Why is it that I have to take Progesterone if I am taking Estrogen?
Progesterone can be prescribed for many different reasons, often in appointments we talk about the benefit of progesterone on sleep, anxiety and PMS symptoms. As a part of these benefits progesterone provides balances to the potentially harmful effects of estrogen, this includes protection against uterine cancer and normalization of blood clotting. For this reason we do NOT recommend unopposed estrogen therapy for any of our patients. If the type or dose of progesterone is not working right for you, contact us and we can help you optimize your treatment.
I was told that if I don’t have uterus, I do not need Progesterone. Should I be using this?
When HRT first started with the availability of Premarin, it was used daily on its own. After a few years an increased risk of uterine cancer was seen in women who had not had a hysterectomy (removal of the uterus). Doctors found that adding Progesterone daily prevented the increased risk of uterine cancer. This association led to the idea that women with a prior hysterectomy do not need Progesterone treatment.
BHRT strives to balance the sex hormones and reduce the risk of breast cancer. Natural Progesterone in a pill or cream form can improve sleep and reduce anxiety. There is also evidence that daily Progesterone can reduce the chances of breast cancer in women. BHRT does not believe in the HRT adage of ‘no uterus, no progesterone’.
Why do I need to apply the BIEST cream at night before my bloodwork collection? We request the Biest to be applied at night, so we can have a 9-12 hour window from the time of application to the bloodwork collection. If you apply your creams 24 hours before the bloodwork, your levels come back too low. If you have your bloodwork collected immediately after applying your creams, you bloodwork counts come back too high. Bloodwork collected 9-12 hours after the collection, gives us the best view of your levels. We also prefer your blood to be collected in the morning as your own hormone levels fluctuate from morning to afternoon, so this is the best comparison from the last collection.
I started the BHRT 2weeks ago and now I am having a period/ spotting, I have not had a period since 1yr? What do I do?
It is not uncommon to have a brief resumption of menstruation at the start of BHRT. The shorter the time interval from menopause to initiation of BHRT, the more likely this is to occur. In general, the doses of estrogen used in BHRT, are not sufficient to result in resumption of a regular menstrual cycle. First, do not panic. The bleeding doesn’t represent a health concern and will be addressed by your practitioner. Quite often, with continuation of the BHRT, menstruation will cease over 1-2 months. If not, a dose reduction in estrogen will correct the problem. Persistence of bleeding despite safe, low hormone levels will prompt a pelvic ultrasound and/or gynaecologic referral. if you are using the Biest cream to the vulva, you can start applying it to the skin to reduce the absorption of estrogen until the bleeding/spotting resolves.