I had a complete hysterectomy 20 yrs ago and use the patch until approx 9 mo ago. I started having hot flashes, headaches, heart palpitations. I have tried a couple other estrogen creams/gels without success. Symptoms have increased. I asked Dr to start me on the lowest dose and work up but she told me if I am still having symptoms I need a stronger dose. Is this correct?
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Q: How do I know if I am taking the right dosage of estrogen?
Answers (2)
12/29/09 11:36am
Hi, Lonelyheartsclub,
I'm not a doctor, but I have learned that the dosage amount that works tends to vary by individual. Therefore, your doctor very well may be correct, but you may want to get a second opinion from another medical professional.
I'd also suggest that you consider some lifestyle changes to see if these will make a difference. For instance, I started having heart palpitations about two years ago. My doctor suggested that I cut out caffeine (which I did). I also started exercising regularly, taking CoQ10, eating a Mediterranean diet regularly, and actively working to lower my stress level. Those simple steps seem to have worked and my heart is pretty much back to beating as normal. And I also have found that certain foods can trigger hot flashes - for me, it's beer. So I rarely drink a beer and instead opt for wine. You may have other foods that trigger hot flashes and headaches so you may want to keep a record of what you eat to determine what the trigger is.
Take care and keep us posted!
Dorian
12/30/09 1:34pm
Hi LHC,
One of the most common reasons that women who have had hysterectomies continue to have symptoms even tho they are on estrogen--even on higher and higher doses of estrogen--is that they are out of hormonal balance.
Unfortunately many doctors view the purpose of progesterone very narrowly and see it only as helpful to protect the uterus against estrogen. Therefore, if you've no uterus, you get no progesterone. Our hormones acted in a balance up to menopause and need to be in balance to work most effectively afterwards. Ask your doctor for a prescription for progesterone (Prometrium). Not only should that help the hot flashes, you may find that it improves your sleep and mood (2 of the important functions of progesterone). Also, progesterones down-regulates estrogen receptors meaning that when you put the 2 together, you can use lower doses of estrogen for the same effect.
There is a small population of women who have had hysterectomies who will continue to have hot flashes even with the addition of progesterone. Although the mechanism is not clear, it has been common in practice for quite a number of years to add testosterone (1-1.5mg) to the estrogen and this will decrease/eliminate the hot flashes.
Good luck to you and Happy New Year,
Sandy, RN, CNM,
Certified Menopause Clinician
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By lonelyheartsclub— Last Modified: 12/26/10, First Published: 12/21/09
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