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[Cassie]

Hi Ladies I have been on Oestrogel for approx 20 yrs as went through early meno and just recently went onto a compounded BHR cream as I no longer want to get a monthly bleed. The Estrogen part of the cream is made up of 80 Estriol and only 20 Estrogen and I really did not feel good on it at all, very jittery and not well. I have decided to stick with the gel which has always worked well for me and just use a compounded Prog cream to hopefully keep my uterine lining thin. I was prescribed 20mg rub on I am hoping this will be fine for the 1 pump of gel I use. I have spoken to some lovely ladies on this forum who also have used creams. Has anyone had any experience and did you also find the Biest cream not great because of too much Estriol?

[Cassie]

Anyone used compounded Bi Est creme?

[sheila99]

Sorry, no experience of it but I would have thought an ordinary patch with estradiol rather than estriol would be better anyway. I'm assuming you know but for anyone else reading this post if you use a progestogen cream instead of a prescribed progestogen it's really important to arrange your own scans to make sure your lining isn't building up (cancer risk) as the creams are normally much weaker.

[joziel]

Biest is not really 'HRT", it's ineffective with that much estriol. Estradiol is what you need.

Progesterone is not adequately absorbed through the skin and any topical cream will not protect your uterine lining sufficiently.

If you are taking enough estrogen, you WILL have a bleed. Estrogen is growth-proliferative - which is why it keeps cells young and has so many anti-aging mechanisms. You can't take something which is growth proliferative and expect it only to affect your skin and heart and brain, it's also going to affect your uterus and cause 'growth' there.

The only solution is to take a crap small amount of estrogen (and so be subject to all the health drawbacks of not enough estrogen) or to schedule a bleed so you know when it will happen and you allow the build up to come out.

As Dr Felice Gersh says - what builds up, must come out.

[Cassie]

Thanks for the responses ladies. I am a bit confused as my Dr says the P creme is absorbed much the same as the gel I am on, I guess I will have to keep an eye on the scan and see whats what. The idea of taking it is that I no longer want to have a withdrawal bleed. I only use 1 pump of the gel, I seem to absorb well as it keeps my symptoms at bay and my blood tests are usually in the acceptable range.

[dangermouse]

The progesterone creams and gels can be effective to protect the womb as long as monitored with scans. I believe MaryG uses a gel and has clear scans.

[bombsh3ll]

Please do not rely on progesterone cream for endometrial protection if you are using systemic estrogen.

This is not safe as the progesterone molecules are too large to cross the skin in any meaningful quantity.

This is why the only licensed transdermal progestogen is synthetic, in the combi patch.

You are essentially using unopposed estrogen which if continued for a long time significantly increases the risk of endometrial cancer.

Now not everyone taking unopposed estrogen will get endometrial cancer - there is data from the 1960s and 70's suggesting between 30 and 60% on oral estrogen alone developed some degree of malignant or premalignant changes over several years of use, but it is important that you know the risks.

In rare cases specialists will sometimes use unopposed estrogen in a low dose such as you are taking, however these patients are monitored with regular scans to make sure they are not developing hyperplasia, so please make sure this is happening for you if you aren't using an effective progestogen.

[joziel]

Yes, what bombshell says. And what i said before.

[Mary G]

The progesterone creams and gels can be effective to protect the womb as long as monitored with scans. I believe MaryG uses a gel and has clear scans.

Yes, that's right dangermouse.

To be clear, I'm currently using progesterone gel every day alongside 75mcg Cerazette.  The progesterone gel is produced by the same manufacturer as my Oestrogel (Oestraclin) and I was able to get approximately 50mg progesterone per day from it which is OK for one pump of gel and my uterine scans were always way below 5mm.  I used to occasionally bolster it up with 50mg vaginal Cyclogest but not very often.

I have now had to add in the Cerazette because I needed to increase my Oestrogel to two pumps to prevent my brain stem auras - this migraine sub-type is caused by low oestrogen levels.  By keeping the Cerazette to a minimum and continuing with the progesterone gel I'm managing well with no side effects, not even breast pain.  I could have used Cyclogest @50mg every day but it's a bit messy and taking a pill is easier.

I have used compounded progesterone lozenges in the past (see my thread in the Alternative Therapies section) and they was excellent.  It's expensive but it works.  It comes as a buccal lozenge, sublingual drops or a transdermal cream.  I didn't have any side effects at all and once again, uterine scans were usually about 3mm.  I would have continued with the compounded progesterone but Brexit meant they could no longer post it to an EU state.

I think the NHS over prescribe progesterone, probably because they don't routinely scan women unless they have a problem.  I think they worked out the minimum amount that works and then doubled it.

[Cassie]

Thank you ladies for all your input, really appreciate it. I think compounded HRT has progressed in leaps & bounds over the years. I am currently consulting with an integrative Dr who works with a compounding pharmacy. I have questioned that poor pharmacist and was assured that their creams have a certain, I cannot recall the technical term, ingredient which allows the P particles to enter the system, transdermally, much as I would imagine, is in the Oestrogel, so am really hoping, this is the case. I will have a scan in the next few months and keeping fingers crossed all is well. Tx

[Mary G]

That's good Cassie, I found the pharmacists at the Specialist Pharmacy were extremely helpful and always happy to answer questions.  They kept me informed about new products too.

I hope the compounded progesterone route goes well for you.