In this episode, we respond to Karen.  Karen read an article of ours on BHRT and sent these concerns about her menopause and hormone dosages.  We love Karen's question because it shows how technical BHRT can be. As you will see from Karen's question, there are multiple aspects to consider when treating a woman with hormones.  

Karen’s Concerns: 


Her symptoms of weight gain, hot flashes, and night sweats 
The many avenues of dosing such as estradiol patches, hormones creams and the combination of taking progesterone, estrogen, and testosterone.
What ratio of estradiol to estriol she should be taking. And even if she should bypass the static hormone dosing and take a rhythmic dosing schedule.
Lab testing and what her levels may or may not be telling us.
If she can apply estriol vaginally
If estriol or some of these hormones are by prescription only
Not to mention, understandably she is concerned about the risks of estrogen without sufficient progesterone.

Karen's Question:
I am struggling to find the right dosage and combination of BHRT. I believe that I am sensitive to Progesterone. I am 53 and started menopause at age 50.

Hot flashes and weight gain are my two main symptoms (I was super thin my entire life, and now I'm 35 pounds overweight). I have 2-5 flashes a night not soaking, but they wake me (otherwise I would sleep fine) and always one at 4 or 5 am.

During the day I have several not unbearable but that is only while on BHRT (when I stopped taking everything it was brutal). I have been taking some form of BH for about 2 years now. I tried the patch Estradiol started at .5 and increased to .75mg.

My symptoms became tolerable, and the flashes were going away to the point that I only got the one early in the morning and maybe minor 1 or 2 during the day. But then I would take progesterone (pill) 100mg (and gradually tried to decrease).

As soon as I took the progesterone, the flashes would increase in intensity and frequency. I switched to cream currently taking a combined cream of 5mg estradiol/gm, 30 mg/gm of progesterone, 6 mg of testosterone/gm 1/4 gm applied once a day.

I still have difficulty losing weight, and flashes are still multiple times a night and throughout the day. (however, when I stop its 10 times worse). I'd like to switch to a biest and even cyclical dosing. I've read the Wiley protocol, but the dosing looks super high (at least to start).