I am far from being an HRT veteran. I’ve been using supplemental estradiol and progesterone to help treat my tumultuous perimenopausal symptoms for 20 months now. As most women who eventually decide to try HRT will tell you, it can take a while to get your optimal dosing and delivery routes mastered. At my age, I probably have a minimum of five years before I cross into official menopause.
Dosing refers to the amount, or prescription strength level, of estradiol or progesterone you are taking. For example, the typical dose of an ibuprofen pill is 200 mg. Similarly, estradiol comes in various standard dosages. Delivery route pertains to the manner in which you take your HRT. Generally, there are two mainstream routes – transdermal (through the skin) through a patch, cream or gel – and oral by taking pills. A less common route is beneath the skin through hormonal pellets, but you won’t find much information about that here.
Being on HRT for as long as I have, some might think I would have reached the height of results I could obtain. But I was wrong. While I was feeling much better – I’m talking leaps and bounds from the pits of my state in late 2020 – I was still experiencing periodic night sweats and rare episodes of what I call sub-threshold “alertness.” By that I mean that the rhythm of my day, usually night, could be thrown off kilter by anything that disrupted the predictability I now try to maintain in my daily regimen. An apt example would be the noise of a train outside rendering me hyper-alert even though I was just about to nod off into dreamland.
I knew that this was not entirely unusual. Women in perimenopause and menopause forums and communities online shared similar tales. Being more easily triggered by the mundane and having breakthrough sweats are associated with something being a bit off base hormonally. I was already at a relatively upper-limit-dose of estradiol, but I decided to proceed with my dilemma and visited my doctor anyway.
To make a long story short, it was decided that I could do a test run of changing my dosages and delivery routes. Though transdermal estradiol tends to be the go-to formula by most prescribers, this default choice may not take into account the differences in women and how we metabolize or process the supplemental hormones. In fact, many women complain that they don’t absorb estradiol well through the skin, especially with patches, or that they can feel the patch “run out” of hormones before it’s time to change it. Plus, estradiol patches are ridiculously expensive, even with insurance. The compounding cost over months and years, if totaled, can be astonishing.
So I am now taking oral estradiol for a spin. The results and differences so far are subtle, in that they feel completely natural and unforced. But the night sweats that were breaking through seem to have mostly ceased. (The treatment goal is not always complete remediation, but rather a statistical improvement. Yet that hasn’t stopped me from pursuing my personal hormonal Eureka.) Not only am I waking up dry, my mentality feels that much more dialed in. I am finding myself doing more of what I used to, somehow not overthinking to the extent I’m inclined to as a Type A person, and feeling less internal frustration with the theatrics and drama of having teenagers and a lot of real life stuff going on in the background.
These oral estradiol pills are where it’s at! At least for me right now.
The caveat and disclaimer here is that every woman is different, and the decision on the dosing and delivery of your hormonal therapy will need to be made in consultation with your doctor. Generally, oral estradiol is avoided for women considered at-risk, including being obese, diabetic, having a history of blood clots, smokers and others. Fortunately, I don’t have any of the risk factors that typically curtail doctors from prescribing oral estradiol in pill form.
Did I mention that it’s also much, much less expensive? Your mileage on cost may vary depending on your insurer or your budget, but I feel like it’s highway robbery for there to be such a premium on patches, when pills are exponentially cheaper and kinder to my wallet.
If you’re on estradiol patches and still not feeling quite right, my first recommendation would be to revisit the dose. Are you taking enough, or is your doctor playing it too safe and conservative? That is a common problem. Sometimes you may be able to convince your doctor to prescribe a higher dose, and other times you may have to seek out a provider who is more interested in helping you feel better than in doing HRT the lazy way – prescribing the same baseline dose to each woman.
If you increase your patch dosing and still are not satisfied, I think oral estradiol pills are a rationale proposal. I take mine in the morning each day, and I do not sense any diminishment in my day that could signal a hormonal slump. I feel level, even and balanced.
I will also add that I do a lot of other stuff aside from my estradiol pills, but I am not going to promote my personal lifestyle and prescription plan because every woman is different. I will say that the only thing I’ve changed recently is the addition of estradiol pills, and it feels absolutely wonderful.
The Real Peri Meno is devoted to all things perimenopause - the science, treatments, care, understanding, personal experiences, relationships, culture and more. The brain child of Keisha D. Edwards, The Real Peri Meno developed out of her own shock-and-awe experience with perimenopause and navigating the disjointed U.S. medical system in search of answers, support and relief.
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