Dealing With Peri Menopause

The usual level that one tries to achieve for postmenopausal women is about 60 to 80. In younger premenopausal women who are cycling, the estradiol levels range from 50 to about 300, although the 300 is for a brief time, and the average is more like 80-100. There is a correlation between long-term exposure to estrogen (dose and time related) and breast cancer, so in general it is a good strategy to use as low a dose as possible that eliminates the symptoms. Unfortunately, sometimes eliminating mood symptoms, hot flashes, and vaginal dryness requires levels of estrogen above 150, whereas to simply protect bones from osteoporosis a level of 60-80 is all that is needed. It is harder to stabilize symptoms in the premenopausal period, when hormones fluctuate, than in the post-menopausal period. My recommendation to you would be to not exceed the highest conventional doses of estrogen: estradiol patches of .1 or oral estradiol of 2.0. If you still have night sweats or hot flashes use other means to control them – medications like Bellergal, Clonidine or the herbal remedy Remifemin. Also, some progesterone, testosterone or other nutritional support may help you. The progesterone or other progestin will become necessary at some point if you have not had a hysterectomy. After you have been stabilized, and are truly in menopause (not easy to tell when this happens if you are on hormones; you may have to go off meds for two weeks to ascertain this), over a period of one to two years it would be desirable to gradually reduce your estrogen doses. The patches are the most convenient way to do this, as they come in graduated doses. Gradually reduce the dose to 0.075, .05, .0375, and then .03 or .025 three to six months at a time. There is no question that the lower doses and estradiol levels are healthier if taken for a prolonged period. There is a phenomenon with estrogen that if your body gets use to high doses, more estrogen receptors are produced and it requires higher doses to get the same effect. This can be reversed somewhat by weaning off. Good luck!

Dr. Mary Davenport