Since Hurricane Maria, even shortages of IV fluids have been routine. Easier for errors to occur. Needs fixing.
All of this could be improved by enforcement of anti-trust law. Horizontal and vertical integration of supply and massive profit for shareholders and CEOs, with Congress allowed to trade, is driving shortages of many critical medications, as well as high prices of generics and brand names. Write your legislators.
Controlled prescriptions are locked in to one pharmacy and generally difficult to change at all, but for hormones this post is tremendously helpful as are all your others. Thank you so much.
I just started gabapentin at night for night sweats. I can’t believe how much it helps! I used to feel like a human furnace and now I’m a normal temperature!
What a helpful bunch of info! Thanks so much. My NP would absolutely not hear of cutting patches, but I'll have a closer look at the insert. I'm living in a country where no patches are available, but since I self pay in the US, I was able to get a full year'$ worth. Also good to know that the higher dose of progesterone you mentioned can help with hot flashes. It also helps me with sleep but my NP would not prescribe it continuously, only for days 1-12 of the month. Le sigh.
Whoa. I was just about to start vaginal estrogen based on all the research but, I’m ANA to legumes including soy. Will have to consult allergist. I didn’t realize soy was used in MHT. Im sure it’s fine for most allergic people but, I’m hyper sensitive.
The chemical is extracted from soy. I've never seen allergy listed as a concern in any guidelines, but your allergist could tell you. I can ask an allergist I know. Premarin vaginal cream is made from horse urine, so it would be an option for someone who is concerned.
I worked with naturopaths and used compounded bi-est vaginally (internally) for several years and had great success managing all my perimenopause symptoms with that plus progesterone. Then I switched providers and the bi-est wasn't working as well, which made me question the legitimacy of the compounding pharmacy. I switched to my HMO for HRT because of that and to save $$. I was put on estrogen patches and no matter the dose, I got up to two .1 patches at the same time, my symptoms were terrible. I was finally, after years, connected to my HMO system's "menopause expert" and she prescribed the oral estrogen but inserted into the vagina. We've had to play with the dosage, but I immediately felt better and my symptoms are under control now. I know this is off-label for oral estrogen, but it may be something for others to consider with their healthcare professional.
Perhaps the use of soy to produce etsrogen patches is one reason why women who take thyroid medication have to be more careful. Presently in my area (Ontario) only one pharmacy has any patches (Climara) but a new script from a GP is a must. Estrogel not available at one large pharmacy chain, vagifem so far and premarin cream is available. The pharmacy I deal with will not call a competeing pharmacy to help out a customer, we have to do the leg work. Currently there are only two drugs listed by WHO for essential drugs, diabetes and thyroid. A few antibiotics here as well are not available.
No, the issue with soy and thyroid medications is soy affecting absorption from the gut. Estradiol pills don’t have soy, they have a single chemical extracted from soy that is converted into estradiol that your body recognizes as estradiol, not soy.
But estrogen pills are supposed to interact with levothyroxine doses. There seems to be conflicting information regarding what products can be used when on a replacement for thyroid. . I assume vagifem should not be an issue? Patches now I have no clue.Thank you for responding.
I stand corrected on the essential drug list from WHO. I looked over the 2023 list today (extensive for sure). A few I noticed are not available here presently and the word estrogen is listed with no other information.
Since Hurricane Maria, even shortages of IV fluids have been routine. Easier for errors to occur. Needs fixing.
All of this could be improved by enforcement of anti-trust law. Horizontal and vertical integration of supply and massive profit for shareholders and CEOs, with Congress allowed to trade, is driving shortages of many critical medications, as well as high prices of generics and brand names. Write your legislators.
Controlled prescriptions are locked in to one pharmacy and generally difficult to change at all, but for hormones this post is tremendously helpful as are all your others. Thank you so much.
Yes! Thank-you SO much for taking the time to write this article!
Please do an article on vaginal estrogen! Can that help in lieu of the patch?
I have been told by one gyn that some women need both.
I just started gabapentin at night for night sweats. I can’t believe how much it helps! I used to feel like a human furnace and now I’m a normal temperature!
I have a lot of success with gabapentin. So glad it is helping you.
I'm only taking it at night. Do you have patient's take it during the day too? If so, at what dosage? I'm taking 300mg.
Is there any potential downside to continuous progesterone?
What a helpful bunch of info! Thanks so much. My NP would absolutely not hear of cutting patches, but I'll have a closer look at the insert. I'm living in a country where no patches are available, but since I self pay in the US, I was able to get a full year'$ worth. Also good to know that the higher dose of progesterone you mentioned can help with hot flashes. It also helps me with sleep but my NP would not prescribe it continuously, only for days 1-12 of the month. Le sigh.
If we opt to stop HRT because of shortages, etc. is it alright to just stop it outright?
Whoa. I was just about to start vaginal estrogen based on all the research but, I’m ANA to legumes including soy. Will have to consult allergist. I didn’t realize soy was used in MHT. Im sure it’s fine for most allergic people but, I’m hyper sensitive.
Thanks learned so much here.
The chemical is extracted from soy. I've never seen allergy listed as a concern in any guidelines, but your allergist could tell you. I can ask an allergist I know. Premarin vaginal cream is made from horse urine, so it would be an option for someone who is concerned.
How do the estradiol gels measure up in efficacy for women who have just entered menopause approximately one year ago experiencing hot flashes?
The products have never been studied head to head so we don;t have that data. The patches are the most studied of the transdermal.
I worked with naturopaths and used compounded bi-est vaginally (internally) for several years and had great success managing all my perimenopause symptoms with that plus progesterone. Then I switched providers and the bi-est wasn't working as well, which made me question the legitimacy of the compounding pharmacy. I switched to my HMO for HRT because of that and to save $$. I was put on estrogen patches and no matter the dose, I got up to two .1 patches at the same time, my symptoms were terrible. I was finally, after years, connected to my HMO system's "menopause expert" and she prescribed the oral estrogen but inserted into the vagina. We've had to play with the dosage, but I immediately felt better and my symptoms are under control now. I know this is off-label for oral estrogen, but it may be something for others to consider with their healthcare professional.
Really informative and interesting article.
Thank you.
I have an unrelated pharmacy based question for a future post:
What evidence/ data is available to show contraindications of dietary & herbal supplements taken alongside MHT?
I appreciate that this is an impossible question to answer given the level of deceit & health fraud within the unregulated wellness industry!
The NHS only advises against St.Johns wort.
What evidence based information do we currently have?
Wow, I had no idea. I guess I've been lucky - no issues with the patch or Yuvafem in SE Texas (so far). I'll keep this on my radar.
Great thanks. Premarin will be the go to. Better safe.
Perhaps the use of soy to produce etsrogen patches is one reason why women who take thyroid medication have to be more careful. Presently in my area (Ontario) only one pharmacy has any patches (Climara) but a new script from a GP is a must. Estrogel not available at one large pharmacy chain, vagifem so far and premarin cream is available. The pharmacy I deal with will not call a competeing pharmacy to help out a customer, we have to do the leg work. Currently there are only two drugs listed by WHO for essential drugs, diabetes and thyroid. A few antibiotics here as well are not available.
No, the issue with soy and thyroid medications is soy affecting absorption from the gut. Estradiol pills don’t have soy, they have a single chemical extracted from soy that is converted into estradiol that your body recognizes as estradiol, not soy.
But estrogen pills are supposed to interact with levothyroxine doses. There seems to be conflicting information regarding what products can be used when on a replacement for thyroid. . I assume vagifem should not be an issue? Patches now I have no clue.Thank you for responding.
That has nothing to do with soy, and is likely due to the effects of oral estrogens on proteins in the liver.
I stand corrected on the essential drug list from WHO. I looked over the 2023 list today (extensive for sure). A few I noticed are not available here presently and the word estrogen is listed with no other information.
In my region (the PNW) there is a Progesterone shortage as well!!
I can do a post about converting to a progestin if people also need that