4. Dear Pharmacist,
I’m very confused about the forms of estrogen. Can you explain them to me?

Estrogen comes in many forms and strengths. The reason for this wide variety is to taylor the dosage as closely to you, the patient, as possible. The wide choice of therapy allows the doctor to individualize the therapy to match your symptoms.

There are oral tablets, patches, and foams. Vaginally, there are creams, tablets and rings.

The oral tablets are available in different strengths and formulations. They are available in a bioidentical tablet (same estrogen as is found in your body) and a conjugated tablet (a few different estrogens together). It will be up to you and your doctor to discuss your individual therapy. One example, estrogen tablets are metabolized in your body through your liver. If you have had liver disease, a better choice may be an estrogen patch or foam. There are other situations that will help you and your doctor decide which form of estrogen you should be taking or using. The doctor will consider your medical history in choosing a product.

Vaginal estrogen products are usually prescribed when the problem is more localized in the vaginal/bladder area and not used much for hot flashes. If you are having vaginal problems such as itching or have problems with urinary tract infections, a low dose estrogen cream or vaginal tablet may help rebuild the vaginal tissue and not be absorbed into your system therefore decreasing the risk of side effects.

There is also a type of estrogen replacement that is custom compounded. It is a cream that is individually produced in pharmacies. There is usually no testing done on these creams to see how much is absorbed or how predictable are the blood levels produced. At this point, there is no scientific evidence to say that these are any better or safer that the government approved products.

In closing, there are many estrogen products on the market. This is a good thing as this means that you and your doctor can choose a product at the lowest dose possible to alleviate your symptoms. You also get a choice, you may not want to rub on a foam daily, perhaps a tablet would be best for you, or vice versa.
Make an appointment with your doctor and go in with a list of your symptoms from the most important to you, to the least and discuss them.

*Please note that if you have a uterus, a progesterone product will also be required.

5. Dear Pharmacist,
How does the doctor know how much estrogen to prescribe?

The doctor doesn’t know the exact amount at the beginning . The doctors have protocols and guidelines as to where to start and with what dose, but it also depends upon you, the patient, to help with these decisions. Are you having severe hot flashes? Night sweats? Is insomnia your main problem? Vaginal discomfort? Emotional ups and downs?

Communication is the key to treatment. You have to describe your symptoms to your doctor so she/he has a place to start. Take in your symptom diary. Prescribing estrogen for night sweats is certainly different than prescribing it for vaginal atrophy. Your doctor will treat your symptoms until they are relieved with the lowest possible dose of estrogen . Make sure to give them your feedback both positive and negative. Be collaborative!

6. Dear Pharmacist,
I’m always itchy around my girl parts. Do you have something that will stop the itch?

Vaginal itching occurs often in perimenopause and menopause due to decreasing estrogen levels. Estrogen keeps the vaginal walls thicker and less prone to the thinning that leads to itching, dryness or even tearing with intercourse.

Firstly, you want to be certain that the itchiness is caused by menopause and not something else like a yeast infection. See your doctor.

For mild itchiness, you may want to try an over-the -counter lubricant like Replens. This may increase the lubrication in your vaginal area enough to stop the itch.

For moderate or severe irritation and itchiness, your doctor may prescribe a topical estrogen cream. This will increase the thickness of the walls in the vagina, restore the moisture and can relieve the dryness that leads to the itchiness.

Other non-prescription options to help are wearing loose, cotton underwear, good personal hygiene, and using fragrance free products to clean the vaginal area.

Readers! Send your questions to deborah@vergowoman.com. They will be answered by a female pharmacist with over thirty years of clinical pharmacy experience.

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