Hormone and Estrogen Replacement Therapy Problems

HRT and feedback problem

As the estrogens go up, the hotflashes should go away. Have you had a blood (serum) estradiol level drawn? The reason I ask is that sometimes estrogen replacement can get too high while chasing hotflashes and the high levels actually cause stress-related hot flashes. I've seen this in some women and they actually need to decrease levels of HRT.

Also keep in mind there are other causes of hotflashes. They are listed at hot flashes causes. They include: hyperthyroidism/thyrotoxicosis anxiety, panic attacks, carcinoid syndrome, pheochromocytoma, drugs, diencephalic epilepsy, tuberculosis, and malaria. If your serum estrogen level (usually estradiol) is normal, your doctor may need to look for some of these other causes.

Normal estradiol levels depend on the laboratory and units it's reported in. In menopause, the range may be 10-20 pg/ml or 40-70 pmol/L. In normal reproductive age women during the menstrual cycle, estradiol levels range from 50-400 pg/ml.

In our lab, values under 100 pg/ml can be associated with hot flashes so if your levels are the same units, you might need more estrogen as your doctor has indicated.

What different preparations have you tried other than the patch and the Estratest?

These are all estradiol products and conjugated estrogens. Did you try any Estratab, which is estrone synthesized from plant steroids?

This is not an excessively high dose. In fact for surgical menopause (ovarian removal) most women require the equivalent of 1.25 mg Premarin.

There can be a variability of each tissue's sensitivity to estrogen. Some women will get moderate breast pain before reaching doses that relieve hot flashes. Others may have nerve or skin tingling at very low doses. Others will have irritability and headaches but still have hot flashes. Some women may take very high doses but still have vaginal dryness. If endometrium is quite sensitive, women with a uterus have bleeding at low doses.

Yes. There can be an effect at the central nervous system level, involving catecholestrogens.

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Hormone and Estrogen Replacement Therapy Problems