How to use NHRT

Karen33January 23, 2002

Hi everyone! I've been reading with great interest and decided finally to post a message. I'm 52 with an FSH of 84 which means I must be menopausal. I still get my period every now and then, but they're usually 7 months apart. I recently changed doctors because my last one wanted to do a hysteroscopy/D&C without even doing a pelvic sonogram first to check my endometrial lining. I said no thanks and found another doctor who seems knowledgeable about natural hormone replacement therapy and the various herbs and supplements on the market. My diet is very healthy and I take in lots of soy. I exercise regularly and do lots of yoga (I'm a yoga teacher) which, by the way, is one of the best forms of weight bearing exercise you can do. If you haven't tried it, you might want to consider it. Yoga also alleviates stress through deep relaxation and breathing. But back to me.....I'm taking a bunch of supplements, such as black cohosh, chasteberry, gingko biloba, st. john's wort, flax seed oil, plus the necessary vitamins (calcium, E, A, B, C, etc.)And they have all helped tremendously. But not enough. In the past year, my big problem has been vaginal dryness and frequent UTI's. With my new doctor, we decided to try Estriol vaginal cream (the "weak" estrogen), just 1 gram twice a week and natural progesterone cream (I was using the OTC kind, but she doesn't trust the dosage). I found a great compounding pharmacy in my area and they make up both for me. Of the natural progesterone cream, I'm using 1/4 teaspoon (or 1 and 1/4 grams) twice per day. That's my first question. Does anyone out there who uses the cream feel that's too much? When I measure out 1 and 1/4 grams, that's quite a lot of cream. I plan to use it on for 3 weeks and off for one, which I guess is pretty standard. I just recently started the estriol cream, using it every night for one week, and then just twice a week after that. Suddenly, my breasts feel a bit tender. Could that small amount of "weak" estrogen be affecting me that quickly? That's my second question. And here's my third question: if I'm using the estriol cream, should I eliminate the black cohosh completely, which is a phytoestrogen and used by many women instead of going on hormones. My partner lives at a long distance and we haven't seen each other since I started this regimen. So I'll let you know if it works for the vaginal dryness the next time we get together. In the meantime, I would so appreciate any advice from all the wise women out there who read this forum.

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I also use the cream and I think it is a lot too! It seems to be working fine for me and when I don't rub it in at night, I have trouble sleeping and have night sweats. As for the estridiol, yep that will make your breasts sore as can be until your body adjusts to it. I take black cohosh, but I do not take any estrogen at all at this time. So I think that is a question to ask your doctor, or ask it on WebMD, Joan Starker on menopause. She is pretty good about researching medical questions and getting back to you. Good Luck Les

    Bookmark   January 23, 2002 at 8:45PM
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Why does an FSH of 84 and being age 52 mean you "must be menopausal?" If you're still having periods even if every 7 months you are not post menopausal, although you might be perimenopausal. FSH is a waste of time and money when used to determine menopausal status.

Your sore breasts might be the result of your prescription progesterone cream which presumably actually contains a significant amount of progesterone unlike the otc stuff. Breast tenderness is a known side effect of progesterone. It's unlikely that enough of the estriol from the vaginal cream is getting into your systemic circulation to cause this problem although it's remotely possible. You do know that the estriol cream is not intended to be used as a lubricant and its use should be avoided for 24 hours or so before sexual intercourse?

    Bookmark   January 24, 2002 at 9:35AM
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Leslie, thanks so much for the response. I find that I'm sleeping much better too since I started with the natural progesterone cream. And could you tell me what dosage of Black Cohosh you're taking? I've been told the recommended dosage is 1 or 2 40 mg. tablets twice a day. I'm only taking one twice a day but again, wondering if I should eliminate it completely. I guess I could try and see what happens, if anything. And Leigh, you made a statement that was a surprise to me, that breast tenderness is a known side effect of natural progesterone cream. I've done a good deal of reading about this product, and that's something I have never heard before! Could you tell me exactly what your source is? I'd like to read this for myself. Thanks! I'm open to any other comments from readers out there.

    Bookmark   January 24, 2002 at 10:18AM
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I said it is a known side effect of natural progesterone. If you go to the thread someone posted last night about prometrium (which is oral natural progesterone) you will see it listed there. For more information about the known side effects of natural progesterone go to and use progesterone as your search term. Incidentally, women who have problems with breast tenderness during their cycles usually develop this problem in the last half of the cycle when progesterone is present naturally. For most, the problem ends with menstruation when progesterone almost disappears only to reappear after ovulation as progesterone levels increase again.

    Bookmark   January 24, 2002 at 10:44AM
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I am not sure what the dose is for the black cohosh, but I will check it out and let you know. As for Natural Proegsterone Cream, I have never heard of breast tenderness either. I have not had any problems so far with the cream and I use it twice a day. By now, I would have had some soreness..I think. I will get back to you with the dosage.
Enjoy the day. Les

    Bookmark   January 24, 2002 at 3:28PM
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The dose of the black cohosh is 20mg. I take one pill
in the am and one in the pm. I hope this info helps.

    Bookmark   January 25, 2002 at 9:25AM
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Leslie, thanks for the info! That's half the dose of the pills I'm using. Mine are 40 mg each and I take one in the am and one in the pm. I may cut back to once a day and see if it makes a difference one way or the other. I just don't want to be taking something unless I really seem to need it. Thanks again.

    Bookmark   January 25, 2002 at 1:28PM
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Yes try that. I think th e black cohosh and natural
progesterone cream are helping me a lot. Les

    Bookmark   January 25, 2002 at 4:17PM
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Hi Karen and other contributors
I'm nearly 50 and still having periods. I was suffering from several unpleasant menopausal symptoms such as hot flushes, trouble sleeping, acute vaginal dryness and lack of libido over the past 1-2 yrs. I had a hysteroscopy/D and C due to build up of uterus lining 2 yrs ago and since then periods have been regular, but light and only about 3 days. I decided to try an OTC progesterone cream just after Christmas and was amazed at how quickly all those symptoms disappeared. If I forget to rub some on before bed I don't sleep well - hot flushes and waking up feeling very scared about something - but then I lie there and can't for the life of me work out what the hell it is I'm scared about! I live in France and the gel I'm using is called Progestogel which you can find on the Net. My first period after starting on the progesterone cream was much heavier than since the op, though not abnormally so, and I felt SO much better. My second one is due at the end of this week and I've been having the most painful menstrual cramps as of several days back. Never had anything like it before - well maybe when I was much younger, for a day or so, but never day after day! Anyone else experienced this? Does it mean I need to increase the dose? When my period starts I'm planning to have a week off the gel (although the info in the Progestogel packet says to use it every day, even when you have a period) but I've read some women's contributions to this forum who have said they can't bear to be off it that long, because all the symtoms return. So maybe I'll follow the pkt instructions instead! I started this progesterone cream without consulting my gynae. He put me on HRT twice last year (pills then patches) and both times I gained weight immediately and felt awful - effect of the estrogen I think. I have found a new female gynae in Paris who specialises in menopause and have an appointment with her in early March to discuss what I'm doing and see if she feels I should be making any adjustments or perhaps using a progesterone cream for which you need a prescription. I would be interested in any feed back to this msg.

    Bookmark   January 26, 2002 at 5:52AM
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Hi Linda. Everything I've read about the natural progesterone cream says that women still getting their periods should stop using the cream the day the period starts and stay off of it for a week. I know what you mean about sleeping better, by the way. Same here. As for the heavier, more painful periods. All I can tell you is my own history. The last couple of years I was getting my period on a somewhat regular basis (I don't think it's really been regular for about 10 years), I experienced extremely heavy bleeding and horrible cramps. I had to take presciption drugs to alleviate the pain. In my case, if was my body in perimenopause, doing what happens with a lot of women before the periods finally end. It got worse and worse, and then stopped, though not completely, as I still have experienced a small period every seven months for the last year. I think it's great that you found a doctor who specializes in menopausal issues. That's nine tenths of the battle, finding a physician who knows a lot about this. I did the same thing just recently, finding a doctor who looks at it both medically and holistically, who prescribes natural hormone therapy when appropriate but also understand the benefits of nutrition, exercise, herbs, and supplements. Good luck and please let us know how the appointment in March goes.

    Bookmark   January 28, 2002 at 10:37AM
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