Any switch from Premarin to natural estrogen?

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Any switch from Premarin to natural estrogen?

Postby Rita » Tue Oct 18, 2005 6:41 am

Now that I know Premarin helps greatly with my symptoms I am concerned about the health risks. I'd like to switch to a natural estrogen. Has anyone done this? Is is safe to take Premarin with natural herbs? Anyone know the best plan? I can't just quit the Premarin because I feel too good!!!! I am taking lots of vitamims and minerals already. I have a product called PhytoEstrogens Plus EFA's made by Solaray. Anyone have any expience with it? Any advice would be greatly apprecitated.
Thanks Rita
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Postby drjudy » Wed Oct 19, 2005 9:59 am

Dear Rita,

I've had a lot of patients switch from Premarin to 'natural,' which usually means estradiol. Premarin is actually natural too, just more natural to horses than humans. The headline-making results that came out of the Women's Health Initiative about the dangers of hormone therapy were probably more about the age (average63) and underlying health of the participants (lots of smokers and overweight women who may already have had some narrowing and inflammation of their arteries) than about the Premarin. Provera, the progestogen used in the WHI, is also a suspect with respect to some of the adverse outcomes.

All that said, I too prefer estradiol as the best estrogen for replacement therapy. The problem that I see occasionally, however, is that Premarin is a blend of a number of different hormone molecules, some of which have other benefits not available in plain estradiol. Particularly, some of the Premarin hormones have androgenic (male hormones like testosterone) properties that enhance energy. So some women who are probably at a point in life where they don't make much testosterone feel better on Premarin.

Another problem with the switch is that Premarin is formulated to last all day, whereas oral estrogen has only a 6-8 hour mode of action. So if women switch from Premarin to a.m. estradiol, by night they're hot and sweaty. That's why I prefer the patch (Vivelle Dot or Climara), or at least twice daily dosing with oral estradiol (Estrace).

Discuss with your doctor the possibility of switching from Premarin to estradiol. Roughly equivalent doses would be .5-1 mg. of Estrace (taken as .25-.5 mg twice daily) or Vivelle Dot .05. You can use lower doses of estrogen via the patch as the hormones are absorbed directly through the skin.

The problem with herbs and hormones is that some herbs are phytoestrogens that compete for the same cellular receptors as your hormones. The phytoestrogens are weaker, and may unpredictably affect how the hormones work. If you want to do both, I'd use the hormones first to check out how they work, then add herbs and see what changes. If hormones are agreeing so with you at this phase of life, you might want to skip the herbs for now.

Best wishes,
Judy
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Postby Rita » Wed Oct 19, 2005 3:07 pm

Thanks Dr. Judy for all that info!!! So would "the patch" and/or estradiol be less harmful to your body than Premarin?

Rita
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Postby drjudy » Fri Oct 21, 2005 9:42 pm

I like to think of the bioidentical hormones as more beneficial rather than less harmful. There is abundant evidence that hormones provide multiple ongoing benefits to the body, particularly if initiated early in menopause. Premarin actually has a fair amount of evidence supporting its benefits in that group of women as well.

Judy
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