Submitted by JSmith on
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I have a few questions regarding moving patients off of premarin 625/5, can someone help?

1. If a patient has been on premarin ,625/5 for years, how would you go about weaning her? Would you keep her on it for 2 days and add estradiol 2.4 with progesterone 100mg qhs? Which would be best: topical or oral progesterone?

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Estrodial and Progesterone Protocols - Answers

Hi JSmith,

For my patients I usually start the new regimen and stop the Prempro after two or three days. In answer to your second question, yes. It's a good start. I find they usually need more estradiol but start at 2.4 and see how she does in three weeks.

In terms of which would be best topical or oral progesterone, I would say that oral would be easier for the transition.

I hope that helps! If you have further questions just let me know.

Erika Schwartz, MD.

Thanks!

Dr. Schwartz,

Thank you so much for your help. I have one quick follow up. For a young patient, less than 25 with PMS- can one try progesterone first , then if no improvement after increasing doses, add estradiol?

Many thanks

Jamie Smith

Re: menopause and sexual drive

Bioidenticals - estradiol, progesterone, testosterone and DHEA help with libido. For studies, please refer to:

- Zdanowicz, N - Sexuality and menopause, a Belgian study,
- Nieto, C - Comparative pharmacokinetics and preliminary efficacy of two topical vaginal preparations of estriol versus marketed reference product Ovestinon in postmenopausal healthy volunteers,
- Witis, S, Climacteric sexuality and more.

We use DHEA suppositories.5mg HS in conjunction with estradiol, progesterone and testosterone in TD preparations as per our protocols with high degree of success.

For further information, you might consider registering for the BHRT Fall 2011 Preceptorship Program.
http://bioidenticalhormoneinitiative.org/content/2011-preceptorship-program