The safest way to handle vaginal atropy according to all the research which I have seen is with a BHRT estriol vaginal cream and hylauronic vaginal suppositories.
I find that a base of topical systemic cream estrogen is needed also to make sure that the vaginal works well. And any time which you use estrogen it is always safer to use a progesterone, whether you have a uterus or not. After all you still have breasts and the rest of your body.
Of course amounts all depend on your symptoms and a good hormone test by a good doctor. So be sure to consult with a hormone specialist. https://pmc.ncbi.nlm.nih.gov/articles/PMC4515379/
"Studies in Europe have evaluated various low and ultra-low dose estriol preparations and shown them to be safe and effective [30, 32]. Since estriol is a weaker estrogen, has a shorter duration of binding to nuclear receptors, and cannot be converted to estradiol, it has no appreciable effect on the endometrium when vaginally administered once daily and in low doses [1, 30, 32–33]. This balance of efficacy and minimized untoward effects makes estriol a very appealing possibility for the future. The lack of any FDA-approved estriol preparations, however, limits its availability in the United States to custom compounded preparations."
You can find a doctor to prescribe a compounded vaginal estriol by calling your local compounding pharmacy and asking for a doctor that uses BHRT, vaginal estriol and hormone testing.
Minimum, 1 gram of Estradiol Vaginal cream 0.01%, 3 times a week. Apply more than a pea size amount to Clitoris, Vulva, urethra and Vestibule. Use as much as you think you need and as often. Moisturizers are for comfort they won't help with the atrophy. Progesterone is not required for local vaginal estradiol. Estriol will not help with GSM, it's too weak. Make sure the prescription is written correctly so you will have enough medication for vulva and vaginally. "Apply 1 and 1/2 grams vaginally 3 times per week.
@sirene
frequently the problem with estrogen cream are the additives and the base.
Versa Base is a good base to try for those of us with reactive tissue.
But.... here is a listing from google of what additives and base to try or lose:
"While VersaBase is already designed to be hypoallergenic, irritation in sensitive vaginal or vulvar tissue is often triggered by specific secondary additives. Eliminating the following common culprits from your compounded formula can significantly reduce the risk of burning or itching:
Propylene Glycol (PG): This is one of the most frequent causes of vaginal burning in commercial products like Estrace. VersaBase is formulated to be Propylene Glycol-free by default.
Parabens: These preservatives (like methylparaben or propylparaben) are common allergens and can disrupt the vaginal microbiome. VersaBase is paraben-free.
Glycerin: While a humectant, glycerin can sometimes feed Candida albicans, potentially increasing the risk of yeast infections, which lead to secondary irritation.
Fragrances & Dyes: These offer no therapeutic benefit and are high-risk triggers for contact dermatitis in the vulvovaginal area."
Also, Sirene, your compounding pharmacist may be able to make up a hyaluronic acid suppository, at a very affordable price point, with a script from your doctor. I even third or quarter my HA suppository which is an even better price point. 🙂
Minimum, 1 gram of Estradiol Vaginal cream 0.01%, 3 times a week. Apply more than a pea size amount to Clitoris, Vulva, urethra and Vestibule. Use as much as you think you need and as often. Moisturizers are for comfort they won't help with the atrophy. Progesterone is not required for local vaginal estradiol. Estriol will not help with GSM, it's too weak. Make sure the prescription is written correctly so you will have enough medication for vulva and vaginally. "Apply 1 and 1/2 grams vaginally 3 times per week.
@kisu
I am not sure how you can say that estriol will not help with Genitourinary Syndrome of Menopause (GSM).
Numerous research studies show that estriol (specifically in low-dose vaginal gel or cream form) is highly effective at treating Genitourinary Syndrome of Menopause (GSM). Plus, it is safer and less likely to cause bleeding . links below
Also the hormone amount needed depends on each individual and needs to be guided by a hormone specialist.
I am finding from self reporting that many women without a uterus/ovaries seem to need stronger intervention in the form of estradiol. Whereas, women who still have a uterus/ovaries frequently have a problem with bleeding especially if estradiol is used vaginally. My hormone doctor refuses to use estradiol vaginally, he says that it is just too dangerous. Indeed, in Europe some forms of estradiol are restricted after 2 months. https://www.medscape.com/viewarticle/919501
Estradiol is safest used as a topical systemic cream, not vaginally. Even with topical use estradiol may be too strong for many women. So be sure to have the appropriate tests and start with the smallest amount and strength.
Some forms of estradiol have been restricted to limited use in Europe. https://www.medscape.com/viewarticle/919501
Progesterone is always appropriate to use to balance estrogen use. There is a reason why the body always produces progesterone; it makes estrogen safer, and even if you don't have a uterus/ovaries you have breasts and all the other estrogen receptors found in the body. Keep yourself safe. https://pmc.ncbi.nlm.nih.gov/articles/PMC7188038/:,mostly%20undetectable%20throughout%20the%20study. https://pmc.ncbi.nlm.nih.gov/articles/PMC9452593/.
"Conclusions
Ultra-low-dose 0.005 % estriol vaginal gel is safe and effective in preventing recurrent urinary tract infections in postmenopausal women with genitourinary syndrome of menopause, reducing the incidence and potentially decreasing the susceptibility to urogenital infections by improving vaginal pH."
Estriol is also shown to maintain bone health: https://pubmed.ncbi.nlm.nih.gov/8741364/
Hyaluronic acid suppositories are recommended by Sloan Kettering for vaginal atrophy. I personally have found a larger impact from hyaluronic suppositories than from estrogen vaginally.
I have found from talking with women about BHRT/HRT for decades that we are all individuals and need the help of a hormone specialist and some good hormone testing and even then the body decides what it wants to do with the hormones which you use. Indeed, the body has the ability to convert most hormones into other hormones. Estriol is one of the few hormones that does not convert to other hormones, which is one reason that it is so safe.
Also, one more warning, many of us continue to make our own estradiol decades into menopause. So if you then start supplementing with estradiol without hormone testing, you run the risk of too much estradiol and all the problems which comes with that. Until just recently at the age of 73 years old I have made plenty of estradiol and even at 73 I make some estradiol and am just beginning to need a small amount of estradiol systemically.
Over and over again I have seen women who decide to follow someone's advice to take estradiol vaginally and then they have to have a D&C because of hyperplasia and bleeding. Start with the least amount needed and least strength plus have a good doctor and good hormone testing. Keep yourself safe.
@kisu
I am not sure how you can say that estriol will not help with Genitourinary Syndrome of Menopause (GSM).
Numerous research studies show that estriol (specifically in low-dose vaginal gel or cream form) is highly effective at treating Genitourinary Syndrome of Menopause (GSM). Plus, it is safer and less likely to cause bleeding . links below
Also the hormone amount needed depends on each individual and needs to be guided by a hormone specialist.
I am finding from self reporting that many women without a uterus/ovaries seem to need stronger intervention in the form of estradiol. Whereas, women who still have a uterus/ovaries frequently have a problem with bleeding especially if estradiol is used vaginally. My hormone doctor refuses to use estradiol vaginally, he says that it is just too dangerous. Indeed, in Europe some forms of estradiol are restricted after 2 months. https://www.medscape.com/viewarticle/919501
Estradiol is safest used as a topical systemic cream, not vaginally. Even with topical use estradiol may be too strong for many women. So be sure to have the appropriate tests and start with the smallest amount and strength.
Some forms of estradiol have been restricted to limited use in Europe. https://www.medscape.com/viewarticle/919501
Progesterone is always appropriate to use to balance estrogen use. There is a reason why the body always produces progesterone; it makes estrogen safer, and even if you don't have a uterus/ovaries you have breasts and all the other estrogen receptors found in the body. Keep yourself safe. https://pmc.ncbi.nlm.nih.gov/articles/PMC7188038/:,mostly%20undetectable%20throughout%20the%20study. https://pmc.ncbi.nlm.nih.gov/articles/PMC9452593/.
"Conclusions
Ultra-low-dose 0.005 % estriol vaginal gel is safe and effective in preventing recurrent urinary tract infections in postmenopausal women with genitourinary syndrome of menopause, reducing the incidence and potentially decreasing the susceptibility to urogenital infections by improving vaginal pH."
Estriol is also shown to maintain bone health: https://pubmed.ncbi.nlm.nih.gov/8741364/
Hyaluronic acid suppositories are recommended by Sloan Kettering for vaginal atrophy. I personally have found a larger impact from hyaluronic suppositories than from estrogen vaginally.
I have found from talking with women about BHRT/HRT for decades that we are all individuals and need the help of a hormone specialist and some good hormone testing and even then the body decides what it wants to do with the hormones which you use. Indeed, the body has the ability to convert most hormones into other hormones. Estriol is one of the few hormones that does not convert to other hormones, which is one reason that it is so safe.
Also, one more warning, many of us continue to make our own estradiol decades into menopause. So if you then start supplementing with estradiol without hormone testing, you run the risk of too much estradiol and all the problems which comes with that. Until just recently at the age of 73 years old I have made plenty of estradiol and even at 73 I make some estradiol and am just beginning to need a small amount of estradiol systemically.
Over and over again I have seen women who decide to follow someone's advice to take estradiol vaginally and then they have to have a D&C because of hyperplasia and bleeding. Start with the least amount needed and least strength plus have a good doctor and good hormone testing. Keep yourself safe.
@kathleen1314 Estriol and estradiol both have roles in treating GSM, but they are not equivalent.
Estriol is a much weaker estrogen — roughly 10 to 100 times less potent than estradiol. That’s why it is often described as “gentler,” although studies have not shown it to be inherently safer.
It’s important to clarify several points based on current consensus guidelines from NAMS, ACOG, and the International Society for the Study of Women’s Sexual Health.
0.01% Low-dose vaginal estradiol is considered a first-line therapy for GSM and has minimal systemic absorption. At recommended doses it does not increase endometrial risk and does not require progesterone.
The European restriction often cited applies only to high-dose estradiol creams, not modern low-dose vaginal formulations.
Because of its lower potency, estriol can work well for mild GSM. However, women with more severe symptoms often require estradiol simply because it provides stronger tissue restoration. When used this way, 0.01% low-dose vaginal estradiol remains minimally absorbed and is considered very safe.
One important point that often gets overlooked is that GSM affects not just the vagina, but the entire vulvovaginal and urinary tissue.
Clinical guidelines specifically note that vaginal estrogen can be applied to the vulva, vestibule, and urethral area when symptoms involve burning, urinary discomfort, or external dryness.
Many women with severe GSM need more than a tiny “pea-sized” amount initially. Standard dosing protocols often include a loading phase (for example, daily use for several weeks) before transitioning to maintenance dosing.
In the U.S., estriol is not FDA-approved and is typically available only through compounding pharmacies or as non-standardized OTC cosmetic products.
Current menopause guidelines from organizations such as NAMS and ISSWSH continue to recommend the 0.01% Estradiol Vaginal Cream as a first-line treatment for GSM due to its extensive safety data and effectiveness.
Over the counter Estriol remains an alternative option, particularly for women who prefer a lower-potency approach or cannot tolerate estradiol.
Ultimately, different women respond differently, and the goal is simply to find the safest and most effective option for each individual.
@kathleen1314 Estriol and estradiol both have roles in treating GSM, but they are not equivalent.
Estriol is a much weaker estrogen — roughly 10 to 100 times less potent than estradiol. That’s why it is often described as “gentler,” although studies have not shown it to be inherently safer.
It’s important to clarify several points based on current consensus guidelines from NAMS, ACOG, and the International Society for the Study of Women’s Sexual Health.
0.01% Low-dose vaginal estradiol is considered a first-line therapy for GSM and has minimal systemic absorption. At recommended doses it does not increase endometrial risk and does not require progesterone.
The European restriction often cited applies only to high-dose estradiol creams, not modern low-dose vaginal formulations.
Because of its lower potency, estriol can work well for mild GSM. However, women with more severe symptoms often require estradiol simply because it provides stronger tissue restoration. When used this way, 0.01% low-dose vaginal estradiol remains minimally absorbed and is considered very safe.
One important point that often gets overlooked is that GSM affects not just the vagina, but the entire vulvovaginal and urinary tissue.
Clinical guidelines specifically note that vaginal estrogen can be applied to the vulva, vestibule, and urethral area when symptoms involve burning, urinary discomfort, or external dryness.
Many women with severe GSM need more than a tiny “pea-sized” amount initially. Standard dosing protocols often include a loading phase (for example, daily use for several weeks) before transitioning to maintenance dosing.
In the U.S., estriol is not FDA-approved and is typically available only through compounding pharmacies or as non-standardized OTC cosmetic products.
Current menopause guidelines from organizations such as NAMS and ISSWSH continue to recommend the 0.01% Estradiol Vaginal Cream as a first-line treatment for GSM due to its extensive safety data and effectiveness.
Over the counter Estriol remains an alternative option, particularly for women who prefer a lower-potency approach or cannot tolerate estradiol.
Ultimately, different women respond differently, and the goal is simply to find the safest and most effective option for each individual.
Yes that is why estriol is safer and why the body chooses this estrogen as the hormone to use during pregnancy.
And yes estradiol is 10 times stronger than estriol. 10times more likely to cause breast problems, uterine problems and just generally over react throughout the body if not countered by progesterone effectively.
And certainly not the estrogen that fits the "the principle of starting with the lowest effective dose of hormone therapy (HRT) which is a cornerstone of modern clinical practice. Experts strongly recommend beginning with the lowest dosage that relieves symptoms, such as hot flashes or vaginal dryness, to minimize potential risks and side effects." Estriol not estradiol fits this mantra. Then if and when you need estradiol add it topically and systemically rather than right next to the uterus; you would never put estradiol on your breasts, and your doctor would be horrified if you did. There is a reason for this; estradiol is too strong.
The only reason estriol is not used by all doctors is that many of them do not use compounding pharmacies and estriol is compounded just for the patient at the dose and level which they need.
The problem is many women are prescribed hormones without any hormone testing. This is dangerous for women especially those like me who make their own estradiol, even into deep menopause. So if one woman needs estradiol then another can have dangerous side effects from it or at least be subject to testing and possible D and Cs to check their uterus to bleeding. Starting with estriol at the lowest dose would eliminate most of these problems.
Again "start with the lowest effective dose of hormone therapy and amount of hormones" this does not mean starting with estradiol.
Over and over again, I have seen women, especially those with a uterus/ovaries, who bleed when using estradiol even systemic topical. It just doesn't make sense to take the strongest estrogen and to place it right next to the uterus where it can overstimulate and cause bleeding. Especially with no hormone testing to see what the woman is producing on her own.
Why use the strongest estrogen if you don't need it and put it right where it will cause you the most problems, next to the uterus? Doctor's who do this all the time would be horrified if anyone put estradiol on their breasts. The problem is obvious in this context, why not with the uterus.
And progesterone....it protects women from overstimulation of estrogens and just because you don't have a uterus doesn't mean you have no breasts or estrogen or progesterone receptors all thru your body. We need progesterone for good health.
Estriol may not be used in the USA as freqently as estradiol but it is used in the rest of the world and researched to be effective and more safe. Indeed, if the compounding pharmacies had a stronger lobby I think that all doctors would be prescribing estriol. It is just safer.
You say finally; "Ultimately, different women respond differently, and the goal is simply to find the safest and most effective option for each individual."
I agree. I also believe in ""the principle of starting with the lowest effective dose of hormone therapy " as the best way to find the safest and most effective option supported by a good hormone doctor and good hormone testing.
I looked this up because it is new for me. While reading about it I began to wonder if you had explored bhrt with your health provider. Can you share a bit of information about yourself. Age, when you entered menopause, Osteoporosis, vaginal atrophy and dryness?
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Premarin vaginal cream
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1 ReactionThe safest way to handle vaginal atropy according to all the research which I have seen is with a BHRT estriol vaginal cream and hylauronic vaginal suppositories.
I find that a base of topical systemic cream estrogen is needed also to make sure that the vaginal works well. And any time which you use estrogen it is always safer to use a progesterone, whether you have a uterus or not. After all you still have breasts and the rest of your body.
Of course amounts all depend on your symptoms and a good hormone test by a good doctor. So be sure to consult with a hormone specialist.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4515379/
"Studies in Europe have evaluated various low and ultra-low dose estriol preparations and shown them to be safe and effective [30, 32]. Since estriol is a weaker estrogen, has a shorter duration of binding to nuclear receptors, and cannot be converted to estradiol, it has no appreciable effect on the endometrium when vaginally administered once daily and in low doses [1, 30, 32–33]. This balance of efficacy and minimized untoward effects makes estriol a very appealing possibility for the future. The lack of any FDA-approved estriol preparations, however, limits its availability in the United States to custom compounded preparations."
You can find a doctor to prescribe a compounded vaginal estriol by calling your local compounding pharmacy and asking for a doctor that uses BHRT, vaginal estriol and hormone testing.
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1 Reaction@anitabanion I started using Revaree since I cannot use estradiol. It seems to help some.
Minimum, 1 gram of Estradiol Vaginal cream 0.01%, 3 times a week. Apply more than a pea size amount to Clitoris, Vulva, urethra and Vestibule. Use as much as you think you need and as often. Moisturizers are for comfort they won't help with the atrophy. Progesterone is not required for local vaginal estradiol. Estriol will not help with GSM, it's too weak. Make sure the prescription is written correctly so you will have enough medication for vulva and vaginally. "Apply 1 and 1/2 grams vaginally 3 times per week.
@sirene
frequently the problem with estrogen cream are the additives and the base.
Versa Base is a good base to try for those of us with reactive tissue.
But.... here is a listing from google of what additives and base to try or lose:
"While VersaBase is already designed to be hypoallergenic, irritation in sensitive vaginal or vulvar tissue is often triggered by specific secondary additives. Eliminating the following common culprits from your compounded formula can significantly reduce the risk of burning or itching:
Propylene Glycol (PG): This is one of the most frequent causes of vaginal burning in commercial products like Estrace. VersaBase is formulated to be Propylene Glycol-free by default.
Parabens: These preservatives (like methylparaben or propylparaben) are common allergens and can disrupt the vaginal microbiome. VersaBase is paraben-free.
Glycerin: While a humectant, glycerin can sometimes feed Candida albicans, potentially increasing the risk of yeast infections, which lead to secondary irritation.
Fragrances & Dyes: These offer no therapeutic benefit and are high-risk triggers for contact dermatitis in the vulvovaginal area."
Also, Sirene, your compounding pharmacist may be able to make up a hyaluronic acid suppository, at a very affordable price point, with a script from your doctor. I even third or quarter my HA suppository which is an even better price point. 🙂
-
Like -
Helpful -
Hug
1 Reaction@kisu
I am not sure how you can say that estriol will not help with Genitourinary Syndrome of Menopause (GSM).
Numerous research studies show that estriol (specifically in low-dose vaginal gel or cream form) is highly effective at treating Genitourinary Syndrome of Menopause (GSM). Plus, it is safer and less likely to cause bleeding . links below
Also the hormone amount needed depends on each individual and needs to be guided by a hormone specialist.
I am finding from self reporting that many women without a uterus/ovaries seem to need stronger intervention in the form of estradiol. Whereas, women who still have a uterus/ovaries frequently have a problem with bleeding especially if estradiol is used vaginally. My hormone doctor refuses to use estradiol vaginally, he says that it is just too dangerous. Indeed, in Europe some forms of estradiol are restricted after 2 months. https://www.medscape.com/viewarticle/919501
Estradiol is safest used as a topical systemic cream, not vaginally. Even with topical use estradiol may be too strong for many women. So be sure to have the appropriate tests and start with the smallest amount and strength.
Some forms of estradiol have been restricted to limited use in Europe. https://www.medscape.com/viewarticle/919501
Progesterone is always appropriate to use to balance estrogen use. There is a reason why the body always produces progesterone; it makes estrogen safer, and even if you don't have a uterus/ovaries you have breasts and all the other estrogen receptors found in the body. Keep yourself safe.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7188038/:,mostly%20undetectable%20throughout%20the%20study.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9452593/.
"Conclusions
Ultra-low-dose 0.005 % estriol vaginal gel is safe and effective in preventing recurrent urinary tract infections in postmenopausal women with genitourinary syndrome of menopause, reducing the incidence and potentially decreasing the susceptibility to urogenital infections by improving vaginal pH."
Estriol is also shown to maintain bone health:
https://pubmed.ncbi.nlm.nih.gov/8741364/
Hyaluronic acid suppositories are recommended by Sloan Kettering for vaginal atrophy. I personally have found a larger impact from hyaluronic suppositories than from estrogen vaginally.
I have found from talking with women about BHRT/HRT for decades that we are all individuals and need the help of a hormone specialist and some good hormone testing and even then the body decides what it wants to do with the hormones which you use. Indeed, the body has the ability to convert most hormones into other hormones. Estriol is one of the few hormones that does not convert to other hormones, which is one reason that it is so safe.
Also, one more warning, many of us continue to make our own estradiol decades into menopause. So if you then start supplementing with estradiol without hormone testing, you run the risk of too much estradiol and all the problems which comes with that. Until just recently at the age of 73 years old I have made plenty of estradiol and even at 73 I make some estradiol and am just beginning to need a small amount of estradiol systemically.
Over and over again I have seen women who decide to follow someone's advice to take estradiol vaginally and then they have to have a D&C because of hyperplasia and bleeding. Start with the least amount needed and least strength plus have a good doctor and good hormone testing. Keep yourself safe.
@kathleen1314 Estriol and estradiol both have roles in treating GSM, but they are not equivalent.
Estriol is a much weaker estrogen — roughly 10 to 100 times less potent than estradiol. That’s why it is often described as “gentler,” although studies have not shown it to be inherently safer.
It’s important to clarify several points based on current consensus guidelines from NAMS, ACOG, and the International Society for the Study of Women’s Sexual Health.
0.01% Low-dose vaginal estradiol is considered a first-line therapy for GSM and has minimal systemic absorption. At recommended doses it does not increase endometrial risk and does not require progesterone.
The European restriction often cited applies only to high-dose estradiol creams, not modern low-dose vaginal formulations.
Because of its lower potency, estriol can work well for mild GSM. However, women with more severe symptoms often require estradiol simply because it provides stronger tissue restoration. When used this way, 0.01% low-dose vaginal estradiol remains minimally absorbed and is considered very safe.
One important point that often gets overlooked is that GSM affects not just the vagina, but the entire vulvovaginal and urinary tissue.
Clinical guidelines specifically note that vaginal estrogen can be applied to the vulva, vestibule, and urethral area when symptoms involve burning, urinary discomfort, or external dryness.
Many women with severe GSM need more than a tiny “pea-sized” amount initially. Standard dosing protocols often include a loading phase (for example, daily use for several weeks) before transitioning to maintenance dosing.
In the U.S., estriol is not FDA-approved and is typically available only through compounding pharmacies or as non-standardized OTC cosmetic products.
Current menopause guidelines from organizations such as NAMS and ISSWSH continue to recommend the 0.01% Estradiol Vaginal Cream as a first-line treatment for GSM due to its extensive safety data and effectiveness.
Over the counter Estriol remains an alternative option, particularly for women who prefer a lower-potency approach or cannot tolerate estradiol.
Ultimately, different women respond differently, and the goal is simply to find the safest and most effective option for each individual.
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1 Reaction@kisu
Estriol is the weaker estrogen.
Yes that is why estriol is safer and why the body chooses this estrogen as the hormone to use during pregnancy.
And yes estradiol is 10 times stronger than estriol. 10times more likely to cause breast problems, uterine problems and just generally over react throughout the body if not countered by progesterone effectively.
And certainly not the estrogen that fits the "the principle of starting with the lowest effective dose of hormone therapy (HRT) which is a cornerstone of modern clinical practice. Experts strongly recommend beginning with the lowest dosage that relieves symptoms, such as hot flashes or vaginal dryness, to minimize potential risks and side effects." Estriol not estradiol fits this mantra. Then if and when you need estradiol add it topically and systemically rather than right next to the uterus; you would never put estradiol on your breasts, and your doctor would be horrified if you did. There is a reason for this; estradiol is too strong.
The only reason estriol is not used by all doctors is that many of them do not use compounding pharmacies and estriol is compounded just for the patient at the dose and level which they need.
The problem is many women are prescribed hormones without any hormone testing. This is dangerous for women especially those like me who make their own estradiol, even into deep menopause. So if one woman needs estradiol then another can have dangerous side effects from it or at least be subject to testing and possible D and Cs to check their uterus to bleeding. Starting with estriol at the lowest dose would eliminate most of these problems.
Again "start with the lowest effective dose of hormone therapy and amount of hormones" this does not mean starting with estradiol.
Over and over again, I have seen women, especially those with a uterus/ovaries, who bleed when using estradiol even systemic topical. It just doesn't make sense to take the strongest estrogen and to place it right next to the uterus where it can overstimulate and cause bleeding. Especially with no hormone testing to see what the woman is producing on her own.
Why use the strongest estrogen if you don't need it and put it right where it will cause you the most problems, next to the uterus? Doctor's who do this all the time would be horrified if anyone put estradiol on their breasts. The problem is obvious in this context, why not with the uterus.
And progesterone....it protects women from overstimulation of estrogens and just because you don't have a uterus doesn't mean you have no breasts or estrogen or progesterone receptors all thru your body. We need progesterone for good health.
Estriol may not be used in the USA as freqently as estradiol but it is used in the rest of the world and researched to be effective and more safe. Indeed, if the compounding pharmacies had a stronger lobby I think that all doctors would be prescribing estriol. It is just safer.
You say finally; "Ultimately, different women respond differently, and the goal is simply to find the safest and most effective option for each individual."
I agree. I also believe in ""the principle of starting with the lowest effective dose of hormone therapy " as the best way to find the safest and most effective option supported by a good hormone doctor and good hormone testing.
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1 ReactionHas anyone taken Osphena? What was your result?
@bmalsch
I looked this up because it is new for me. While reading about it I began to wonder if you had explored bhrt with your health provider. Can you share a bit of information about yourself. Age, when you entered menopause, Osteoporosis, vaginal atrophy and dryness?