]

I agree to get our bloodwork to know where the hormone levels are at BUT the pellets are waaaay more expensive compared to the patches 😌

[@NotACat2237]

This came at a good time. I'm currently switching off the patch because I started having an allergy to it.

[@ginas57]

Same here. Started on a patch but my skin gets red bumps every single time

[@Sumermak]

Don’t go off it… just switch the patch to a different ones your probably allergic to the adhesive.

[@sassyt1545]

The NIH did a study on contact dermatitis from estrogen patches and the conclusion suggested site rotation of the patch and/or a small amount of clobetasol (topical steroid), prior to patch application to ward off allergic skin reactions.

[@kathealy60]

Great episode! I appreciate the dosing suggestion for the testosterone pellet; I believe I got too much when I got mine originally. What is your feeling on the dosage for estrogen calculation for the pellet? Thank you!

[@laila11778]

I think my dosage was too high too because the tri-est cream made my skin blotch terribly. I just quit. It was just too much but they said it was the lowest dosage.

[@drsusan]

6-10 mg for E in pellet - I start almost everyone on 6 mg unless they are over 200 pounds

[@kathealy60]

@@drsusan Thanks so much - this is helpful as I see my practitioner today!

[@kmjdebay]

@@drsusan Thank you. My OBGYN provider was trained by Rebecca Glaser and we worked on the right T dose for about a year and I was OK on 100, but then in 2021 I chose to increase to 112.5 to better protect my bones. I am on 112.5 T and 25 E. Next time I will try lower E, but I have had trouble thinking on a lower dose. Theoretically, is 6mg equivalent to .05 patch? I was on a patch for years at .1, then .075, until I stopped making any testosterone. I've been on pellets since 2010.

[@hulasenorita]

@@drsusanis 125 for testosterone dosage good for 132 lbs is my weight and 5.2 height.

[@doodieevanshenagan3330]

With patches, if you swim, one should get water proof bandaides to cover the patch……wondering about baths.

[@emcoss]

I purchased T gel last week in Mexico. I’m using 1/20th the men’s dose to start. Let’s see how I feel.

[@peacepocket]

is it over the counter in Mexico or did you have to get a prescription?

[@emcoss]

Over the counter.

[@mazeygirl2408]

Did she ever talk about injections? She mentioned it in the wording on the screen but never discussed it. I have not ever done the pellets and the reason why is once you do it your stuck with it for months. I agree with some of the other people on here finding the right balance is definitely the key. Going to talk to my FMDr about injections, which gives me more control. I had to have a complete hyster at 23 and 55 now so I have tried alot of things that have just been meh.

[@kali542]

I could not tolerate estradiol E2 at all. It worked for a bit, then after a while I had horrible symptoms. I tried so many different routes for 14 years. At one point I even had a hypertensive emergency. I was bloated, fat, retained fluid, swollen breasts and moody on estradiol no matter what I added to it (other hormones). Finally, I switched to the dreaded horse pee estrogens. I have been on for 2 years and lost weight, happy & healthy. I know everyone throws the equine estrogens under the bus for not being bioidentical, but they are from natural source (horse) and easier than a synthetic yam product for me! also: this is nuts but I use the cream and rub it in to my skin tiny bit 3x a day. I learned it on a hysterctomy support group.

[@tamarakieper5029]

What is the equine estrogen called please?

[@marikatarver60]

What is the name please😊

[@leslieharari8755]

@@tamarakieper5029 premarin

[@kali542]

@@marikatarver60 I generally don’t say the brand. So no one thinks I’m selling it. There’s only one brand. Google search conjugated equine estrogen.

[@bmbarnum]

@@tamarakieper5029 likely Premarin

[@katrinabennett2759]

Dear Dr. Susan, how do you feel about pulse-dose 1st 12 calendar days of month only for a post-menopausal woman? I am concerned that my better since Progesterone-sleep will be affected and this will also cause a "bleed" 😢

[@rmh691]

The problem with compounding pharmacies is that you are really trusting that the pharmacist and pharmacy is reputable and delivering the same dose with each prescription. This has been shown time and time again not to be the case. For example, and this goes for any drug - say your prescription is for 5 mg. dose. When they looked at prescriptions issued over a six month period, On a 30 day refill schedule, all six prescriptions had widely varying strengths from a quarter as much to three times as much. So until this is FDA approved and you can buy it that way like you can buy estrogen, it’s a crap shoot what you are getting month to month from a compounding pharmacy. Also, you do not mention that there are patients where the pellet dose is too much where they get side effects and you are stuck if that happens for as long as those pellets are in you because they cannot be removed. If you’re using a patch or a cream and the dose is too high for you, you simply stop using it and don’t take the next dose. That’s a huge difference and I don’t understand why you don’t mention that.

[@NiaLaLa_V]

Yeah I have a hard time trusting anyone now because I worked as a clipper in the legal cannabis industry in washington state. I am also a curious person so I got close with the managers and learned about the process, and I found out they were selling stuff under the same name so people think it is always the same product but it wasn't. It varied from plant to plant, harvest to harvest, the levels of all the phenols and flavonoids and stuff they market it for were changing in every single batch. The whole year I worked there they never figured out how to get consistency in the product but they kept selling it and they were meeting all legal requirements because they only make them monitor things like the thc amount.

[@sheahill3340]

I have been on pellets for ten years, before and after hysterectomy. No problems and no adverse effects. I tried shots and patches and both were much more problematic.

[@susandeakin6513]

My GYN doctor would never agree to prescribe testosterone made for males. I had to cry in her office to let me have some compounded cream T for libido. She gave me 1% cream.

[@SusanWautelet-ob9xh]

Do you feel like the cream is working? i just had my bloodwork drawn for T. No libido for me, i'm foggy and very moody so i'm hoping the T will give me the last of the missing puzzle piece.

[@janereinhardt4715]

Maybe a 1% placebo.

[@drsusan]

1 percent is meaningless- you need to ask how many mg you are getting . 5 mg daily would be standard (at least in Australia !)

[@CatamaranChannel]

1% = 2.5mg is fine, just use more. 2% = 5mg is the standard, which is 10 times less then what men mostly get/want.

[@susanvanputten492]

Also, I had a primary tell me oral estrogen was the only way to get heart protective benefits! I stopped b/c my estrogen plummeted into post menopause I couldn’t keep my estrogen levels up with a pill.

[@tinajames2940]

First appt next week. In zoom pre-appt meeting she said she doesn’t check hormones because post menopausal there are none. She just puts patients on very low level. All women have some levels of hormones at different times in life right? Considering canceling and looking further for a doc. This one was in another state. Aren’t many close by for this type treatment.

[@juliaantos4605]

My PCP gave me the name of a Menopause Specialist because I was having trouble sleeping. She said I could either get sleeping pills or try HRT. I took the name of the Menopause Specialist and made an appointment 2 months ago.

[@drsusan]

Menopause.Org is a great resource and we would be happy to see you here either in person or remotely

[@valkimpton5566]

Dr Hardwick, what is the type of measurement used for estradiol you use? is it picogram per millilitre? (you recccommend for ex. 40-80 but please add the rest! I am in Canada

[@monicachristine1434]

Dear Dr.Susan, I have a Question: I've been on 50mg oral Pregnenolon and 25mg DHEA for 2 months now and feel great with it. I don't like creams and can't get pellets here in Germany. Would it be better to get those hormones micronized and formulated in a lipid matrix? It's supposed to bypass the liver that way.... True or myth?

[@Candleflower42]

Thanks so much - I learned from you to take my sub q BIEST at night since progesterone helps sleep. My estrogen level was in 500’s and I don’t remember for certain but that might have been drawn when I was still taking in the morning and had a morning blood draw. I wondered why it would be so high on just 1.25. I wonder if the same weight woman taking the same amount of estrogen and blood draws at same time would have the same estrogen level.

[@drsusan]

Way too high ! I'm glad they checked

[@monicagalvan5645]

Can you provide healthy ranges of estradiol, testosterone and progesterone for post menopausal women on HRT?

[@drsusan]

There is no consensus on this and there is hot debate about it, but in general Estradiol levels in the 40 to 100 pg/ml range reduce symptoms and also provide protect protection for all of the health benefits that we want without any adverse side effects The highest levels of testosterone that we achieve as women in our 20's are approximately 50 to 100 ng/dL So my personal opinion is, we should stay somewhere within that range and at levels over 150 we start to see side effects

[@nikas8318]

Do you have in your practice postmenopausal patients on testosterone only without supplemental estrogen and progesterone? And if yes, do you see them converting testosterone into estrogen in blood work?

[@sandandsparrow]

Unfortunately health insurance doesn't cover compounded creams, pellets or sprays.

[@13nlsc]

But what about if we still need to take progesterone orally?

[@LeighClark-zf8oi]

What do you think of labial compounded cream?

[@drsusan]

Great locally for dryness - but doesn't get got your system to help anything else

[@user-mw4fb7jj5s]

I am 66 and been on HRT for 15 years. When I first started I was taking .037 patch and 100 mg progesterone daily. After a few years I had numerous breast biopsies because of suspicious areas. I got tired of it and switched to taking progesterone the first 10 days of the month only. I was told progesterone keeps your breasts in an agitated state. I would like to go back to daily dosage but cautious. What do you recommend?

[@JesusSaves7012]

What about sublingual or buccal method of estradiol tablets?

[@yvonnesoto9313]

I clicked on the link to make an appointment and it says that the page is no longer available. I live in Orlando Florida. Would I have to travel over there for a first personal visit? Or the first visit a television, no need to move personally?

[@drsusan]

[e-mail] They will discuss with you

[@michellewilson1221]

can you give your thoughts on Bijuva? I take it because when I used an estrodial patch and oral progesterone, I had gastritis. Taking Bijuva doesn't cause it. I am not totally sure which one did it but I am assuming it was the progesterone since it was oral. What would you suggest to a patient like me to take? Patch and progesterone???? I am on testosterone shots and do well with those. I used to use pellets, but I need to be on something that insurance covers... that's actually why I haven't come to your clinic... need to go through insurance :)

[@drsusan]

I have no experience with that product :)

[@silviadamen]

Women's International Pharmacy offers Testosterone in a cream and it's VERY easy to order and use, once you have a prescription from a doctor. The key is to FIND a doctor that will actually prescribe it!

[@janmartell9792]

I'm 66 yrs old and have been on bio identical hormones for about ten yrs. Originally I used capsules which took my hot flashes away. I switched drs and she prescribed creams. Ever since I've used the cream my hot flashes are back. It's been two year now. My dr says my levels are good, as of saliva trsting. Do you have any idea why I'm having hot flahes since stopping the capsules?

[@drsusan]

Hot flashes mean your estradiol level is too low. I would suggest trying a patch. There's no science supporting using saliva testing and if you're having hot flashes, then your levels are too low no matter what your doctor tells you.

[@melissab467]

Does the transdermal dose reflect the actual absorption rate? Transdermal applications are not 100% absorbed.

[@bnb97a16]

I am on .05mg estradiol patch & 200mg micronized progesterone. My serum estradiol is 54 while my serum progesterone is 0.3 so my NP wants me to increase progesterone. The 200mg progesterone makes me sleepy even the next day & I actually felt better on 100mg progesterone so I don’t know what to do!

[@angelinadrobina5037]

A question for you if you would be so kind. I asked for progesterone to help me sleep and it did but I felt pretty rubbish the next day / I commented on one of Dominique’s videos and Dr Taylor said of course you felt terrible you don’t need it (because I have had a hysterectomy and still have my ovaries) so I am confused and still sleepless 👀👀 I do see a prominent OBGYN bashing ‘Pellet farms’ and I do think it’s unnecessary as you can clearly see you and others that promote them are so genuine and want to help women so don’t condone that attitude Thank you for all of your hard work 🙏🏻 I love my Estrodial gel and am waiting the three months to see a specialist to get testosterone in Australia / I’ll be sticking to the lowest dose after your comment thank you for that 🇦🇺

[@drsusan]

Barbie Taylor is correct that you don't need progesterone for uterine cancer prevention but it does help many women sleep but everybody is different so there are lots of other wonderful products I can help with sleep like magnesium 5HTP melatonin and gaba. I would make sure that you're taking bioidentical progesterone that does help most people sleep, but everybody is different and I've made a lot of videos about sleep. I hope you find them helpful.

[@tesiemarie8942]

I was told you still need progesterone. Our ovaries still make it and Estradiol. Why would you replace one and not the other? I have also learned that lack of progesterone can cause thyroid problems. Sure nuff, went to have labs done and my thyroid is low. I will be starting progesterone next week. I too had a complete hysterectomy(still have ovaries). I am on the pellets now, but still have depression, anxiety and some panic attacks. I’ve never in my life had these problems. The pellets do help a good bit, but I am going to add progesterone to see if it helps me more. I hope you get better soon

[@angelinadrobina5037]

@@tesiemarie8942 and you 🙏🏻💛💛

[@amyphillips367]

I’ve done estradiol gel and patch. My body did not absorb it.

[@staceysplain3019]

Could you please explain how the results vary from a saliva test compared to a blood test.

[@drsusan]

The idea is that saliva measures free levels of T - we can also check that in blood now. So usually more difficult and expensive to do salivary testing and no additional benefit

[@Susan-xg7qn]

I am missing something , not sure. You say to get blood work done to check your levels, for estrogen & progestrone, but then say how can they be accurate if you levels go up & down, depending on time of day you apply gel , or have a patch ? So, this is confusing and contradicting ? I am 61, 4 years on HRT, 1 pump Gel, and 100mg progestrone. FYI.

[@drsusan]

No, it's not contradictory. I explained it as well as possible. It's important to time the blood draw. I mentioned in detail if you're wearing a patch, it doesn't much matter when you draw it however, it will fluctuate during the week and we want to be not excessively high or low with progesterone and we don't need to draw the blood level and with cream or gel you want to draw it 6 hours later. As I mentioned the reason to do this is to make sure your level is not excessively high or zero which is possible, even with a patch. The alternative is not drawing your blood at all and you would have absolutely no idea what's going on so we need to understand that levels to fluctuate, but we want to rule out having excessively high or close to zero absorption.

[@susanhudson5371]

It was determined back in January that at some point I had had a subacute stroke. I am 63yo and previously took Estradiol .05mg for the past 10-12 years. I was told to stop that medication since it can cause strokes. Now I am not sleeping well and have terrible night sweats. I can't get Veozah because my insurance doesn't cover and it would cost me $500. Now I am taking Paxil but it's not helping much. What are my options?

[@drsusan]

Non oral estrogen does not increase risk of stroke. That's misinformation:)

[@l.beukema8570]

I am curious how to come by pellets in the Netherlands. I am now on patches, I am interested in pellets. How would I go about that?

[@drsusan]

I am not sure if they're available overseas you would have to do some research

[@netlane100]

Would you recommend to take estradiol continuously or 3 weeks a month? My naturopath believes, that continious hrt can give a risk of bad estrogen metabolites, so he also suggests to take DIM and brocoli extract. What do you think about it?

[@drsusan]

You've been making estradiol all your life -continuous estradiol is the standard of cure. That's what I recommend. You've never had a time in your life when you took a break from it so I don't know why that would be suggested. If you're using estradiol, that is the same stuff you've had all of your life. There's no need to take any products to worry about any " bad metabolites". This is biologically identical to what you've made since you were 12 years old.

[@netlane100]

@@drsusan Thank you very much!

[@lisaalexander1824]

Does anyone know if mania is induced in bipolar on any hormones ??...I get mania from Iboprufen..I took them for more energy, bu after 2 days I get psychosis...THEN the hangover on day 3...less energy than ever...😢

[@jenniferwinograd]

I started my estradiol patch at .025 dose and my symptoms abated. The things I noticed the most were that hot flashes, heart palpitations, insomnia and lack of coordination went away. However, another OBGYN I follow on KZbin mentioned .025 is too low of a dose to have an impact on the main reason I am taking estradiol: long term bone, brain, and cardiovascular health. That made me try .05 dosage which made my breasts incredibly sore. It was intolerable. So I went back down to .025 dose which feels like it's the dose that eliminates my symptoms and yet I'm still wondering whether It is enough to protect my bones, brain, and heart. I'm hoping it will. Because of this video I just reached out to my doctor to ask if I can get a blood panel to check my hormone levels, but I'm wondering if it is possible for some people that .025 is in fact enough? I'm not on testosterone and I'm still confused as to why I would want to be on it other than libido? Beyond the libido aspect of it, is there any other reason to be on it?

[@msmc2685]

Health benefits are not dependent on your dose. It’s your blood levels. You want a mininum of 60 to protect bones for estradiol. I keep my levels at least 250. That’s where I feel best.

[@ShazWag]

You could have a consultation with _Menopause Taylor_ , who also has a You Tube channel. She really knows her stuff!

[@christinemack2153]

I believe it can help build muscle.

[@drsusan]

Blood levels would be helpful in your case. Happy to see you in person or virtually!

[@jenniferwinograd]

@@ShazWag Thank you. But a Menopause Taylor video was the reason I went up to .05 dose. She mentioned that the minimally effective dose for long term health benefits was a .05 patch. It really was too high for me though. I was very uncomfortable. I am 5'8" and weigh 123 pounds. I wonder what role BMI plays in dosage.

[@melgun13]

Loved this video. Thx for getting into the weeds regarding dosages. I recently started estrogen patch 0.025 with amazing results immediately, but when it was time to add the progesterone (200 mg for ten days) it felt like too much causing some GI symptoms and reducing the estradiol benefit. I was two months shy of menopause and getting close to 54 in age. Initially I was miffed to not be put on continuous being so close to menopause, but it gave me the chance to see how I felt on E alone first. Should I ask to have Progesterone lowered to 100 or is this not recommended in cyclical? I just haven't felt the same since the first 10 day cycle and not looking forward to the next one. I feel like the P is having a negative effect on my digestion, when the E greatly improved it.

[@pamelajean1968]

Oral progesterone caused digestive issues with me, as well. I'll assume you are talking oral P. What I do is order 5% progesterone cream from Ona's Naturals (1/4 tsp is 62mg) I'll take 100 mg twice a day. No prescription needed. The cream does not cause digestive issues. I used to need a prescription for my compounded progesterone cream, but then I found Ona's creams. They are much more easily absorbed because of the small percentages they have of 3% & 5%. The 10% & 20% creams do not absorb well so don't order them. If you doctor doesn't put you on continuous progesterone, then just buy progesterone cream at Ona's and dose yourself.

[@melgun13]

@@pamelajean1968 thanks for the suggestion. I doubt my Dr will go for this as there isn't much literature supporting creams for uterus protection. Hopefully with the increased funding going towards women's health we'll have better answers in the not too distant future.🤞

[@bbenabe]

I’m on 100 and it’s working great. I take it right before bed.

[@kslmay]

Will the fluctuations in Estradiol cause heart palpitations or fluttering? I experienced this going thru menopause, very scary.

[@drsusan]

Yes it is scary - very common menopause symptom!

[@marlenede-abel1336]

Sorry - you just answered my question.

[@leemeli7585]

1. Even though my testo is rock bottom, even using the lowest dose immediately causes hair thinning and loss. 2. The .25 patch cause high symptoms with swelling pain in legs and headache, in spite of very low blood levels. 3. You didn’t mention the weekly patch, only 4 day. Do you find twice weekly better? I’m low in all hormones but react to even low doses.

[@drsusan]

My preference is the twice weekly patch but there are other products available. My experience with the weekly patches that the levels drop off to towards the end of the week and patients feel symptomatic.

[@KetovoreAnita]

I use Estalis Continuous 50/140 patches twice a week. I know the 50 is estradiol (a bio identical hormone) but the progestogen is NETA norethisterone acetate. I’m guessing this is not bio identical. Is there a bio identical progesterone I could use and just have the estradiol by patch? Thanks

[@CatamaranChannel]

Why not use 100mg or 200mg utrogestan pills, its bio identical and easy on the liver. Have a good meal before you take it, because without it you might feel nauseous.

[@carolanncoleman137]

Taking estradiol patch . O5 testosterone crème by compounding and 100 mg progesterone by mouth, curious as to how I would know if I need more progesterone since you said 100-200 mg/it’s hard in Mi to get a menopause specialist, went to 2 drs and one stopped answering the phone, who prescribed these but told me to stop preglanone and dhea, the other dr said no don’t stop them. Who do you think is correct?

[@drsusan]

100 mg is the minimum dose that has been studied to prevent uterine cancer but some people take more than that if they need it for sleep or moods or anxiety I personally take 200 mg but anything over 100 mg is safe Would be happy to see you remotely or in person to discuss

[@carolanncoleman137]

@@drsusan I would like that but when I called your office some months ago they said no because I lived in Michigan. Is it possible? I asked my combination naturopath/MD office for the doses you recommended and they agreed to give the prescription. So far I feel fantastic.I don’t know if can put my email here since not sure who will view it. I’m Carol Ann

[@countrygirl900]

What do you think about the EString?

[@drsusan]

That's a great product for vaginal dryness, but it does not treat anything else so you also need to take estrogen throughout your body to help with heart health, bone health and neurologic health and all of the other health benefits

[@susandeakin6513]

I would like to know what level of estradiol should I see on my blood test to help protect me from osteoporosis, heart disease and Alzheimers? I use a troche twice a day and I've been told to have my blood drawn 12 hours after my last troche. Mine was 35 pg/ml and I feel awful every day.

[@drsusan]

There is no consensus on this but I personally feel best at 40-80 pg/ml . Troches are the least stable method out there. Would consider changing if you don't feel good

[@susandeakin6513]

@@drsusan Thank you so much!

[@jamiescho7420]

How do you feel about taking progesterone for 21 days and off for 7 days? Any advantage/disadvantages?

[@anne-louisegoldie]

I'm very nterested in this too.

[@ShazWag]

@@anne-louisegoldie My gynaeloclogst suggested I do this to try and encourage a bleed, as my endometrial lignin was becoming too thick from the estradiol, but I didn't bleed and eventually needed a D&C. I've since been on just one pump of _Lenzetto_ transdermal spray, instead of an estradiol gel, and I still take my progesterone every day - both continuously, without any breaks.

[@bbjonas4233]

​@@anne-louisegoldieWhat is the benefit to this?

[@angieflowe3925]

Would love to know this too

[@anne-louisegoldie]

@@bbjonas4233 I need to know more about it, but I've heard that a few days break from progesterone may be beneficial for the receptors. From another menopause specialist on KZbin 😊xx

[@marikatarver60]

So is vaginal estradiol bad for your lining?? lis it better than putting it on your arm???

[@claudiaformolo6535]

How do we know our estrogen is too high or too low? I thought in Peri menopause one experiences symptoms because the levels start decreasing... but mine is at 269 and according to my obgyn is way too high. She wanted to treat me with birth control pills instead. And I'm having terrible symptoms. After a lot of push back I convinced her to get me started on a low dosage, She put me at 0.0375 mg.

[@StrideOrDie71]

That was your number on one day. It could’ve been 50 the next day, then 130 the day after that. This is why we need to go off symptoms and not blood levels. For me, if I’m too high I’m anxious and manic. Too low and I’m depressed. Took a lot of trial and error to get me at the right dose. How are you doing on the .0375?

[@SonnyJean1108]

All the doctors say no, no, no.They don't do hormone.Where do you get the prescription from?I don't understand this

[@shellyv9564]

There are many doctors fully embracing HRT now. Just do a search for HRT doctors in your area 😊

[@drsusan]

Doctors who have training are not saying -this the standard of care is to provide menopausal hormone therapy. This is supported by the American College of OB gynecologists, the menopause Society, and everybody else -so any Doctor who is educated would support hormone replacement for the great majority of women . You could look at the menopause Society website and find somebody in your area. Their website is menopause.org.

[@eleonorarigovic7551]

I started test. 1 month ago at .25% and was feeling like king kong for 2 weeks and then all fizzled. Doc has now lowered my oestrodial gel to half pump per day from 1 pump cause blood level went to 379 from 329 but now at that dose flushes have come back. What do u do when test. elevates oestrodial levels. Im atill on the liw dose test. My menopause journey has been litereally hell. My body temp is always low at around 33 deg and really feel the cold and makes me feel sickish. I am 65. What should my thyroid level be around t3 t4 tsh. Thanku

[@drsusan]

Happy to see you remotely or in person. Would love to have you make an appointment with my office.

[@luadiva]

what is the difference between testosterone and dhea for menopausal therapy?

[@drsusan]

Those are completely different hormones. DHEA is a testosterone precursor.

[@luadiva]

@@drsusan thank you, however I was keen to learn of your thoughts on their both being used in menopausal therapy. I have heard more about DHEA as a solution, but now I am noting the rise of actual testosterone instead of DHEA.

[@gabba7315]

@@drsusan Would love a video about supplementing with DHEA in (peri)menopause treatment.

[@Abbasblesseddaughter]

I use lavender oil. It has really helped and no prescription.

[@bbenabe]

For what?

[@m.flores6615]

So how long should I wait after applying estradiol gel and taking my progesterone capsule for having my blood drawn?

[@drsusan]

6 hours

[@m.flores6615]

Thank you for answering!

[@julienelson7082]

I'm confused with one of the last things you said. Go to Australia to get testosterone cream? My doc prescribed testosterone gel here in the states. Is cream harder to get than gel? Come to think of it, you never mentioned gel form. ????

[@drsusan]

You can get anything compounded ! my suggestion was if you were completely opposed to compounding we have no other option then to use male products or go to Australia

[@julienelson7082]

Thank you! That makes sense.

[@sheryl3268]

How small of a dose can the testosterone pellets be made? Would the pellets dose be low enough to bring blood levels from 16 to just 30 or 40?

[@drsusan]

You can get any dose for something like that I would try 25 mg

[@sheryl3268]

@@drsusan Thanks SO much! I am a couple states away, and if I can manage it, I just might try to see you for it.

[@Juliet875]

So ridiculous they approve pellets for men and not for women. I'm on pellets for Estradiol and Testosterone, love them. So easy to deal with, don't even have to think about it. I was on Progesterone cream and creams just don't work very well. I'm taking 200mg pill now, game changer. Pellets are great, just have to find the right level. Yes, blood work is so important. Thank you so much, great video!

[@jeannewilkins4662]

Hi Susan, can I use semaglutide if I am now getting hormone pellet every 4 months? Thank you

[@drsusan]

We would be happy to see you in our office. Please contact us and we will see you if you live in Texas.

[@marj8885]

I asked my doctor to check blood level, but she said I don't need it because I'm not on the compounded medication. I don't believe this, so where can I go and have my levels be checked.

[@drsusan]

Happy to see you in my office or we can see you remotely. You can get your blood drawn anywhere at many labs without a doctors order like" any lab test now"

[@msraider1500]

How can I find a Dr to help me ? I can't take these hot flashes anymore and don't know where to go.

[@drsusan]

Menopause.org or you can see us remotely !

[@msraider1500]

@@drsusan Thank you. I only see one near me and she's a midwife..?? Do you take insurance?

[@deewilkerson2994]

I’m sorry, several things you mentioned is why so many women don’t have any desire to do HRT.

[@laveshiayarborough-wall8232]

I loved the pellets the insurance wouldn't pay

[@chrismcdonald3799]

What about salivary test to test hormones

[@MaryBethMcCoy]

Salivary testing is not as accurate as blood testing.

[@deborahc7113]

why do u not like T by injs?

[@drsusan]

Because that hurts do you have to do it every week and it's not bioidentical testosterone but it's an option. It's not my preference.

[@TonyaA7]

If birthcontrols made me sick will HRT be the same...My doc tried me on many different kinds of birthcontrol and they all made me not feel well .

[@drsusan]

Totally different - lower dose and not by mouth

[@rlweidner6656]

I was the same with Birth control . I have had great success with the cream. Feel much better!

[@deborahc7113]

i was on est pill, my estrone level was really high, that isnt good, correct?

[@drsusan]

We shouldn't take estrogen orally so you're right that's a good thing to stop.- you don't need to measure estrone that is a weak estrogen that is not important.

[@deborahc7113]

@@drsusan i thought if estrone is high its bad

[@beachbreath2504]

When i tried to lowest dose testosterone pellet i did not have a great experience. Couldn’t wait for it to run its course and be gone from my body.

[@hulasenorita]

What was the lowest dose? Please share !

[@angelaperez2288]

You can also get Testosterone for injections at a regular pharmacy and use a tiny dose... because of the dosage being for men.

[@joannlamothe6640]

What level of testosterone do you like to see your patients at?

[@nushins]

🙏🙏🙏🙏🙏

[@redmoon5287]

please what are these HRT creams made with? Are they truly ” bio identical” ? thank you.

[@drsusan]

Bioidentical is really a marketing term. It just means that they are biologically identical to the human hormones, estradiol progesterone or testosterone. All bioidentical hormones are synthetic - they often come from a plant source and then are synthesized in the lab to look exactly like human hormones . Some are just synthesized in the lab from other molecules, but the endpoint is they look exactly the same as human hormones so in that way, they are bio identical. It's good to know that bioidentical really is a marketing term that has been used to make people think that something is better or safer than something else but anything that is biologically identical to human estradiol or testosterone or progesterone is bio identical, and most of these products come from a plant source

[@Katepwe]

@@drsusanI’ve read that the term body identical is being used instead.

[@karolmolpus9536]

My doctor will not give it to me, afraid of cancer. She is a young OBGYN

[@drsusan]

Well, she has not read any literature lately. I would find a new one. Menopausal hormone therapy reduces the risk of several cancers and has been well studied not to increase the risk of any cancer I suggest that you give her the book "estrogen matters," and read it yourself and also "the new menopause" by Dr. Haver is a very good resource

[@julienelson7082]

What does your body feel like with too much testosterone ???

[@drsusan]

I've never experienced that, but you would have masculinization symptoms like oily skin, acne, hair growth, hair loss on your head, potentially deepening of your voice, clitoral enlargement, etc.

[@julienelson7082]

I guess I'm more specifically wondering how does your body FEEL with too much testosterone .... Nervous, sad, angry, jittery, etc etc I see people on here who say "I didn't like how I felt with testosterone" (when it was high) and I've always wondered what they meant.

[@kmjdebay]

@@julienelson7082 When I was first on a pellet, because my T was zero, the provider started too high. I FELT super horny, energetic. I gradually reduced dose over the next year until I found the sweet spot. Is that what you needed to know?

[@kmjdebay]

@@julienelson7082 Horny.

[@theseeker1948]

Pellets can’t be changed like other delivery methods so you’re stuck with them until they dissolve.

[@kmjdebay]

A good reason to start low.

[@katherineb9]

thank you for this important information. What do you think about cycling HRT, doing 12 days of progesterone for instance out of the month. Dr Gersh talks about how important it is to cycle . Would love your thoughts on this kzbin.info/www/bejne/sHaYfZSJbd5rrdU

[@drsusan]

I don't want to have a period and my patients don't either continuous hormone replacement allows you not to have a cycle and to get the benefit of progesterone every day which is fantastic for sleep and moods so that is not my preference

[@lisaalexander1824]

Ffs...laws !!!