What is the right dose of HRT for you? Hormones and POI | The Dr Louise Newson Podcast

How do you work out what the right dose of HRT is for you and balance the benefits with any potential risks?
In this episode, Dr Louise talks about HRT doses with Corinna Bordoli, who began experiencing menopausal symptoms when she was just 10 years old.
Corinna shares her experience of premature ovarian insufficiency (POI) - menopause before the age of 40 - and of the challenges she faced in getting a prescription for a higher dose of estrogen to help both her symptoms and future health.
Dr Louise and Corinna discuss why hormone needs and absorption can vary from woman to woman, particularly for those with POI.

[@hasinapatel1233]

I went to the doctor today I got exactly what i wanted ,estrogen patch 50 progesterone × 2 to take at night isn't it sad that i had to tell her what i wanted she was happy to give me it. I pray it works because my mood is very low but don't think im depressed as i generally don't suffer from depression so at a loss these videos are really helpful because everyone cant afford to go private we have to do our own research and hope for the best.

[@joycehennequin8469]

I'm did the same thing as you,lm only on Oestrogen at the moment hoping to get Testosterone added in a couple of weeks.But l had to ask for it as she said l think your depressed.

[@athenachloewoodrow6356]

I appreciate you both so much. I have been to two menopause specialists in the United States and though they are supportive in helping me and prescribing a HRT, they still are worried about dosing too high. One of them talks about keeping blood estradiol levels at about 70. I had my estradiol levels checked during very menopause and I was at 250. I just don't understand why they are so scared of allowing blood levels to be at the normal physiological range. If we've been bathed an estradiol our whole lives, why are they now trying so desperately to keep us at a low level in menopause? And these are the specialists. I just don't understand

[@Corrans]

Excellent question!

[@alisonjackson5814]

Freighters of being sued!

[@crh251]

I think providers still have the old WHI study in the backs of their minds which was totally flawed. They are afraid. My estradiol right now is only 69. I want it much higher than that. I know I’ll feel better. We have estrogen receptors all over our body. I think we should be bathing in it too.

[@fancytapes5851]

According to Newson Health, and others I have read, 250 and above is the volume we need for bone protection. 70 is a terribly low level. Run from that doctor if you can.

[@j_miracle7064]

@@fancytapes5851 You've probably read information in different units. Newson Health is UK based so will use pmol/L, in the US they use ng/ml For estrogen, 250 pmol/L = 68.09 ng/ml

[@ktcee803]

So much great information here. Ive been on estradot 100 for over 5 years. Recently tests show despite parches, i have the lowest esteogen in my system than ever before. I don't understand why. I suffer with awful symptoms. Tiredness, sore joints, immune issues, terrible sleep, terrible libido. Just awful. I dont know what to do.

[@Sillysausage17]

Increase your dose , maybe not absorbing now .

[@angelas.9717]

I'm new to HRT and still learning...Are you also taking micronized oral progesterone? Was the estradot working for a while and then stopped? If yes to the second question, it might be that your receptors are no longer responding because of continuous dosing...and that you may need to try what is called "cyclical dosing" wherein you stop the oral progesterone for several days a month (and maybe the estradial, I'm not sure) and have a bit of a "fake" menstrual period. Check out Dr. Felice Gersh on KZbin and on Google. She is a proponent of that regimen.

[@ktcee803]

@@angelas.9717 I'm not using progesterone at all because it affects me badly. I have Estradot 100. That's all. But I have started a powder that's got mavA and ashwaghanda in it and I find it helps with some of the anxiety I have. Yes, I do have to change the hrt and restart it. Seems to help with absorption. I read that the hoone receptors in the skin can get flooded. They need a break! And put patches or cream elsewhere for better absorptive.

[@KSMP]

I'm taking two pumps of estrogel daily. Each bottle has 64 metered doses I believe? I've noticed that when I get close to the end of a bottle my symptoms, especially insomnia get worse. And the gel seems thinner like more of each dose is actually just alcohol. Is that a real thing? And is there a way around this besides stopping before the full number of doses? My benefits might not cover more than one bottle per month and I doubt my doctor would prescribe it that way. The patches don't agree with me because they cause wild mood swings 😢

[@thecoloringoasis5616]

Curious if sudden difficulty continuing to lose weight after instant, surgical menopause and difficulty with orgasms, such as harder to achieve it and barely feel it when it occurs, does this mean you are too low-dose of a hormone patch? They started me on .05 Estrodial patch and I don’t have hot flashes, but I do have those other symptoms. Wondering if it would improve with a higher dose?

[@mermaidmaca]

Thanks so much for this Dr Newson. 😊x

[@NM-qc2dh]

The other question is that if two different women have the same serum oestradiol level regardless of the dose of patch applied to the skinwill they have the same physiological effects or do they affect the women in differing degrees. I too did not improve enough on Estradot 100 even though my serum level was 293pmol/l . I was advised that 100mcg was the max dose. I have since increased the patch dose to 200mcg with uterogestan 200mg at night with dramatic improvement in symptoms.However , my serum oestradiol level is now 732 pmol/l. I regret that I have had to take matters into my own hands, but I really didn’t know what else to do as Medical opinion is so diverse and it is so difficult to get a knowledgeable reasoned opinion. Also my testosterone level was undetectable and so I have been started on Tostran 2%, 1 pump every other day which has resulted in a serum level of 3.1nmol/l, ( upper level 2.6) . Initially the effect of the testosterone was pronounced but after about a month it appears to have tapered off. I have an Nhs appointment coming up, so I think this will be an interesting conversation…. I do not really know whether 732 pmol/l is an acceptable serum level of oestradiol but I can say that I feel miraculously better in every way. Any advice would be most welcome.

[@tessashepherd580]

Thank you - so very informative

[@deborahh3912]

Love your podcasts, so informative and empowering! I consulted a menopause clinic here in Ireland. They gave me HRT without any blood tests, or any tests whatsoever. They finally did bloods and only testosterone was low. They don't prescribe this so wanted me to up HRT instead. My hair started falling out so I stopped everything. Is there any way of boosting testosterone?

[@joycehennequin8469]

Oh l do feel for you and l pray you get sorted out ❤

[@brookehanson7431]

What is a POI specialist called? I live in US and am having difficulty finding a qualified doctor to help me

[@jt8142]

POI = Primary Ovarian Insufficiency (in women less than 40 years old) In the U.S., you can see a gynecologist or endocrinologist regarding this issue

[@mariedawn-]

Hi Louise, I’m a lifetime pcos sufferer, is there a reasonable explanation for the combined pill being made from synthetic and altered versions of hormones and for there being no pill which contains testosterone? I have suffered my whole life, whether off or on the pill, and now it seems obvious that big pharma has knowingly engaged in large scale malpractice, producing harmful medications that have never adequately met my needs. I’m also childless and not by choice and I feel that my life has been limited in all aspects by poorly designed medications. I don’t have words for the lack and loss I have experienced.

[@courtneyreid9862]

I’m so sorry to hear your story. I was denied HRT for many years for no reason! It’s criminal how we’re treated!!!!!! I hope you find the right doctor! I am also trying carnivore diet…

[@Lynds-kw2pr]

Hi there I was wondering if you could tell me if it’s best to take progesterone by pill or cream? I was prescribed this for pms symptoms that are severe. I am feeling really nervous about taking this even though I am desperate to help my symptoms. I read some horror stories about weight gain or loss with taking progesterone only. Any insight would be so helpful thank you for your videos ❤

[@encinosarah]

So what is the right dose of HRT for me and how do I figure it out?

[@crh251]

I would start low and work your way up. I’d start with both estradiol and progesterone. Go by how you feel. If you’re post menopausal your hormones are already so low that they are undetectable. That’s how mine were too.

[@encinosarah]

@@crh251 Thank you.

[@gilliandowney5225]

The rule is the younger you are the higher dose you need.

[@m.flores6615]

It is said thay No progesterone is needed without womb? Are there no other benefits of progesterone besides protecting uterus lining?

[@crh251]

There are lots of benefits of progesterone. I think women without a uterus should still take it.

[@nstowolosow]

One of the benefits progesterone relaxes you and helps with sleep.

[@m.flores6615]

@@nstowolosow progesterone has not help me with insomnia, instead is making my insomnia worse … I really dont understand why : progesterone level was rather low (0.6 ng/ml and estradiol 1 pg/ml))and when I increased a little bit then I couldnt sleep at all

[@jeanies8495]

For HRT I have a uterus I’m on an estrogen patch, but for my progestin , I am taking the mini pill Lyza, .35 mg a day. I hope that’s enough for menopause, I’m 53. Is Lyza okay? They are not giving me anything else, pills or topical

[@patriciapyper4617]

How long are you in perimenopause why do you get neausa post menopause and vertigo on evorol Conti patches please thanks ♥️🌹

[@yensounta6501]

This is the best discussion I've seen on the topic of POI, especially the dosage nuances. Please continue 🩷

[@Corrans]

I am currently using the birth control pill as HRT. If i use testosterone gel, is that being eliminated by the raised SHBG? Or is it worthwhile uaing testogel whilst on the pill?

[@cearilindubhlaoi9507]

If your SHBG Is high your hormones are not fully available to you ...the low side SHBG Is always better..

[@crh251]

The birth control pill is not the best solution for menopause. I would look into plant based hormones that are not synthetic. If it’s bringing you some relief though then continue. You want to feel good.

[@Corrans]

@crh251 thank you. I am now on biodentical hormones. Appreciate the reply.

[@helenalovelock1030]

@@Corrans I never knew this either. Birth control completely synthetic and knocks out our natural hormones with synthetic ones

[@faceitfindit1751]

21:37 had a full hysterectomy and been trying to convince my doctor to put me on 2 patches of 50 mg . But they don’t know how to prescribe the utrogestan . Makes me so sad that doctors in this field in different countries we try to get the info for them to help us . What do you think ?

[@jenifercabaniss7299]

There is a certain time in my month with estrodoil and progesterone that I am just exhausted! I feel like I need testosterone? Help! What could be wrong?

[@mariagebrial8395]

Hello my period stopped I have been taking HRT for 10 years I stopped because I keep getting leg cramp. I have no hot flush I can sleep ,my problem is I lost sex interest . What kind of HRT can I take? I tried estrogin cream it didn’t help?

[@jt8142]

Leg cramps are often due to magnesium deficiency not HRT

[@angelas.9717]

I heard that testosterone for post-menopausal women is solely to improve desire. But in the US, women cannot get it via a standard CVS/Walgreens type of Rx as it is only available to men. USA women CAN get a testosterone Rx via a doctor who works with a compounding pharmacy (there is varied opinions about the efficacy of compounding pharmacies.) Hope this helps.

[@shannonhoffman5875]

If you're on bioidentical creams HRT can you still take soy products I was taking a soy product before HRT to relieve menopause symptoms and I still take it Den on HRT for about 5 months

[@patriciapyper4617]

How long does it take evorol Conti patches to go through the skin when you change your patch please thank you ♥️🌹

[@destinationunknown4959]

Immediately

[@itsme_shanti]

Is the shortage of HRT due to the increase in gender therapy?? these are the hormones they use to transition male-female, specifically Estrogen..

[@alisonjackson5814]

No. There are a tiny number of people on that drug therapy and millions on hrt so it wouldn’t make enough difference. I think it’s more to do with the government & nhs have never prioritised women’s health, haven’t increased their purchasing of hrt at the same time that there’s been a massive upturn in demand.

[@helenalovelock1030]

Ofcourse not only a tiny tiny amount of the population are transgender and absolutely millions of women wanting HRT now. No need to blame transgender population

[@athenachloewoodrow6356]

🙏

[@PLT722]

There’s not such a thing as ‘early menopause’! It’s always a sign of imbalance in the body that can be remedied by herbs ( Chinese or Ayurvedic best )

[@helenalovelock1030]

“Herbs” didn’t work at all for my mum. Besides where is the clinical evidence?

[@MrDandelio]

@@helenalovelock1030 yes! Hundreds of women just working with one practitioner !

[@ebuzalkovska]

I had premature menopause at 39. Herbs did not help, neither did acupuncture

[@j_miracle7064]

@@ebuzalkovska Just diagnosed at 31. Not sure how this person thinks herbs are going to magically grow me some more eggs!

[@MrDandelio]

I believe that’s not menopause but POF = premature ovarian fatigue. Can be healed with the right approach 🩷