Transdermal vs. Oral
Oral hormone preparations are metabolized in the gastrointestinal tract. Transdermal and vaginal preparations avoid the gastrointestinal tract and the liver, thereby minimizing potential side effects of hormones such as blood clots. In addition, the transdermal method permits the use of smaller doses of medications, which also helps to minimize potential side effects. Transdermal ovarian cream can be used
for many health concerns, in various doses and combinations.
Estrogen
Estrogen dominance, in which inadequate amounts of progesterone are being produced, may be treated with bio-identical progester- one transdermal cream. A common dose is 30mg/0.1ml. A 2% progesterone cream has 20mg of progesterone per milliliter. This preparation is taken according to men- ses—once a day for the first part of the menstrual cycle, twice a day for the rest of the cycle. This regimen will be using progesterone to balance es- trogen. If a woman has irregular menstrual cycles, the schedule of dosing can go by the calendar— once a day for the first 14 days of the calendar, twice a day for the rest of the month. A woman in perimenopause may use pro- gesterone as above. However, if menses have stopped for some months, she may go to proges- terone twice a day. She may want to consider es- trogen at some point if she develops menopausal symptoms such as hot flashes. A patient who is menopausal, (according to lab results and symptoms) and who has no risk factors for estrogen use, may be prescribed Bi Est (80% estriol and 20% estradiol) along with pro- gesterone 30mg in a combination preparation, for example 0.125mg Bi Est/0.1ml and progesterone 30mg/0.1ml. This preparation may be used twice a day, 0.1ml each time. A low dose of testos- terone, 0.125/0.1ml, may be added if there are symptoms of dry skin, decreased libido, or bone density issues; testosterone levels should be in the midrange if testosterone will be ordered. Other estrogen combinations also are pos-
sible—Bi Est ratio of 50/50 for example. Some providers prescribe Tri Est (estriol 80%, estradiol 10%, and estrone 10%); however, estrone may not need to be prescribed since estradiol converts in the body into estrone and estrone can convert back into estradiol.
Initial experiences with Bi Est years ago started with high doses of estrogen, similar to the doses in oral contraceptives. However, repeated follow-up testing and assessment indicated lower doses are just as effective and minimize the po- tential side effects of estrogen.
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