His and Her Health

I am new here and thought I would see if anyone else has had an experience like mine and if anyone has answers. I had a total hysterectomy 7 years ago at 30 years old. I have tried all hormones - traditional and bioidentical. I have used all kinds of delivery methods. Nothing works. If I used estrogen right now I would have heart palpations within 30 minutes. Although I experience hot flashes, they would increase almost immediately. I am at my wits end. I want to do the hormones because I feel that my body needs them, but they don't like me. Now what?

I'm post-menopausal and working with a doctor on HRT. One thing I learned, which I'd never heard about before, is that the balance between the different hormones is crucial. For example, although I was on both estrogen and progesterone, I was still having hot flashes. The doc had to raise the ratio of progesterone to estrogen before they went away. If your doctor hasn't already tried this type of adjustment, you might want to look for someone else. I don't know what sort of specialist knows most about HRT. Maybe someone else out there can help with that.

I am assuming that when you say total hysterectomy, you mean that your ovaries were removed, and not just your uterus. The good news is that you are in the group that has the best results for hormone replacement. I wish you could clarify what hormone systems you have tried. Ideally, you should always try as hard as possible to make transdermal hormones work, as they have the best cardiac profile and risk profile.
Heart palpitations are commonly caused by falling estradiol, but it sounds like yours are caused by rising estradiol as well. In order to defeat this, you need to try a smoother delivery system. Try a patch and/or Estrogel. Have you tried Vivelle or Climara patches? Particularly the Vivelle dot? These take 24 hours to reach full strength, and that may smooth things out for you. Generic patches often don't have the same smooth rise of estradiol. Unfortunately, the only way to know if one of these brands is right is to try them.
Second, if you had problems with a compounded cream, it's not surprising. The pharmacies and so called hormone experts often push those creams, but they are not the optimal delivery for most women. An estradiol cream usually causes and intense and quick rise in estradiol levels, and then drops rapidly as well. In your case, you would probably have heart palpitations immediately after applying and a few hours later when it wears off. Estrogel gel has a much smoother action in the bloodstream for most women, without the sharp peaks and rises that can trigger heart palpitations and/or panic attacks. Estrogel must be applied two or three times a day to get sufficient estradiol into the bloodstream.
Estradiol pills may also help, if done properly. A number of women report that the generics cause your sort of problem, but that the brand, Estrace does not. Even better for most women, is Estrace compounded into microionized form. Microionization is a way of treating medication to slow its uptake in the digestive system. Any good compounding pharmacy can do this, but you may respond differently to the brand and the generic. Or you can try taking a half dose in the morning and a half dose at noon.
You are also in need of testosterone. But don't add in testosterone until you have the estradiol issue fixed.

<small>[ 01-22-2008, 02:42 PM: Message edited by: Moderator ]</small>