Question 76
Doctor N,
I had a complete hysterectomy a year ago, and still have not found the answer to HRT. A month ago I started the patch .1mg, I also use testosterone cream 1%, 1/16 tsp. everyday. My question is, how long before I can measure my hormone levels again. I'm feeling really tired and unmotivated, but I want to give this a chance. Also, if I put on a new patch Mondays and Thursdays, what day should I have my estrogen level checked? Do you recommend saliva or blood testing? Thank you,
Reply:
I am sorry that you are having so much difficulty. The next step may be to try a combination estradiol / testosterone gel that is rubbed on the skin and absorbed directly into the bloodstream. If that is not effective, I have found that when all else fails subcutaneous hormone implants of estradiol and testosterone rarely fail to help. I would read question 52 in the Ask Dr N section and the Hysterectomy Overview section, which is under the Hysterectomy heading. You can access them from their links on the Main Menu on the left hand side of the home page. www.drN4u.com
If you want to see someone who does this, or if I know anyone in your area who specializes in menopausal problems and HRT, send me an email telling me what area you live in and I will let you know if I know of anyone near where you are located.
I do not believe that there any advantage to saliva testing. I have discussed this just this week with my colleagues, who are recognized worldwide as experts in menopausal medicine, while at the North American Menopause Society meeting in Orlando, Florida. It was their collective opinion that it provided no further insight and was potentially less accurate than blood testing and that the real issue is finding an effective therapy for the individual patient.
I understand and empathize with your dilemma. It was seeing patients like yourself whose quality of life was impacted so drastically that motivated me to specialize in the care and treatment of menopausal women. Unfortunately, as you already know these problems occur more frequently when the menopause has been induced by removal of the uterus and ovaries.
Dr N