Re: a question for women in the group

June 1, 2010

Hang in there. You are making progress it sounds like.CE Grim MDHello,I'm not on any medication for thyroid. My T3 is under out of the range and my t4 is right at the bottom.I've had a gp saying thyroid is a bit low, other doc said about trying thyroxine. Also had people say its my pituitary causing central hypothyroid.I don't care what it is just wish someone would help me.I'm now seeing a neurogastro doctor.He said I have several problems affecting endocrine system, adrenals are damaged, gastro problem and have to see ENT for sinus problems.Hope your all okay, I starting to give up not much point in being here anymore. Can't eat, funstion normaly, get about, work ort socialise..so depressed now can't see any light at the end of my tunnel.Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 09:05:33 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group But TSH was lowish so she should be getting enough it would appear. Unless there is a pit prob not making TSH.CEWhen they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

Sounds like someone did not take a very good Endocrine Hx to me.CE Grim MDI'm not on anything, did feel better whenb tried armour a year ago but developed servere AI symptoms.So needed cortisol tested and pituitary etc so then started fighting to get to barts hospital.I've been in but just had news that would of completly screwed my results whilst I was in there.I was pregnant, not now iom sure being pregnant would alter my results. Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 08:01:27 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group When they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

Oh, thank you. That means so much Dr. Grim any little positive comments really help me right now. :)Sent using BlackBerry® from OrangeDate: Tue, 01 Jun 2010 10:00:29 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Hang in there. You are making progress it sounds like.CE Grim MDOn Jun 1, 2010, at 9:36 AM, moseleymandhotmail (DOT) co.uk wrote:Hello,I'm not on any medication for thyroid. My T3 is under out of the range and my t4 is right at the bottom.I've had a gp saying thyroid is a bit low, other doc said about trying thyroxine. Also had people say its my pituitary causing central hypothyroid.I don't care what it is just wish someone would help me.I'm now seeing a neurogastro doctor.He said I have several problems affecting endocrine system, adrenals are damaged, gastro problem and have to see ENT for sinus problems.Hope your all okay, I starting to give up not much point in being here anymore. Can't eat, funstion normaly, get about, work ort socialise..so depressed now can't see any light at the end of my tunnel.Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 09:05:33 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group But TSH was lowish so she should be getting enough it would appear. Unless there is a pit prob not making TSH.CEWhen they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

What does hx mean? :)Sent using BlackBerry® from OrangeDate: Tue, 01 Jun 2010 10:01:28 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Sounds like someone did not take a very good Endocrine Hx to me.CE Grim MDOn Jun 1, 2010, at 9:39 AM, moseleymandhotmail (DOT) co.uk wrote:I'm not on anything, did feel better whenb tried armour a year ago but developed servere AI symptoms.So needed cortisol tested and pituitary etc so then started fighting to get to barts hospital.I've been in but just had news that would of completly screwed my results whilst I was in there.I was pregnant, not now iom sure being pregnant would alter my results. Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 08:01:27 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group When they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

By taking this you might be around long enough to be concerned about bone loss.

> >

> > >

> > > The WWI found a very slight decrease in breast cancer with horse pee

> > > only (Premarin). It found a very, very slight increase with horse

> > > pee + synthetic progestin (Provera). The biggest problem found, and

> > > I've read this elsewhere, is an increase in stoke risk for women who

> > > go many years without estrogen after meno, and then start on it

> > > years later. No good studies, as far as I know, have been done with

> > > bioidentical estradiol and bioidentical progesterone. I can't

> > > believe they are still doing studies on conjugated estrogens and

> > > synthetic progestins. I guess it is $$$.

>

> > > I read somewhere the other day that female physicians have a higher

> > > rate of estrogen use than they prescribe for their patients. Can't

> > > remember where I read that though.

>

June 1, 2010

Did anyone ask if you were pregnant?I certainly did not and need to be lashed for not doing that.CE Grim MDWhat does hx mean? :)Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 10:01:28 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Sounds like someone did not take a very good Endocrine Hx to me.CE Grim MDOn Jun 1, 2010, at 9:39 AM, moseleymandhotmail (DOT) co.uk wrote:I'm not on anything, did feel better whenb tried armour a year ago but developed servere AI symptoms.So needed cortisol tested and pituitary etc so then started fighting to get to barts hospital.I've been in but just had news that would of completly screwed my results whilst I was in there.I was pregnant, not now iom sure being pregnant would alter my results. Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 08:01:27 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group When they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

No, no one asked me if I could be pregnant. I'm surprised they couldn't of picked it up, especially if they were testing all of my pituitary hormones.What would this mean? Would if affect, cortisol, thyroid etc Don't worry if you can't get involved I know its not PA. I've not got copies of all tests they've done. I've not even got a clinic letter following the cats and mets urine they took and said results were pending.I ve contacted the consultants secretary to advise her of what's happened and see neurogastro consultant next thursday, so will discuss with him too.Sent using BlackBerry® from OrangeDate: Tue, 01 Jun 2010 12:12:36 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Did anyone ask if you were pregnant?I certainly did not and need to be lashed for not doing that.CE Grim MDOn Jun 1, 2010, at 10:55 AM, moseleymandhotmail (DOT) co.uk wrote:What does hx mean? :)Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 10:01:28 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Sounds like someone did not take a very good Endocrine Hx to me.CE Grim MDOn Jun 1, 2010, at 9:39 AM, moseleymandhotmail (DOT) co.uk wrote:I'm not on anything, did feel better whenb tried armour a year ago but developed servere AI symptoms.So needed cortisol tested and pituitary etc so then started fighting to get to barts hospital.I've been in but just had news that would of completly screwed my results whilst I was in there.I was pregnant, not now iom sure being pregnant would alter my results. Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 08:01:27 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group When they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

In any endocrine complaint one must always ask about pregnancy. Esp with nausea, vomiting, swelling etc.Did we ask if you peroids had become irregular?I did not do that as I must have forgotten how old you were.CE Grim MDNo, no one asked me if I could be pregnant. I'm surprised they couldn't of picked it up, especially if they were testing all of my pituitary hormones.What would this mean? Would if affect, cortisol, thyroid etc Don't worry if you can't get involved I know its not PA. I've not got copies of all tests they've done. I've not even got a clinic letter following the cats and mets urine they took and said results were pending.I ve contacted the consultants secretary to advise her of what's happened and see neurogastro consultant next thursday, so will discuss with him too.Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 12:12:36 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Did anyone ask if you were pregnant?I certainly did not and need to be lashed for not doing that.CE Grim MDOn Jun 1, 2010, at 10:55 AM, moseleymandhotmail (DOT) co.uk wrote:What does hx mean? :)Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 10:01:28 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Sounds like someone did not take a very good Endocrine Hx to me.CE Grim MDOn Jun 1, 2010, at 9:39 AM, moseleymandhotmail (DOT) co.uk wrote:I'm not on anything, did feel better whenb tried armour a year ago but developed servere AI symptoms.So needed cortisol tested and pituitary etc so then started fighting to get to barts hospital.I've been in but just had news that would of completly screwed my results whilst I was in there.I was pregnant, not now iom sure being pregnant would alter my results. Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 08:01:27 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group When they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

My periods are irregular. They stopped completely for 1.5 years. Then they just came back the last 4-5 months, extremely heavy and clots and very painful but irregular and only last two days.I'm quite shocked that I did manage to get pregnant when I had a consultant advising me about IVF a year and a half ago.She said I had pituitary problem or ovaries had failed as no other explanation for estrogen that low.She also said my thyroid was low but wouldn't be the cause of it all. Sent using BlackBerry® from OrangeDate: Tue, 01 Jun 2010 15:09:30 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group In any endocrine complaint one must always ask about pregnancy. Esp with nausea, vomiting, swelling etc.Did we ask if you peroids had become irregular?I did not do that as I must have forgotten how old you were.CE Grim MDOn Jun 1, 2010, at 1:33 PM, moseleymandhotmail (DOT) co.uk wrote:No, no one asked me if I could be pregnant. I'm surprised they couldn't of picked it up, especially if they were testing all of my pituitary hormones.What would this mean? Would if affect, cortisol, thyroid etc Don't worry if you can't get involved I know its not PA. I've not got copies of all tests they've done. I've not even got a clinic letter following the cats and mets urine they took and said results were pending.I ve contacted the consultants secretary to advise her of what's happened and see neurogastro consultant next thursday, so will discuss with him too.Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 12:12:36 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Did anyone ask if you were pregnant?I certainly did not and need to be lashed for not doing that.CE Grim MDOn Jun 1, 2010, at 10:55 AM, moseleymandhotmail (DOT) co.uk wrote:What does hx mean? :)Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 10:01:28 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Sounds like someone did not take a very good Endocrine Hx to me.CE Grim MDOn Jun 1, 2010, at 9:39 AM, moseleymandhotmail (DOT) co.uk wrote:I'm not on anything, did feel better whenb tried armour a year ago but developed servere AI symptoms.So needed cortisol tested and pituitary etc so then started fighting to get to barts hospital.I've been in but just had news that would of completly screwed my results whilst I was in there.I was pregnant, not now iom sure being pregnant would alter my results. Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 08:01:27 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group When they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

I've got a very strong taste of salt in my mouth after having a tiny amount. I'm struggling to eat as been feeling sick and no appetite. I had a couple of bits of plain chicken added a little salt a couple of hours ago and can taste it so strongly.Sent using BlackBerry® from OrangeDate: Tue, 01 Jun 2010 15:09:30 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group In any endocrine complaint one must always ask about pregnancy. Esp with nausea, vomiting, swelling etc.Did we ask if you peroids had become irregular?I did not do that as I must have forgotten how old you were.CE Grim MDOn Jun 1, 2010, at 1:33 PM, moseleymandhotmail (DOT) co.uk wrote:No, no one asked me if I could be pregnant. I'm surprised they couldn't of picked it up, especially if they were testing all of my pituitary hormones.What would this mean? Would if affect, cortisol, thyroid etc Don't worry if you can't get involved I know its not PA. I've not got copies of all tests they've done. I've not even got a clinic letter following the cats and mets urine they took and said results were pending.I ve contacted the consultants secretary to advise her of what's happened and see neurogastro consultant next thursday, so will discuss with him too.Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 12:12:36 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Did anyone ask if you were pregnant?I certainly did not and need to be lashed for not doing that.CE Grim MDOn Jun 1, 2010, at 10:55 AM, moseleymandhotmail (DOT) co.uk wrote:What does hx mean? :)Sent using BlackBerry® from OrangeFrom: Clarence Grim <lowerbp2mac>Date: Tue, 01 Jun 2010 10:01:28 -0500To: <hyperaldosteronism >Subject: Re: a question for women in the group Sounds like someone did not take a very good Endocrine Hx to me.CE Grim MDOn Jun 1, 2010, at 9:39 AM, moseleymandhotmail (DOT) co.uk wrote:I'm not on anything, did feel better whenb tried armour a year ago but developed servere AI symptoms.So needed cortisol tested and pituitary etc so then started fighting to get to barts hospital.I've been in but just had news that would of completly screwed my results whilst I was in there.I was pregnant, not now iom sure being pregnant would alter my results. Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 08:01:27 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group When they say thyroid is low, do they mean FREE T3 and FREE T4, or do they mean TSH? They move in opposite direction. If you’re taking a T4 synthetic, that might have something to do with your life stopping. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3 3.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answer has been "but you are small"???!!!! Surely your height doesn't mean you don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mandSent using BlackBerry® from Orange I have no faith in docs understanding thyroid. What exactly are your results for FREE T3 and FREE T4? With their respective ranges. Also TSH. If your TSH is in the lowest of range, that’s more HYPER than HYPO. “WNL” means nothing to me because they don’t understand what normal means. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of a Hall Thanks for answering, Val. In the past year I think I've lost half of what I used to have on the top of my head and now I seem to be losing it all over my head. I went to my PCP a couple of weeks ago to see if he could find a medical cause for it and he just blew me off, told me I was worrying about it too much. I told him I didn't think worrying was inappropriate since his hair is thicker than mine now. I had him check my thyroid again since my skin is also extremely dry and I'm tired all the time. He called last week and said my T3 & T4 were WNL but my TSH was in the lowest range of normal. He wants me to try .25 mcg levothyroxine and see if I can tell a difference. I looked it up and that seems to be a sub-therapeutic dose, so obviously he's just placating me. I'm not feeling love for him right now. a

June 1, 2010

Mandy, if your Free T3 is below range and your T4 is right at

the bottom, you are seriously hypothyroid.

Where is your TSH? Do you

get copies of your tests? The idea

that your height has anything to do with your thyroid levels is MALPRACTICE.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of moseleymand@...

Hello,

I'm not on any medication for thyroid. My T3 is under out of the range and my

t4 is right at the bottom.

I've had a gp saying thyroid is a bit low, other doc

said about trying thyroxine. Also had people say its my pituitary causing central hypothyroid.

I don't care what it is just wish someone would help me.

I'm now seeing a neurogastro doctor.

He said I have several problems affecting endocrine system, adrenals are

damaged, gastro problem and have to see ENT for sinus problems.

Hope your all okay, I starting to give up not much point in being here anymore.

Can't eat, funstion normaly,

get about, work ort socialise..so depressed now can't

see any light at the end of my tunnel.

From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymand@...

I have this problem too. My tsh is low and my T4 is 13.2 (12-22) t3

3.5 (4-6.5) tsh: o.68

I've had a couple of doctors say my thyroids a bit low but most recent answer

has been " but you are small " ???!!!! Surely your height doesn't mean

you don't need thyroid more in range..

So frustrating when you can't function and your lifes stopped.

mand

June 1, 2010

Hypothyroidism can absolutely prevent conception.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of moseleymand@...

She also said my thyroid was low but wouldn't be the cause of it all.

June 1, 2010

My comment is based in this information.

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PREMARIN: A blend of estrogens with extensive evidence to support your recommendation3-17

Evidence supports starting appropriate symptomatic menopausal women on estrogen therapy22

No increased risk of invasive breast cancer with PREMARIN after an average follow-up of 7.1 years3

No increased risk of coronary heart disease with PREMARIN after an average follow-up of 7.1 years23

A significant increased risk of stroke and DVT associated with PREMARIN after an average follow-up of 7.1 years4,23

Significant relief of moderate to severe vasomotor symptoms in as early as 3 weeks6

Findings on breast cancer

Evidence supports starting appropriate symptomatic menopausal women on estrogen therapy.22 Data from the Women's Health Initiative (WHI) trial show that in all age groups, there was no increased risk of invasive breast cancer with PREMARIN after an average follow-up of 7.1 years.3

Adjudicated data from the WHI Estrogen-Alone Substudy, a prospective, randomized, doubleâ€`blind trial comparing estrogen alone with placebo in 10,739 women aged 50-79 years who had undergone a hysterectomy.

The use of estrogens has been reported to result in an increase in abnormal mammograms requiring further evaluation.22

Effect on vasomotor symptoms

PREMARIN can provide significant relief of moderate to severe vasomotor symptoms as early as 3 weeks.6 In the Women's Health, Osteoporosis, Progestin, Estrogen (HOPE) Study, a randomized, double-blind trial comparing PREMARIN with placebo in 2,673 healthy, postmenopausal women with an intact uterus (including an efficacy-evaluable population, n=241 at baseline in the vasomotor substudy):

84% reduction in the number of hot flashes by week 4 with PREMARIN 0.625 mg (n=27)6.22

94% reduction in the number of hot flashes by week 12 with PREMARIN 0.625 mg (n=27)6.22

Effect on bone mineral density

In the 2-year Women's Hope Study, PREMARIN provided a significant increase in spine and hip bone mineral density.2,7

* Data from the Women's HOPE Study: a 2-year study of 2,673 healthy postmenopausal women (average age of 53.3 years). The BMD substudy included 822 women.† Modified intent-to-treat population.‡ Differences from baseline and placebo were significant (P<0.05).§ P=0.02 for 0.3 mg vs. 0.625 mg. Percentages rounded to nearest tenth. All subjects received one 600-mg tablet of Caltrate® daily.

Range of dosing options

PREMARIN has been shown to provide symptom relief and bone protection at every dose: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, and 1.25 mg.6.7,22

Important Safety Information

WARNINGS

ENDOMETRIAL CANCER

Adequate diagnostic measures, including endometrial sampling when indicated, should be undertaken to rule out malignancy in all cases of undiagnosed persistent or recurring abnormal vaginal bleeding. (See WARNINGS, Malignant neoplasms, Endometrial cancer in the Prescribing Information.)

CARDIOVASCULAR AND OTHER RISKS

Estrogens with or without progestins should not be used for the prevention of cardiovascular disease or dementia. (See CLINICAL STUDIES and WARNINGS, Cardiovascular disorders and Dementia in the Prescribing Information.)

The estrogen alone substudy of the Women's Health Initiative (WHI) reported increased risks of stroke and deep vein thrombosis (DVT) in postmenopausal women (50 to 79 years of age) during 6.8 years and 7.1 years, respectively, of treatment with daily oral conjugated estrogens (CE 0.625 mg), relative to placebo. (See CLINICAL STUDIES and WARNINGS, Cardiovascular disorders in the Prescribing Information.)

The estrogen plus progestin substudy of WHI reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and DVT in postmenopausal women (50 to 79 years of age) during 5.6 years of treatment with daily CE 0.625 mg combined with medroxyprogesterone acetate (MPA 2.5 mg), relative to placebo. (See CLINICAL STUDIES and WARNINGS, Cardiovascular disorders and Malignant neoplasms, Breast cancer in the Prescribing Information.)

The Women's Health Initiative Memory Study (WHIMS), a substudy of WHI, reported an increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 5.2 years of treatment with daily CE 0.625 mg alone and during 4 years of treatment with daily CE 0.625 mg combined with MPA 2.5 mg, relative to placebo. It is unknown whether this finding applies to younger postmenopausal women. (See CLINICAL STUDIES and WARNINGS, Dementia and PRECAUTIONS, Geriatric Use in the Prescribing Information.)

In the absence of comparable data, these risks should be assumed to be similar for other doses of CE and MPA and other combinations and dosage forms of estrogens and progestins. Because of these risks, estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.

PREMARIN is indicated in the treatment of moderate to severe vasomotor symptoms due to menopause, the treatment of moderate to severe symptoms of vulvar and vaginal atrophy due to menopause, and the prevention of postmenopausal osteoporosis.

PREMPRO is indicated in women who have a uterus for the treatment of moderate to severe vasomotor symptoms due to menopause, the treatment of moderate to severe symptoms of vulvar and vaginal atrophy due to menopause, and the prevention of postmenopausal osteoporosis.

PREMARIN Vaginal Cream is indicated in the treatment of atrophic vaginitis and kraurosis vulvae and the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause.

When prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered. When prescribing solely for the prevention of postmenopausal osteoporosis, therapy should only be considered for women at significant risk of osteoporosis and for whom non-estrogen medications are not considered to be appropriate.

PREMARIN, PREMPRO, and PREMARIN Vaginal Cream should not be used under any of the following conditions or circumstances: undiagnosed abnormal genital bleeding; known, suspected, or a history of breast cancer; known or suspected estrogen-dependent neoplasia; active venous thromboembolism or a history of this condition; active or recent arterial thromboembolism; liver dysfunction or disease; in patients with a known hypersensitivity to their ingredients; known or suspected pregnancy.

In a clinical trial, the most commonly reported (â‰¥5%) adverse events for PREMARIN that were statistically different than placebo included vaginal moniliasis, vaginitis, vaginal bleeding, dysmenorrhea, and leg cramps. In a clinical trial, the most commonly reported (â‰¥5%) adverse events for PREMPRO 0.45 mg/1.5 mg and 0.625 mg/2.5 mg that were statistically different than placebo were mastalgia, vaginal bleeding, vaginal moniliasis, leg cramps, dysmenorrhea, breast enlargement, and vaginitis. In a clinical trial, there was no difference in the commonly reported (â‰¥5%) adverse events for women taking PREMPRO 0.3 mg/1.5 mg compared to those taking placebo. In a prospective, randomized, placebo-controlled, double-blind study, the most common adverse reactions (â‰¥5%) for PREMARIN Vaginal Cream are headache, infection, abdominal pain, back pain, accidental injury, and vaginitis.

Please see Prescribing Information, including Boxed Warning, for PREMARIN, PREMPRO, and PREMARIN Vaginal Cream.

The appearance of the PREMARIN tablets is a trademark of Wyeth Pharmaceuticals.

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> >> > I don't know why anyone would use horse pee when bioidenticals are> > available.> > > > You'll note that even with horse pee estrogen, bone density is increased.> > > > Val>

June 2, 2010

Hello Val,My tsh is 0.68 I know iam hypothyroid but why won't they help me!!? I've spoken to a doctor who said he would treat my thyroid and cortisol but wanted me to carry on the nhs s thought I have something more complicated.I don't know what to do, I was going to give this neurogastro guy a chance as he said I have several problems and needs to start with my gut but I'm struggling to wait any more.Iam 34 I should be having children and married at my age but no 5 years of not going any where, ill, no confidence due to wonky face, can't eat normally.This new doctor is goinbg to give me anti ds but thyroid tablets would help much more!!Do you think its pituitary gland by them results?What would you do? I'm so desperate. Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 15:46:55 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group Mandy, if your Free T3 is below range and your T4 is right atthe bottom, you are seriously hypothyroid. Where is your TSH? Do youget copies of your tests? The ideathat your height has anything to do with your thyroid levels is MALPRACTICE. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.uk Hello,I'm not on any medication for thyroid. My T3 is under out of the range and myt4 is right at the bottom.I've had a gp saying thyroid is a bit low, other docsaid about trying thyroxine. Also had people say its my pituitary causing central hypothyroid.I don't care what it is just wish someone would help me.I'm now seeing a neurogastro doctor.He said I have several problems affecting endocrine system, adrenals aredamaged, gastro problem and have to see ENT for sinus problems.Hope your all okay, I starting to give up not much point in being here anymore.Can't eat, funstion normaly,get about, work ort socialise..so depressed now can'tsee any light at the end of my tunnel.From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t33.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answerhas been " but you are small " ???!!!! Surely your height doesn't meanyou don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mand

June 2, 2010

Other doctor isn't NHS he is regsistered as nutritional doctor Dr.Peatfield.Sent using BlackBerry® from OrangeDate: Tue, 1 Jun 2010 15:46:55 -0600To: <hyperaldosteronism >Subject: RE: a question for women in the group Mandy, if your Free T3 is below range and your T4 is right atthe bottom, you are seriously hypothyroid. Where is your TSH? Do youget copies of your tests? The ideathat your height has anything to do with your thyroid levels is MALPRACTICE. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.uk Hello,I'm not on any medication for thyroid. My T3 is under out of the range and myt4 is right at the bottom.I've had a gp saying thyroid is a bit low, other docsaid about trying thyroxine. Also had people say its my pituitary causing central hypothyroid.I don't care what it is just wish someone would help me.I'm now seeing a neurogastro doctor.He said I have several problems affecting endocrine system, adrenals aredamaged, gastro problem and have to see ENT for sinus problems.Hope your all okay, I starting to give up not much point in being here anymore.Can't eat, funstion normaly,get about, work ort socialise..so depressed now can'tsee any light at the end of my tunnel.From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of moseleymandhotmail (DOT) co.ukI have this problem too. My tsh is low and my T4 is 13.2 (12-22) t33.5 (4-6.5) tsh: o.68I've had a couple of doctors say my thyroids a bit low but most recent answerhas been " but you are small " ???!!!! Surely your height doesn't meanyou don't need thyroid more in range..So frustrating when you can't function and your lifes stopped. mand

June 2, 2010

Even in there being a bit biased they do say there is a significant increased

risk of stroke,dementia and DVT associated with

PREMARIN.

> > > >

> > > > I don't know why anyone would use horse pee when bioidenticals are

> > > > available.

> > > >

> > > > You'll note that even with horse pee estrogen, bone density is

> > increased.

> > > >

> > > > Val

> > >

> >

>

June 2, 2010

All meds and many foods have some risks associated with them. It is up to us to

learn what the risks are then decide if we want to take the risks.

> > > > >

> > > > > I don't know why anyone would use horse pee when bioidenticals are

> > > > > available.

> > > > >

> > > > > You'll note that even with horse pee estrogen, bone density is

> > > increased.

> > > > >

> > > > > Val

> > > >

> > >

> >

>

June 2, 2010

That is a good question. It seems Wyeth the maker of PREMARIN use many studies

to show both the good and bad side.

> > > >

> > > > That's an ignorant comment, Francis. I love how men can make these

> > > broad

> > > > assumptions about estrogen. Have you read the WWI? Do you know the

> > > > relative risks?

> > > >

> > > > I have severe bone loss from hyperparathyroidism that went

> > > undiagnosed for

> > > > at least 14 years. By the time I got a diagnosis, my bones were in

> > > serious

> > > > shape. And, even if estradiol didn't help bones, I feel better on

> > > it. I

> > > > repeat, I will quit using it when they pry it out of my cold, dead

> > > hands.

> > > >

>

June 2, 2010

Remember Merck and Vioxx also Fosamax. Vioxx just caused heart attacks.

Fosamax, one of the most prescribed drugs to help increase bone density,

actually does the reverse on the bone in the jaw-by destroying it. The lawsuit

claims.

> > > > > >

> > > > > > I don't know why anyone would use horse pee when

> > bioidenticals are

> > > > > > available.

> > > > > >

> > > > > > You'll note that even with horse pee estrogen, bone density is

> > > > increased.

> > > > > >

> > > > > > Val

> > > > >

> > > >

> > >

> >

>

June 3, 2010

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Home > Welcome Newsweek readers

What are bioidentical hormones?

(This article was first printed in the August 2006 issue of the Harvard Women's Health Watch. For more information or to order, please go to http://www.health.harvard.edu/womens.)

Many women and health experts continue to struggle with the turnaround in attitude toward hormone therapy in the wake of the Women's Health Initiative (WHI) trial of combined estrogen and progestin (as Prempro) for preventing later-life ills. The trial was stopped early, in 2002, because hormone users had a higher risk of breast cancer, heart disease, stroke, and blood clots. Though the added risks were small, many women and their clinicians concluded they must discontinue hormone therapy. Many of these women found that hot flashes, sleeplessness, and other menopausal symptoms returned with a vengeance.

Hormone therapy is still considered the most effective treatment for symptoms. But women are not rushing back. One concern of health experts is that women are turning to alternatives they think are safer — but may not be.

Even before the WHI results came in, many women were looking for something different to relieve hot flashes, night sweats, and vaginal dryness. Some women disliked the side effects of hormone therapy, such as breast tenderness or bleeding. Others worried about estrogen's link with breast cancer. Still others were opposed to taking drugs for symptoms because doing so implies that menopause is a disease rather than a normal life passage. Some women objected to the use of pregnant mares' urine — the source of estrogen in oral conjugated equine estrogens (Premarin), the only estrogen tested in the WHI trial.

In search of "natural"

Many women assume that "natural" hormones would be better or safer — but the term "natural" is open to interpretation.

Any product whose principal ingredient has an animal, plant, or mineral source is technically natural. It doesn't matter whether the substance is ground, put into capsules, and sold over the counter — or extracted in a laboratory, manufactured by a pharmaceutical company, and made available only by prescription. For example, the soy plant is the source of supplements that some women take to ease menopausal symptoms; it's also used, along with yams, to make the estrogen in the FDA-approved hormone drug Estrace.

But unlike Estrace, soy supplements aren't regulated and haven't been rigorously tested in humans, so we don't know whether they're safe or effective. There's some evidence that certain soy components may actually stimulate breast tumor growth. So "natural" doesn't necessarily equal "safe" — and may simply be a euphemism for "unregulated."

Enter "bioidentical"

The interest in a more natural approach to hormone therapy has focused attention on bioidentical hormones — hormones that are identical in molecular structure to the hormones women make in their bodies. They're not found in this form in nature but are made, or synthesized, from a plant chemical extracted from yams and soy. Bioidentical estrogens are 17 beta-estradiol, estrone, and estriol. (Estradiol is the form of estrogen that decreases at menopause.) Bioidentical progesterone is simply progesterone. It's micronized (finely ground) in the laboratory for better absorption in the body.

Bioidentical hormone therapy is often called "natural hormone therapy" because bioidentical hormones act in the body just like the hormones we produce. But here again, that tricky word natural muddies the waters. Pregnant mares' urine is natural, but Premarin is not bioidentical, at least not to human estrogen. The same goes for Cenestin, which is made from plants but is not bioidentical.

Technically, the body can't distinguish bioidentical hormones from the ones your ovaries produce. On a blood test, your total estradiol reflects the bioidentical estradiol you've taken as well as the estradiol your body makes. On the other hand, Premarin is metabolized into various forms of estrogen that aren't measured by standard laboratory tests. Proponents of bioidentical hormones say that one advantage of bioidentical estrogen over Premarin is that estrogen levels can be monitored more precisely and treatment individualized accordingly. Skeptics counter that it hardly matters, because no one knows exactly what hormone levels to aim for, and symptoms, not levels, should be treated and monitored.

How do I find bioidentical hormones?

Bioidentical estrogens and micronized progesterone are made into a range of products, many of which are FDA-approved and available with a prescription at your local drugstore (see chart, "FDA-approved hormones for menopausal symptoms"). Commercially available bioidentical estradiol comes in several forms, including pill, patch, cream, and various vaginal preparations. Micronized progesterone comes in a capsule or as a vaginal gel.

FDA-approved hormones for menopausal symptoms

Type/source

Brand name(s)

Preparations

Bioidentical?

Estrogens

Conjugated equine estrogens (CEE)/pregnant mares' urine

Premarin

PillVaginal cream

NoNo

Synthetic conjugated estrogens/plants

Cenestin, Enjuvia

Pill

No

Esterified estrogens/plants

Menest

Pill

No

17 beta-estradiol/plants(micronized)*

Estrace, others

Pill

Yes**

Alora, Climara, Esclim, Estraderm, Vivelle, others

Patch

Yes

Estrogel

Transdermal gel

Yes

Estrasorb

Topical cream

Yes

Estrace

Vaginal cream+

Yes

Estring

Vaginal ring+

Yes

Estropipate (modified estrone)/plants

Ortho-Est, Ogen, others

Pill

No

Ogen

Vaginal cream+

No

Estradiol acetate

Femring

Vaginal ring

Yes

Estradiol hemihydrate

Vagifem

Vaginal tablet+

Yes

Ethinyl estradiol

Estinyl

Pill

No

Progestins, micronized progesterone

Medroxyprogesterone acetate (MPA)

Amen, Cycrin, Provera

Pill

No

Micronized* progesterone USP

Prometrium

Pill

Yes

Prochieve 4%

Vaginal gel

Yes

Norgestrel

Ovrette

Pill

No

Norethindrone

Micronor, Nor-QD, others

Pill

No

Norethindrone acetate

Aygestin, others

Pill

No

Combined hormones

CEE and MPA

Premphase, Prempro

Pill

No

Ethinyl estradiol and norethindrone acetate

Femhrt

Pill

No

17 beta-estradiol and norethindrone acetate

Activella

Pill

No

Combipatch

Patch

No++

17 beta-estradiol and norgestimate

Prefest

Pill

No++

17 beta-estradiol and levonorgestrel

Climara Pro

Patch

No++

*Particles are made smaller for better absorption.**Bioidentical estradiol until ingested and converted in the liver to estrone.+For vaginal symptoms only.++The estradiol is bioidentical but not the progestin.

Bioidentical estradiol in pill form is converted in the liver to estrone, a weaker bioidentical estrogen. But given in a patch, it enters the bloodstream as bioidentical estradiol. Creams, gels, and lotions applied to the legs or arms can also deliver bioidentical estradiol directly to the bloodstream, although it's uncertain how much is absorbed.

Are bioidenticals safer? No one knows. Studies have shown they can help relieve hot flashes and vaginal dryness, but as yet, few large studies have investigated the differences among the various hormones and methods of administration. More research is needed to further understand these differences and compare the risks and benefits.

Women taking bioidentical estrogen who have a uterus must still take an FDA-approved progestin or micronized progesterone to prevent endometrial cancer. So-called natural, plant-derived progesterone creams sold over the counter contain too little of the hormone to be effective. And yam extract creams don't help because your body cannot convert them into progesterone.

What about compounded hormones?

Much of the confusion about bioidentical hormones comes from the mistaken notion that they must be custom-mixed at a compounding pharmacy. But custom compounding is necessary only when a clinician wants to prescribe hormones in combinations, doses, or preparations (such as lozenges or suppositories) not routinely available — or to order hormones not approved for women, such as testosterone and DHEA. Compounding pharmacies use some of the same ingredients that are made into FDA-approved products, but their products are not FDA-approved or regulated.

One size doesn't fit all in women's health. Compounded hormones can certainly help to individualize treatment, but if you're considering them, be aware of the following:

Compounded drugs are mixed to order, so there are no tests of their safety, effectiveness, or dosing consistency. There is no proof that compounded hormones have fewer side effects or are more effective than FDA-approved hormone preparations. Some clinicians who prescribe compounded hormones order saliva tests to monitor hormone levels. Most experts say these tests are of little use because there's no evidence that hormone levels in saliva correlate with response to treatment in postmenopausal women. There is no scientific evidence that the compounded preparations Biest and Triest, which are largely estriol, are safer or more effective than other bioidentical and FDA-approved formulations. Some proponents claim that estriol decreases breast cancer risk and doesn't increase endometrial cancer risk. Both claims are unproven. Heath insurers don't always cover compounded drugs.

This doesn't mean that you shouldn't consider compounded hormones. Just realize that, in a real sense, you're going to be an experiment of one. Unless your clinician has considerable experience with bioidentical hormones and a particular compounding pharmacy, you're better off with a prescription for commercially available hormones, many of which are bioidentical.

Hormone preparations and delivery systems

Since the end of the WHI's trial of Prempro, the FDA has recommended using hormone therapy only in low doses for a short time for severe menopausal symptoms. Yet experts don't really know how the WHI results apply to other compounds. This leaves women and their clinicians with a number of questions. In the combined hormone trial, the WHI tested only one estrogen (Premarin) and one progestin (Provera), in a single pill (Prempro), at a single dose (0.625 mg Premarin and 2.5 mg Provera). Would a different estrogen or progesterone have fewer side effects? Would lower doses or a different mode of delivery, such as a transdermal (skin) patch or skin cream, be safer?

Different forms of hormones are recognized differently by cells, so it makes sense that their effects might also be different. For example, one study found that among women taking estrogen-only therapy, those who took conjugated equine estrogens (Premarin) had a 78% higher risk for blood clots than users of esterified estrogen (Menest). Also, the progestin medroxyprogesterone acetate (Provera) interferes more with estrogen's good effects on cholesterol than micronized progesterone (Prometrium) does.

The delivery method also is important. When estrogen is taken as a pill, it's first processed through the liver. This stimulates proteins associated with heart disease and stroke, such as C-reactive protein, activated protein C, and clotting factors. When delivered by transdermal patch, estrogen isn't first processed by the liver and — at the same level of blood concentration — doesn't have these effects.

Bottom line

The risk of any hormonal product depends on more than how the hormone is made. That's why it's important to work closely with a clinician to decide what's right for you. If your symptoms are bothersome, discuss your options with a physician or other specialist in menopausal health. To learn more about menopause and bioidentical hormones, visit the Web sites of the Association of Women for the Advancement of Research and Education Project (Project Aware), www.project-aware.org, and the National Women's Health Information Center, www.4woman.org/menopause.

(This article was first printed in the August 2006 issue of the Harvard Women's Health Watch. For more information or to order, please go to http://www.health.harvard.edu/womens.)

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