QuestionDear Dr. Saleeby:
Thanks for answering my question on red rice yeast. Again, as a fellow Allexperts, I appreciate your time.
I don't know many people with have the expertise on bioidentical hormones, so if I might, I'd like to ask you your opinion. I realize you don't know me or my history, so I fully understand that as you frame your answer.
I am 54 years old and have been in menopause (no cycle) for 4 years. Lately I have had vaginal irritation (he feels due to dryness) so my doctor suggested estring. I didn't want to go that route. I am a DES daughter and 9 years ago had a pre-hyperplasia issue that has been resolved for 8 years.
The doctor told me to do research and let him know what I found. The consensus seems to be split...some compounding pharmacists have told me to use a 0.5 estriol, 0.5 testerone and 10 mg. progesterone to 1 gram of vaginal cream. Others say I only need the 0.5 estriol and if I wish..I could also add the testesterone 0.5.
My questions are these: Is progesterone 10 mg. low enough to be effective enough to guard against pre-hyperplasia but not be metabolized to estradiol? Do any of these hormones used either as needed or twice a week long term raise a person's breast cancer risk? Are these doses low enough not to have a lot of systemic absorption? Last question, if I elect to go with the formula with the 10 mg. progesterone and use as needed or once, twice a week, would the progesterone cause breakthru bleeding? I realize the goal of therapy is to use the lowest dose to alleviate symptoms. I just want to make a good and a safe choice. If there is a more natural way to alleviate this problem without the hormones, I'd like to know how to do that.
Thanks. Warmly, Ruthie
AnswerRuthie,
Should you wish for more detailed answers and bio-identical HRT management please visit www.saleeby.net
You wrote: (my answers are within)
My questions are these: Is progesterone 10 mg. low enough to be effective enough to guard against pre-hyperplasia but not be metabolized to estradiol?
Progesterone is not necessarily metabolized to Estrogens but rather it is the Testosterone and DHEAs that are. If you have a uterus then Progesterone is recommended to protect against hyperplasia and uterine dysfxn.
Do any of these hormones used either as needed or twice a week long term raise a person's breast cancer risk?
Yes, there is an inherent risk of increasing your chances with hormones whether natural or synthetic. Even estrogenic foods have a theoretical risk. If you have a cancer that has Estrogen and/or Progesterone receptors then you are at increased risk. However, low dose of Estrogens like E2 (estradiol) and E3 (estriole) are much safer than the pro-cancer E1 (estrone) which should be avoided. E3 is very weak and thus E2 is often added for true estrogenic effect. I use biest often.
Are these doses low enough not to have a lot of systemic absorption?
Systemic absorption occurs in any dose amount... whether applied on the skin or vagina. Obviously the lowest dose that achieve results is where you want to be.
Last question, if I elect to go with the formula with the 10 mg. progesterone and use as needed or once, twice a week, would the progesterone cause breakthru bleeding?
There is a possibility. I rarely recommend PRN use of HRT. HRT in my opinion is not to be used in such fashion, but rather used for other lofty goals.
I realize the goal of therapy is to use the lowest dose to alleviate symptoms. I just want to make a good and a safe choice. If there is a more natural way to alleviate this problem without the hormones, I'd like to know how to do that.
Would be happy to discuss via phone (tele-medicine consultations).
JP Saleeby, MD
www.saleeby.net
