Any one seeing patients that were doing well then have low levels applying creams topically.Is this a saturation absorption problem/I heard it mentioned at the Gaby/Wright seminar and they mentioned using vaginal application to the mucous membrane.If so are you reducing doses and what base are you having it formulated in?
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Re: topical versus vaginal bioidentical hormones
Unfortunately I don't really know of any Pub Med studies that address saturation/absorption problems. In our practice we have found that changing the vehicle often improves absorption dramatically. Most women dislike vaginal administration for systemic usage. There is also increase incidence of infections associated with vaginal administration. Try to change the vehicle and possibly consider FDA approved Estrogel or Elestrin or Vivelle Dot to raise serum levels.