So you and your doctor have decided to replace your decreasing hormones with natural instead of the synthetic alternatives.  Congratulations!  But don’t stop here.  The next puzzle piece is how to get the  inside your body where they can exert their beneficial effects.

And don’t be too quick to swallow the obvious:  a capsule or tablet.  The problem is, many of the benefits of natural HRT will be lost as the hormones go through the process of digestion.

None of your circulating hormones are secreted into your digestive tract as a means of total body distribution.  Glands typically secrete hormones into the local circulation where, eventually, they reach complete systemic circulation.  This is physiologically natural.  Hormone delivery via the digestive tract is not.

When hormones are swallowed, they are exposed to digestive acids and enzymes and metabolism as they are absorbed through the gut wall.  Then, like virtually everything absorbed by the digestive process, they are carried directly to the liver in what is called first-pass metabolism.

As a total day’s amount of hormones reach the liver in a very short period of time, this does several things.  First, it is just plain hard on the liver.  And if other medications are being taken, this adds to the liver’s burden and increases the risk of liver toxicity, injury and gall bladder disease.

Next, the liver does not know that this rapid rise in hormone concentration is short-term.  It operates on the basis that hormone levels are way too high, and begins to make changes to counteract this effect.  The net result is that it affects the way your body has access to the hormones.  It affects the estrogen and progesterone you might be taking, but also affects other circulating hormones and chemicals as well.  This includes thyroid hormone, cortisol and a substance called antithrombin III that helps to protect you from strokes and heart attacks.

These changes can increase your blood pressure and cholesterol, affect your mood, lower your thyroid and cortisol potential and increase your risk for a stroke or heart attack.

At this time, viable options to swallowing your hormones include injections and trans dermal (across the skin) delivery.  Injections have their obvious drawbacks.

However, trans dermal delivery of medications has gained rapid popularity during the last 10 or 15 years.  Estrogen, testosterone, nitroglycerin and nicotine are just some of the different medications in a patch form that are applied to the skin for absorption.  Creams, suppositories and troches are other forms of trans dermal absorption, all of which bypass the digestive system and first-pass metabolism.  This is good.

Creams can be very effective, but because of the extreme variation in skin type (thickness, fat content, water content, etc.), their absorption is erratic and unpredictable.

Suppositories, vaginal and rectal, are very effective and dependable for drug delivery, but lack convenience.

Troches, however, offer the best of all worlds.  A dosage form dating back to the 1800s, troches have regained tremendous popularity for the absorption of medications, especially hormones.  They are effective because the lining of the mouth is thin and rich in blood supply.

Troches are small lozenges that dissolve between the cheek and gum over a period of about 30 minutes.  As it dissolves, the hormones are gradually absorbed into the blood stream, resulting in physiologically natural hormone blood levels.  Also, because these are bio-identical to the hormones your body has produced, they are efficiently recognized, utilized, metabolized and excreted by the body.  Since your own hormones only last about 8 to 12 hours, your natural hormone replacement should be dosed about every 12 hours to give adequate, even blood levels.

Synthetic hormones, however, do not fit receptors exactly and are more difficult for your body to metabolize.  That is why they are usually dosed just once per day.

Because of the tremendous advantages in consistency, effectiveness and the ability to avoid the digestive process, we strongly recommend troches as the primary dosage form for hormone replacement therapy for both men and women.

This information is from – a compounding pharmacy that has been doing this for 45 years.  A thank you to my reader, Linda.


What Is A Troche And How Can It Help You?

What is a and how can it help you?   In case you are curious, it is pronounced (troh-key.)

Being in perimenopause or , you may be experiencing symptoms such as  not being able to sleep at night.  You wake up grouchy and have no energy because you are totally exhausted!

You have night sweats and wake up drenched!   You have to get up and actually put another night gown on, change the sheets and try to go back to sleep!   But now you are wide awake!

What about hot flashes?  You are with a group of workers from your job and all of a sudden, everyone is staring at you – you have sweat running down your face, melting your make-up and causing your clothing  to stick to you!  You look like you just ran a five mile marathon in 90 degree heat!

Your symptoms may have to do with low libido or having mood swings!  Your relationship with your honey and your family has never been worse!

What is a troche 400x300 What Is A Troche And How Can It Help You?

You may experience these symptoms as many women do when they are in – the time when your hormones are decreasing, fluctuating and trying to readjust to the imbalance taking place  in your body.

You may have already discussed your issues with your doctor and you have come to the decision that you want to try the bio-identical hormones.  Are you going to take them in pill form or just what choices do you have on the delivery system of getting them into your body effectively?

First, I say good for you and your decision!  You came to that decision instead of caving into asking for or accepting a prescription for the . You must have done your research!

The synthetic are not one size fits all, they are not something “natural” to your body, and animals (horses) suffer in the process of the manufacturing of them.

Your choices of how to get the dose of hormones into your body are by using these forms:
  • creams
  • pills
  • suppositories
  • patch form
  • injections

There are advantages and disadvantages to each of those choices, mostly disadvantages.  Some of those disadvantages being inconvenient, unsafe and unreliable.

The trans-dermal option – applied through the skin, has become more popular in the last 15 years.  The bio-identical hormone dose for your specific needs would be in a patch form that would be put on your skin to be absorbed.

Using creams, suppositories and troches are also considered trans-dermal.  They bypass the important organs and that is always a good option.

What is a troche and how can it help you?  

You never hear much about troche being a choice of delivery for getting the hormones into your system.

When you use the  in a troche form, your body will recognize these as they are exactly like your own hormones.  Your  body accepts, applies and stabilizes these as your own hormones.

Troches can be different flavors so that they are easily taken like a little lozenge.  The dosage is placed between the gum and the cheek, so the hormones are dissolved into the blood stream.

To maintain levels of your hormones, you should dose every 12 hours as your own hormones last somewhere between 8 and 12 hours as well.
As the lining of the mouth is thin and rich in blood supply, it only takes the process of delivering the hormones about 30 minutes total, to be absorbed.

As you can see, it is a very convenient form and has been known to be reliable dating all the way back to the 1800’s for taking medications.

It seems to me from my research that the troche is the best form of taking bio-identical hormones.  If I were taking any, that is the form I would use.


An Australian research paper about the effectiveness of troches (transbuccal – same thing)

Pharmacokinetics of estradiol, progesterone, testosterone and dehydroepiandrosterone after transbuccal administration to postmenopausal women.

Wren BG, Day RO, McLachlan AJ, Williams KM.

Sydney Menopause Centre, Royal Hospital for Women, Randwick, Australia.

OBJECTIVE: To evaluate the pharmacokinetic profiles of estradiol, progesterone, testosterone and dehydroepiandrosterone in postmenopausal women following single and multiple dosing using a troche and the transbuccal route of administration. METHODS: Each troche contained estradiol (0.5 mg), progesterone (200 mg), testosterone (2.0 mg) and dehydroepiandrosterone (10 mg). A half troche was administered to each of six women and the plasma concentration-time profiles determined over 24 h. Thereafter, a one-half troche was taken twice daily for 2 weeks and concentrations determined over a dosage interval (12 h). Blood and saliva samples were collected at specified time intervals on the first day and again after 2 weeks. RESULTS: Each of the hormones was readily absorbed via the buccal mucous membrane. Peak plasma concentrations of estradiol and progesterone were comparable to those found normally in young menstruating women. CONCLUSION: The transbuccal route is a novel approach to provide therapy for the management of menopause-related symptoms of postmenopausal women without the need to resort to conjugated or synthesized hormones, and may overcome the poor or erratic systemic availability associated with other routes of administration.

Here is further recent research into the effectiveness of troches (sublingual) hormones.

Int J Pharm Compd. 2014 Jan-Feb;18(1):70-7.

The effectiveness of sublingual and topical compounded bioidentical hormone replacement therapy in postmenopausal women: an observational cohort study.


Prior studies demonstrated improved menopausal symptom relief following treatment with compounded bioidentical hormone replacement therapy; however, clinical effectiveness studies evaluating different routes of bioidentical hormone replacement therapy administration are lacking. The objective of this study was to determine the effectiveness of sublingual and topical compounded bioidentical hormone replacement therapy for the treatment of vasomotor, mood, and other quality-of-life symptoms in post-menopausal women. This was a prospective, observational cohort study of women > or = 18 years of age who received a compounded sublingual or topical bioidentical hormone replacement therapy preparation between January 1, 2003 and October 1, 2010 in a community pharmacy. Data collection included patient demographics, comorbidities, hormone regimens, and therapeutic outcomes. Patients rated their vasomotor, mood, and quality-of-life symptoms as absent, mild, moderate, or severe at baseline, at one to three months follow-up, and three to six months follow-up. Baseline characteristics were compared using the chi-square test for categorical variables and the Wilcoxon rank sum test for continuous variables. Symptom intensity between baseline and follow-up periods were compared using the Wilcoxon signed-rank test. A total of 200 patients met study criteria; 160 received topical bioidentical hormone replacement therapy, and 40 received sublingual bioidentical hormone replacement therapy. Most sublingually-treated patients (70%) received an estrogen combination and 100% received progesterone. Nearly half (43%) of the topically treated patients received an estrogen combination (43%) and 99% received progesterone. The percentage of sublingually treated patients reporting “moderate” or “severe” symptoms was significantly reduced at one to three months follow-up for the following target symptoms: hot flashes (31%, P = 0.04), night sweats (38%, P < 0.01), irritability (36%, P = 0.01), anxiety (42%, P < 0.01), emotional lability (38%, P < 0.01), sleep disturbances (35%, P < 0.01), memory loss (35%, P = 0.04), fatigue (33%, P = 0.04), and libido (26%, P = 0.03). Similar reductions were seen at three to six months follow-up compared to baseline. Patients who received topical therapy did not experience significant symptom reductions at one to three months follow-up; however, significant symptom reduction was seen at three to six months for the following: emotional lability (31%, P < 0.01), irritability (29%, P = 0.02), and night sweats (20%, P = 0.04).

Compounded sublingual bioidentical hormone replacement therapy is effective in reducing vasomotor, mood, and quality-of-life symptoms experienced in post-menopausal women. Topical therapy does not appear to improve symptoms as extensively or rapidly as sublingual therapy.

  1. Yes – no problems with soy milk

  2. Hi, I’ve recently gone on BHRT and wondering whether okay to drink soy milk? Thanks

  3. I am using bio Identical hormones, Prozac XR, Ashgwanda, I have had thyroid,adrenal hormone, depression, anxiety problems. A few weeks I ago I have developed burning mouth syndrome, could any of the meds be causing Burning Mouth Syndrome, do you know how to treat or get rid of it please ????? Need help

  4. Hi there Dr Holloway.
    Hope you’re recovering well and soon.
    It’s robyn keen here.
    I have a question about the last script you wrote up for me – I’ve been putting on weight since the last 2 visits and wondering if it’s the troche script or if it’s just my dam hormones making my weight go up.
    Also with the new script the pharmacist said I was to have a half troche twice a day and not the 1/4 the prescribed for me.

  5. Under the tongue works fine. They become effective very quickly

  6. Hello. I started a low dose testoserone troche two nights ago. After the first dose I awoke the next morning feeling revialised a less stiff. After the second dose I felt even better in the morning. I normally sleep well but lately awake feelimg stiff and tired. Can the troches work this quickly? This morning though I noticed my gum was a little tender. Can I disolved the troche under my tongue to give my gums near my cheek a break for a little while?

  7. It depends an whether you have a uterus or not. You would need more progesterone if you have a womb to protect you from uterine cancer. You can stay on this as long as you like for many good reasons, including QOL

  8. Merina has many side effects ( see my web-site under “Women’s health concerns – Mirena” for a list of them. I prefer the BHRT (troches
    I do not like Mirena as it has too many side effects -see under “Women’s health Concerns – Mirena” on my web-site. There is research showing women do better on BHRT (troches) than synthetic hormones.

    } to

  9. Rinse your mouth out once the troches have dissolved. Also, try talking to the compounding chemist, who may be able to change some of the ingredients.

  10. Victoria moule

    I’m 54 and take troche. Im suffering with inflamed gums. What’s the best and fastest way to heal them? It’s really bad

  11. Hi Dr Holloway,
    I’m 53 and had my 3rd Merina inserted a couple of months ago, I’ve also been using Estrodot patches for a few years starting with 50mg and for the last 6 months 100mg.
    However I’m starting to have concerns about this hormone treatment, although my Dr doesn’t seem to be concerned, but it’s not her body. I am wondering if I could benefit from having the IUD removed and using troches instead of Estrodot.

  12. Just thought i would add that i am only on a low dose of Bioidentical hormones. A troche consisting of Biest .25mg, Progesterone 30mg, Testosterone .5mg. Would it be safe to stay on this for a better quality of life. My cholesterol has gone sky high since coming off the troches as well.

  13. I am 60 years old and have weaned myself off Biest. I am suffering with hot flushes, fatigue, sore joints, dry skin, thinning hair etc etc etc. I would like to stay on my Biest troches but is it safe at my age. I have heard of women being on these Bioidentical troches well into their 70s.

  14. What if I’m taking troches And my breast nipples are hurting so bad ,, and I am feeling very irritable am I maybe taking a dosage higher than my body needs ,, plz help Mikaa

  15. The troche does not interfer with thyroxine. Very little of the troche will actually be swallowed, and it will still be absorbed anyway.

  16. No. Give it more time and then have the follow-up test to see why this is happening.

  17. I have been on progesterone troches for 1 week now ,my anxiety has hit the roof is this normal when starting bidentical therypy

  18. I am on thyroxine.. have hashimito disease … I didn’t ask if the troche interferes with absorption of thyroxine… and I wonder if swallowing saliva while troche being absorbed .. is there much of a loss into digestive system?

  19. It is best to take them twice daily to get 24 hour coverage.

  20. Hello

    Should oral compounded trochee be taken twice a day?Any information would be greatly appreciated…

    thank you


  21. Diane, I had reflux also with my troche and the menopause clinic told me to take it after my stomach is full so I started to take mine after my dinner and no more reflux. Hope this helps.

  22. You are unlikely to be estrogen dominant, as hot flushes are caused by low estrogen. the correct treatment should work within a fortnight.

  23. I have heard there is a new natural progesterone available but I have received no information about it to date.

  24. Hi I recently heard theres a new bio progesterone just released available on prescription from a gp. My gp hasn’t heard of it. Do you know what its called? I am on progesterone troche from Aus. Menopause centre, but they are very expensive. I have spinal issues awaiting surgery so I am unable to work. The $95 per month is very tough. That’s why I need the name of the new bio identical progesterone as the article says $30 for the script. Can you please advise or help me with a cheaper option. Initial progesterone was 2, and my thyroid very low. I tried both bio oestrogen & progesterone but ended up with huge sore boobs &feeling yuk. I stopped oestrogen and only take half troche (don’t know what strength) progesterone at night. Feeling better have good energy, I have had to drop menopause centre now and I am running out of meds and need help. I am having another blood test in a few weeks to check thyroid again. Can you please help.

  25. Hi, I hope you can advise me! I am 54 and have really bad menopause symptoms, mainly hot flushes day and night. I did the blood and saliva tests and the dr said I was oestrogen dominant (I can’t see on the tests how she determined this).
    She has put me on troches of DHEA 25, PG 300 & PREG 50.
    I have only been taking them for 1 week and feel a little better in myself (maybe placibo effect?) but has not helped the hot flushes.
    I see you say only oestrogen will help hot flushes. Do I need more if I am dominant?
    How long do troches take to make a difference to hot flushes? Dr said 6-8 weeks, I was hoping for quicker to be honest. Would a cream be quicker?

  26. Small doses of testosterone should not effect your voice – however close monitoring (via blood tests) of your testosterone is essential.

  27. I have been taking Bio Identical hormones, Progesterone for nearly 3 years, felt great on it, but have gradually increased the dose, as my Oestrogen level 1267 progesterone 21.0 according to the current blood tests. My treating doctor has seen that my testosterone has been very low for the last 3 years showing readings of 0.4 , 0.7. *<0.1 and current reading is 0.3.
    I have put off taking testosterone supplement for the last 4 years as I was scared that my voice would deepen, as I am a singer. He mentioned that the dose he will put me on is 1.5mg which is half a troche of the 3mg. I am starting tomorrow morning. He did say that this small dosage would be safe, and if I noticed that my skin is oily, and I start breaking out, then stop it. Usually the voice is affected last.

    Anyway I just need reassurance, if this is going to be ok. Thank you

  28. What is the cost?

  29. Blood test. Look under FAQ on my web-site for the difference between blood and other tests for hormone levels.

  30. Michelle Peirce

    Dr Holloway could you tell me the best way to monitor my trouche levels please? As in blood tests or urine? Thanks.

  31. Your naturopath is wrong. They do not go through the liver and do not do any harm to the liver, in any way. Where is the evidence for what the naturopath said. Naturopaths do themselves lots of harm when they make wild statements like that.

  32. diane collins

    My question was does the trouche bypass the liver. My naturopath says it makes the liver toxic, now I am confused. Are these hormones natural or not?

  33. They do not dissolve if taken at bed time. Take them at least 1/2 before bed-time.

  34. I just started taking bioidentical progesterone 100mg troche, 1/2 troche at bedtime. Perimenopausal, believe I have had estrogen dominance for years, but worse recently. However, they don’t seem to dissolve completely. I put one in at bedtime and it is there for 7-8 hours but there is still a thick white residue there in the morning. The troches are mailed to me so they are the sort of waxy looking kind. Is that white residue still the undissolved progesterone? Or? I don’t want to just swallow it… Thanks

  35. Hello Dr Collin

    I am 55 years old and had a hysterectomy at age 36, but kept ovaries…however, went into menopause at age 48. I went on little estrogen and did ok, evamist, I have tried oral (2mg)estrogen and hot flashes are worse and finger clots.

    I do have Addison Disease with very low cortisol, low testosterone and very low Dhea. My internal medicine doctor said that I do not have enough fat on my body to absorb cream. I tried oral estrace and I get more hot flashes. My endocrinologist said the estrogen is keeping the cortisol medicine I am taking in my body longer so I had to reduce my cortef. I have always been very thin and now since I started compounded troche I gain 11 pounds and feel very bloated.I am upset because it did get rid of hot flashes, but no women or even a male for that matter wants to gain weight. I am taking 1.5mg oral troche. My estrone is showing 144 which is high and my estradiol the ultra sensitive by quests labs shows 15. I am very upset because I had to take all my pants upstairs because I can not wear them. I feel really no one truly understands how to balance these hormones. How can you even check this levels if they fluctuate. I do take progesterone cream two times a week …anymore than that I get yeast infections. My doctors …even hormone docs all said because I have Primary Adrenal Insufficiency and on steroids that these interfere with the other nuclear receptors on same pathway. For example, one doc gave me 5mg of testo daily and I almost went into adrenal crisis as it lowers cortisol. It is very well documented. I also have to be careful with melatonin and Dhea my endocrinologist stated. I can take them but it must be smaller dosages.

    So my questions is how to get rid of the hot flashes and sleep better and why the sudden weight gain from vivelle dot and compounded troche. Do I need to decrease back to 1mg in oral estrogen troche because estrone out the roof. The ultra sensitive test by quest showed estrogen 15 and many doctors stated that ultra sensitive is too sensitive. I don’t know why my doctor did ultra sensitive because she normally check estradiol , estrone. Thank you so much for this website. Any information would be greatly appreciated.

    Thank you


  36. See my web site under Women’s health issues – Livial. There is a list of all the side effects of Livial.

  37. Hi I’m perimenopausal and my Dr has suggested Livial and an ssri if needed. What do you think of this ?

  38. Hi Dr. I was just prescribed progesterone 75mg from a compounding pharmacy taking it at night except during my period. I was diognious with pcos i bleed a lot during my period. My main concern is if i take this will i gain weight? How long after i start taking will i notice the weight gain and can that weight be loss as normally as regular weight? I’ve been trying to loss my belly weight for many years and i would be devastated if i took the progesterone it will give me belly fat. Thank you much

  39. Sandra Perrier

    Hi Dr Holloway, I have been on bio identical progesterone, testost, and i just added biest. I had a hysterectomy 2 years ago, kept one ovary. All my symptoms are gone two weeks after i started all the bio identical hormones, hot flashes, anxiety, mood swings, anger, depression you name it GONE! my problem is, i gained 40 pounds after hysterectomy and no matter what i do, juicing, exercise, i am now on nutrysytem, and NOTHING works! my progesterone is 100 mg, and biest is 1mg. What is going on??? i need this weight OFF!!!

  40. I cannot help you. I would need to see you and do a full history and examination.

  41. Marina van Leyden

    I’ve been taking bio identical hormones (on and off) for the past couple of years. My dr here in the UK has been trying to find the correct dosage and method for all this time… I’ve tried tablets, troches, vaginal suppository, and creams! I’ve been taking DHEA, pregnenolone and progesterone in varying amounts over the period. However, I end up with acne, an intensely itchy and spotty scalp, lank and greasy hair, & cysts – specifically behind my ears. Weird! So I stop taking the hormones and it all clears up. I’ve tried several times now and each time the symptoms above return. I’m currently not taking anything and whilst I am acne free, my libido has disappeared again. Do you have any ideas?

  42. Thanks for your reply ,much appreciated,i will check with the chemist ,
    Kind Regards Melissa

  43. Check with the compounding chemist. An itche could be a reaction to one of the other ingredients in the troche – flavouring, sweetener or filler.

  44. Hi Colin,i have been on the troche for 4 weeks due to pre menopause going through the menopause centre ,but just like to ask you i suffer daily headaches/migraine so the centre was telling me due to hormones so is that true i am giving it a go ,and after taken the troche i have been getting ITCHY is that normal from the medication ,love to hear your thoughts ,

  45. Yes, many. Discuss with your doctor. Most things in life can give you side effects, such as wheat, milk, fruits nuts,flowers etc etc.

  46. You should aim for a progesterone level above 20. Also, consider adding oestrogen( for its powerful osteoporosis prevention properties. ( see professor John Studd and his article on the dangers of drugs like prolia and the benefits of oestrogen ) search my web site for osteoporosis and prof Studd.

  47. Dear Dr Holloway,

    After carefull research I decided to use a Progesterone Troche 50mgs nightly. I persuaded a GP to prescribe it and sought out a compounding Pharmacist. It is 10 years. since commencement. I feel brilliantly well good BMI. Principle reason then hot flushes and poor sleep or sleepless nights as well as long term protection for Breast Cancer ( Ist degree pre meno. family history) & for prevention of Osteoporosis. Disappointedly I have been recently diagnosed with severe Oestopenia. I have commenced Prolia & supplements. Serum/plasma biochemistry all within N/L. My questions are; ? any benefit in increasing Prog. dose to aid the situation, and what are the long term risks of taking Progesterone? Recent hormone studies FSH 72 , LH40, E2 <70 Prog 14.4. Should I be concerned with these readings esp Prog?

    I would very much appreciate your opinion. There is scant medical literature available to answer these questions
    Thank you Helen

  48. Dear Dr Holloway. I started my troches on Christmas Eve . I was fine until I started taking two a day. Since then I have been feeling bloated and nauseous . I haven’t been able to eat but haven’t lost any weight. I am experiencing light headedness and am head achey. I feel weak, lacking in energy and have aching joints worse than before.Is this my body getting used to the hormones. Can I drop back to one a day?

  49. Is it possible to have side effects Fromm the troches?

  50. This is a common comment from many of my patients

  51. Hi Doc, I have been taking a troche for years – pre July 2006. Before that I tried and found nothing that would relieve symptoms of hot flushes, loss of sleep and smarts :-). I have tried to go off the troche several times. Cold turkey for 8 weeks and I had hot flushes, was unable to sleep as well, had tiredness and other symptoms as well as a bad case of burning mouth syndrome. My Gp said it usually started post menopausal so I went back on my troche. 48 hours later my symptoms of BMS were almost negligible and then none. I have tried to wean myself again several times and same thing – BMS arrives about 24 hrs later and worsens until I go back on the troches. The Gp who prescribes my troche monitors my levels yearly and I will stay on my troche now until I get another silly idea that I am now 61 and can do without it. Whilst on the troche of (NHRTOL 5/140 1/2 Troche) peppermint flavor I managed to lose 7 kilos by reducing my food intake and walking with my dog almost every day. I was only 67 kilos before I lost the weight.

  52. Dear Dr Holloway
    Wow – I have read the above posts with great interest. Of course, I realise that everyone is different. I’d love to find out more about how to deal with HRT (for myself). I’m 59 (until the end of this month 🙂 ) and was using only progesterone (troches). I was prescribed 1/4 per day (50) but did a loading dose and upped that to the whole 200mg troche per day. After about 3 months I went to have a check (bloods) to find that my levels were so low – about 10 — all other levels about zero! I would have thought that the higher dose may have upped my levels. At this stage I have not experienced any symptoms to speak of — the only thing I could say is that my sleep was disturbed. I then went on to discover “Harmony Max – Plus” which has a great lot of herbs and have started taking that instead. I can’t really notice any difference. What should I notice with or without taking the progesterone? I do use an awesome nutritional system which perhaps has helped over the years ….. but wondered if I’m doing myself a disservice by not supplementing progesterone. I am aware that one isn’t supposed to supplement estrogen after 5 years of doing that (I used to take biest) — however interestingly enough have never been able to find balance in the levels (blood tests only). My prescribing doctor says he’s never seen anyone like me who doesn’t respond and also that he goes by how a patient “feels”. I merely wonder what I might be missing out on by not taking progesterone ….. if anything. Would the Harmony Max work instead? Somehow the troches were making no impact.
    Many thanks – I know it sounds complicated.

  53. I get exactly the opposite .. if I go near anything to do with oestrogen I get the worst hot flushes and horrendous fluid retention. Progesterone gets rid of my fluid and those horrible effects of bloody oestrogen.

  54. Hi Dr I have been on hrt for 22 years I am 51 I went through menopause at 29! I’ve had tablets but In The last 2 years had patches I was fine but decided with my age and being on it for so long it was time to give my body a rest. I’m on my 12 th day of troche had no symptoms with flushes but I have had a upset stomach and a shaky feeling is this normal due to the swap, can’t work out wether I’ve picked something up or could be troche, wondered if you come across anyone else with same symptoms ?

  55. The hot flushes are caused by lack of oestrogen, and bloating perhaps from too much progesterone. There are other causes of bloating (food allergies, esp gluten, and ovarian cancer). Check them out.

  56. Hello Dr. Holloway, I’ve been taking bio-dent troches for 5 years. I’m 54 years of age. I’m now going through my change. My dosage is : 50/TR 2MG Troche. I’ve noticed that I’m so tired and having a lot more hot flashes. I’ve been taking 2 troches per day – I’ve noticed I feel better. I also noticed I feel more bloated and my breasts are swollen. Do you have any recommendations as to what dose I should try, without being as bloated? Please advise. Thanks in advance.

  57. I just switched from cream to troches as I wasn’t absorbing the estrogen……now I feel very puffy, would something in them make me retain water?

  58. Thank you so much for your response – truly appreciate it. I am testing myself on 200mg and wonder if doing a loading dose, say for 1 or 2 weeks per month would be a good “marker” and then going to 100mg the rest of the time. I.e. is is a good idea to even do a ONE week boost to 200mg or wouldn’t that make a difference?
    Thanks again!

  59. Progesterone will help with sleepin, which is why it is better to take it at night. You need to experiment to find the right dose for you.

  60. Wow what an awesome forum – I’m glad I found it and have read a lot from here. Thank you!
    Dear Dr Holloway
    I have a totally different question. I am using progesterone troches – was prescribed 50mg (i.e. quarter of a troche per day) but with a loading dose to start – the full troche first week and then half. The half is 100mg obviously. I have also learned that a “normal” dose is 100mg per day and my question is …. what should I expect to notice if I drop it back to 50mg per day. Sleeping was an issue – I have no other menopausal symptoms at all – I’m nearly 60. I believe that it may help with libido? I know it isn’t good to self-medicate but I also know that my progesterone levels were about zero or just over – they have come up a bit to the lesser of “normal” scale. Would I notice much difference between the 50 and 100 and/or would it be more beneficial to do as I’ve read above – 50mg morning and 50mg night. Bearing in mind – sleep was an issue … however I did understand the 12 hour window that the level would be affected …. whereas I’m using them 24hourly only. What could occur if taking more than required? Would the body just “deal with it” or is there some other potential issue to take into account?
    I hope this doesn’t sound to complicated :).
    I do take oroxine 100 as well – have been and told I’d need it for life about 30 odd years ago. My weight is constant (use a well reputable nutrition system).
    Thank you and kind regards
    ps I did try pregnonalone – fairly high dose with zero effect at all (on hormone level testing).
    pps it is only now (after many many months of taking troches) that it IS possible sleep is improving – taking half (100mg) at night only. I think I’m gleaning from the notes above that taking the larger dose at night is more beneficial? Instead of splitting it to twice a day.

  61. Your script will cover you until End Oct. I will post you a pathform then see me after that.

  62. Missing a dose now and then wont make much difference.

  63. Hi Dr. I’ve been taking Troche Bi-Est/Testosterone 5mg/1mg for 3 months, after being on pellet implants for 10 years. I missed a day/dose yesterday. How will this effect my blood levels? Is there a baseline level that is maintained all the time through use – or, does it decrease, let’s say zero, and start again with each daily dose? In other words, did I just blow my three months of therapy?

  64. Jeannie De Vries

    Dear Dr. Holloway, I have decided to renew my prescription and give it another couple of months….but I will be in Canada from July 8 to sept 2, I don’t think my script will cover that extent of time, can you fax another script to the compound pharmacy so I can take enough to last me? Also, do I need I call your office to set a follow up appointment, and if so, for when? Thank you, jeannie De Vries


  65. There is no reason I know of why those hormones should cause weight gain – should be the opposite.

  66. Dr Holloway, I am 43 and experince occasional insomnia, mind fogginess, and perhaps some moodiness though that one is questionable as I have delt with depression throughout my life. So my sypmtoms are minimal for premenopause I feel. However, my doctor did prescribe a trouche with the bi-est, test and prog. I am very afriad to begin this medication because I am afraid I will possibly trigger more radical hormonal changes in my body. If I do begin taking these, will have lasting changes to my body’s chemistry? I am also afraid of weight gain. I do work out regularly and try to keep a healthy lifestyle. Will these treatments cause weight gain?

  67. If you are going for best contents like I do, just visit this
    web site daily because it provides quality contents, thanks

  68. SLeep apnoea and testosterone deficiency go together. Best to correct the sleep apneoa before going on TT. TT is best given as a cream.

  69. There is a precaution regarding Testosterone for patients with unresolved Sleep Apnea. Are testosterone troches considered safe for use in such a condition? What would be the best strength?

  70. Even after a hysterectomy, I believe women need progesterone. The natural progesterone has many benefits to you all over. Lack of oestrogen causes weight gain, so make sure your oestrogen level is within the normal premenopause range.

  71. Thyroids need your female hormones to function properly- Thyroid hormone and your other hormones are complementary – They cooperate in helping you to feel well. Stress affects your adrenalk gland, so good hormones reduces stress, so helping your adrenals.

  72. Can bioidentical troches support kidney, adrenal and thyroid function in post menopause? I have gone off my progesterone/ pregnalone troches for a month but have now been diagnosed with hypothyroidism.

  73. Hello,
    My issue is similar to some of the others. I had a FULL hysterectomy 3 years ago. I am taking 2mg of Estradiol. I just had a full blood panel done and it came back as low Vitamin D, easy solve, and low Testosterone. My dr. prescribed the .5mg testosterone mini troche. I am worried about bloating and weight gain, like many of the others as this is one of the reasons I talked to my doctor in the first place. I am 49, active, work out 5 days a week and eat very healthy, etc. I was just not losing the extra fat around my middle and thighs. From reading all the above, I am assuming I can expect fairly good results? How quickly do you notice them and someone told me this is not the kind of testosterone that will help me gain muscle. Curious about that, as well. Thank you.

  74. The dose depends on the result of your oestrogen path test. Try and get it in the normal range. The cream and patch are both equally effective, but the cream allows you to vary the dose.

  75. Hi, I have Panhypopituitarism diagnosed 4 years ago. I replace all anterior hormones. Cortisol, thyroid, estrogen, progesterone, female testosterone and growth hormone.

    I have only been on sex hormones and growth hormone for a year, but have had a hard time finding stability with hormones. I am making the move to all bio-identical bar growth hormone. After seeing my bloods for estrogen on transdermal patch I moved to a cream. My levels were that of a 50 something year old at 36. I then moved to capsules for progesterone and natural dessicated thyroid. I was already on the most identical for cortisol and testosterone.

    A new addition I am being trialled with as my posterior gland doesn’t work that well either is oxytocin. I was selected for troches with these and am slowly transitioning myself across with all hormones at a time to avoid side effects. My question is regarding the cream for estrogen mainly. I dose at 0.5 in the morning directly to my arms (I do testosterone at opposing times in the afternoon). Would the estrogen start working much sooner than patch? Or would effect be slightly slower or faster? Im actually not getting too many menopause symptoms with estrogen so low. But it has disrupted the amount of other hormones that I take and would love to see normal numbers again. It is more like muscle cramps and bone pain being low. It was the only question I forgot to ask my Doctor. Thanks

  76. Pacific Compounds Pharmacy, 327 SE 3rd Ave, Hillsboro 97123 503-640-3080. My naturopath does saliva testing with me then orders the troche. Mine is bio-identical Estrogen, progesterone and testosterone. Not covered by my insurance, it costs about $40/month, plus the saliva tests which are about $100 every few months and not covered by insurance. I skip meals out, shopping and treats in order to have money in the budget for this wonderful programme!

  77. Many thanks for the advice. I have read the recommendations. I have just put in a request for more troches!!

  78. Read “menopause recommendations” on my web-site. The long term benefits of these hormones are prevention of osteoporosis, keeping your brain functioning properly and a big reduction in your risk of a heart attack.

  79. Hello Dr. Holloway. I have taken troches for approximately 20 years. I am aged 70 and thought it was not necessary now so have weaned myself off of them. I have not had any for about a month. I feel o.k. [ I think!! ] I am wondering though if I have done the right thing? The Dr. [ who is not my regular G.P. ] has not seen me in years as I get a repeat prescription over the phone sent to my compounding pharmacy. I have always been very happy with them in every way. My G.P. is not a fan off them so I hope you can advise please.

  80. Using them vaginally is an option many women try. The vagina is a membrane that absorbs well, including medicines. Bloating is a sign of too much progesterone – try reducing the dose. The sore gums comes from the sweetener used in the troches – either stevia or some other (hopefully not artificail) sweetener.

  81. Read the section “Troches” under Bioidentical Hormones on my web-site. This gives you a very accurate view of troches. I have used troches successfully for the last 20 years – the number of breast cancers and strokes in women on troches is well below the national average, never mind the quality of life experienced by these women.

  82. hi julie ask for the menopause centre in sydney tel 1300883405

  83. Patricia Jaramillo

    Hi Dr. Holloway, Is it true that troches are not safe for post-menopausal women to take? I live in Sydney and most of the holistic doctors prescribing bio identical hormones are now moving away from troches and prescribing creams that don’t seem to be working for me, the hot flushes have returned despite an increase in my dosage in the last 8 months.

  84. Hi Dr Holloway – so I can alternate on mornings with these troches – the BiEst and the Prog/ Preg? Could the hair loss be re stopping the Bi-Est? Its escalated in this week since I stopped it.

  85. Jeannie De Vries

    I just started my troche five days ago……I feel so bloated and my belly looks distended….also after having the trochee in my mouth, my gums feel tender and sore…..I read somewhere about taking it vaginally, is that an option? Also is bloating a side effect?

  86. It is permissible to change the dosage as you are doing to improve your well-being. If it works, make the changes. Check with your therapist that it OK to do so.

  87. Hi I was wondering if I could alternate troches : a quarter Prog 250 / Preg 50 with a quarter Prog 200/Biest 1.25 in alternative mornings?
    I am 54 post meno – very healthy and am estrogen deficient. The HRT was prescribed for low bone density, mental fog and insomia and recently dry eye syndrome.
    I stopped the BiEst two weeks ago re it stimulated hyperpigmentation (which faded when I stiopped it) and went back to the prog/preg. I am careful re dosage and am currently only taking a quarter of the Prog / pregnalone once a day instead of twice a day as instructed. I would really appreciate your advice Colin! The reason I am thinking of alternating is due to sudden hair loss which I think is the estrogen withdrawal…Thank you.

  88. Yes, I have treated a number of people with CREST syndrome.

  89. Hi Dr Holloway. I suffer with CREST Syndrome. Are you able to assist in any way or suggest where I might receive some help. Thank you in anticipation. Lyn. xo

  90. Oestrogen is very good for joints. See my blog of 6 Dec 2012.

  91. Dear Dr Holloway I have recently had a hysterectomy with ovaries removed. I have had minimal hot flushes and night sweats. However, I am experiencing very bad joint pain in my feet, ankles and hands, and extreme fatigue. The swelling is really bad and I can hardly walk some days. I am being treated for Rheumatoid Arthritis although blood tests haven’t confirmed a rheumatoid factor. My ESR is 85 which is quite high. I have had lots of other tests for thyroid, diabetes and vasculitis and all clear. I’m thinking maybe hormones have something to do with it. Do you think there could be a connection? Wondering if a bio indentical HRT would help? Thanks

  92. Here are some of the side effects of Implanon, which are included in the insert given by the manufacturers of Implanon:
    Besides changes in menstrual bleeding patterns, other frequent side effects that caused women
    to stop using the implant include:

    Mood swings

    Weight gain



    Depressed mood
    Other common side effects include:


    Vaginitis (inflammation of the vagina)

    Weight gain


    Breast pain

    Viral infections such as sore throats or flu-like symptoms

    Stomach pain

    Painful periods

    Mood swings, nervousness, or depressed mood

    Back pain




    Pain at the site of inse

  93. Implanon is etonogestrel, which is very different from the natural progesterone, and has a different set of side effects.

  94. Tracey Montague

    Sorry Dr Holloway you’re right implanon is not estrogen its progesterone, I meant to say progestrone which is the same as the progestrone troche which I’m taking now. Therefore like I said progestrone does put on weight whether you doctors like to admit it or not.

  95. Here is more research on this topic to show what the evidence is:

    US National Library of Medicine National Institutes of Health
    Search database

    Result Filters

    Climacteric. 2012 Oct;15(5):419-29. doi: 10.3109/13697137.2012.707385.
    Understanding weight gain at menopause.
    Davis SR1, Castelo-Branco C, Chedraui P, Lumsden MA, Nappi RE, Shah D, Villaseca P; Writing Group of the International Menopause Society for World Menopause Day 2012.
    Author information

    The aim of this review was to summarize the literature regarding the impact of the menopause transition on body weight and body composition.

    We conducted a search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2012) for English-language studies that included the following search terms: ‘menopause’, ‘midlife’, ‘hormone therapy’ or ‘estrogen’ combined with ‘obesity’, ‘body weight’ or ‘body composition’.

    Whereas weight gain per se cannot be attributed to the menopause transition, the change in the hormonal milieu at menopause is associated with an increase in total body fat and an increase in abdominal fat. Weight excess at midlife is not only associated with a heightened risk of cardiovascular and metabolic disease, but also impacts adversely on health-related quality of life and sexual function. Animal and human studies indicate that this tendency towards central abdominal fat accumulation is ameliorated by estrogen therapy. Studies mostly indicate a reduction in overall fat mass with estrogen and estrogen-progestin therapy, improved insulin sensitivity and a lower rate of development of type 2 diabetes.

    The hormonal changes across the perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. There is strong evidence that estrogen therapy may partly prevent this menopause-related change in body composition and the associated metabolic sequelae. However, further studies are required to identify the women most likely to gain metabolic benefit from menopausal hormone therapy in order to develop evidence-based clinical recommendations.

  96. Implanon is not oestrogen – it is a chemical called etonorgestrel. It has major side effects. This next quote is from the Better Health Channel ” Menopause occurs when a woman stops ovulating and her monthly period (menstruation) stops. Menopausal women often experience weight gain, particularly around the abdomen. This is often due to declining oestrogen levels, age-related loss of muscle tissue and lifestyle factors such as diet and lack of exercise. However, the exact process leading to weight gain and the relative contribution of the different factors are not understood.”

  97. Double agree!! Coffee shops and restaurants! That comment made me mad. I tried these hormones and after four weeks had 10 straight days of diarreah. I was told I picked up a bug. Amazing how it all went away once I stopped taking them. “Defend the hormone”. When I asked if I stopped cold turkey if I would get a period, I was told I would not. Well, guess what showed up for three days. And, since I’ve been off it, my mind is actually clearer!! One of the reasons I went on it. I got better answers and guidance from the compounding pharmacy than I did the doctor. I’m currently taking a product by the Womens Health Network. Hormones, like that, did not help me.

  98. Agreed Tracey! I put on weight from them as well. My doctor even said it was from the troche as well as the compounding pharmacy.

  99. Tracey Montague

    What a load of poop. Yes estrogen does put weight on for some women. Our age and being less active pfft. I still work full time run off my feet all day and have put 4 kilos on. A number of years ago I had the implanon put on my arm for contraception, which is estrogen, again same thing put weight on. When I had it taken out and no contraception at all I lost the weight. It has nothing whatsoever to do with diet or exercise. I’m now on the troche and again I’ve put the weight on.

  100. There is nothing in the hormones you are on that cause weight gain. The evidence is that oestrogen lowers women’s weight. The evidence in on my web-site under “more on women’s hormone – weight gain” As we age our metabolism slows and we automatically gain weight. We also are less active, and we go out more to coffee shops and restaurants. These are the main culprits.

  101. Dear Dr Holloway, I having been taking the troche for about 4years. My diet hasn’t change, if anything I’m eating less and healthier. I have put on weight. Would the troche have caused that? Thank you, Tina

  102. Not necessary. Troches are not the cure for migraines. Discuss this with your doctor.

  103. Dr. Hollowly, I take a trochedays 12 to 26 of my cycle and then on day 28 or 29 get a massive migraine with 12 to 18 hours of vomiting. I thought the trochr would help prevent the migraines.

  104. Probably due to the dose of biest being to low.

  105. I switched from oral estradiol to biest but bega gsining weight. My doc swit hed me to troches same dose as my oral estradiol 0.5, unfortunately I still seem to be putting on weight I am confused as to why no weight gain with the orl estradiol.

  106. Nobody knows how long the menopausal symptoms can last. The chinese herbs are unlikely to be as effective as the troches.

  107. Dear Dr Holloway. I took troches for approximately 10 years. I weaned off them slowly last year as I am now 63. The flushes have returned so I have resorted to Chinese herbs to help cool the body.mhow long can I expect to feel these flushes before my body “cools down” of its own accord?

  108. There is no connection that I know of, so think you can safely continue your troches. I recommend women rinse their mouths out after the troches dissolve, just as a precaution to wash away any residue.

  109. Hi dr Colin
    I have been use troche for 3yrs now 1/8 twice daily dose is 15/10/80mg biest/dhea/progesterone I have just been told I have a turmor in my nose which is cancerous right above we’re I dissolve the troche is there any connection and should I stop taking them do you know of any other cases as mine

  110. PS>>> The amount of testosterone I was taking was 2mg and it made my hair fall out.
    thanks, Lisa

  111. Hi Dr Colin, I have been on troches for over 2 years Progesterone 300mg Pregnenolone 75mg. 2 months ago my doctor added Biest 1.0 for a short period to help me cope with some extra stress I was having but I got bloated and sore breast so went back to original script after 4 weeks. I have just been diagnosed with breast cancer in the last week and are worried that the troches have caused it. Breast cancer is not in my family and my breast test 2 years ago was clear.

  112. Change compounding pharmacy. You are probably reacting to the sweetener – iether Stevia of saccharine. A different sweetener will usually fix the problem. Also, rinse your mouth out with water once the troches have dissolved.

  113. Hello Dr. Holloway. I am a 55 year old post-menopausal woman. I have been taking a Biest troche (1.25mg) every morning along with a 150 MG capsule of Progest SR at night, for two years with good results.
    Recently however, I started getting sores in my mouth where the troche dissolves. It began with a new refill from my compounding pharmacist. The new troche was tinted blue. (I use peppermint). I returned to the pharmacist and told him my experience. He made me a new formula that was still peppermint, but not blue. I still got sores from them. When I went back with still the same problem, the pharmacist just shrugged and said they’d never heard of this before. My prescribing doctor switched my prescription to a transdermal cream from a click-dispenser. After using the cream for two weeks, hot flashes have returned. Is this common? Is it possible there is no biest in my cream? I do not want to go back to my compounding pharmacist as he seems defensive and does not offer helpful solutions. I just want to get my health back into balance. Do you have any insight into this scenario that might be helpful? I would appreciate it greatly. Thank you.

  114. How long does it take to lose water retention after stopping troches?

  115. Is it normal for some people not to get results from Troche?

  116. If you are not gaining any benefit from the troches, you can stop cold turkey with minimal problems.

  117. Dr Holloway I have been on Troche for 8 months now without significant improvement to how I feel although blood tests have confirmed my Hormone Levels are at a satisfactory level. I had a hysterectomy @ 34 then ovaries removed at 41 never given any HRT but decided to seek advice from a Bioidentical Dr. Can I stop taking Troche cold turkey?

  118. Or could you possibly recommend someone to speak with?

  119. Thank you, Dr Holloway.
    I know 24 is young and this is why I am so sad and over this. I want to live my life.
    Do you think I should come off the progesterone troche all together and just continue to reduce xenoestrogen exposure and take the DIM therapy?

    I know you can’t help me, but I am wondering if you can perhaps answer these 3 questions I have:
    1. Does progesterone cause weight gain, or can it?
    2. Will weight gain only be temporary until my oestrogen is quelled and progesterone becomes dominant?
    3. How long (roughly) does treatment for oestrogen dominance usually take?

    Thank you again for your reply,
    If you can at least give me some vague answers to these questions I would be so grateful.
    chelsea Sidaway

  120. I do not treat women at age 24 as I do not think tampering with their hormones at this age is a good thing. You do have huge issues but I don’t think I am the one to help you. Sorry.

  121. Hi Dr,
    I am wondering if you can help me.
    I am 24 years old and am struggling to get a hold of my life.
    After a few years of the contraceptive pill and other medications, my period ceased when I stopped taking them. In order to get it back, a gynaecologist gave me a 5-week course of progynova- an oestrogen tablet. This kick started my period but since then in one year I have put on 11kgs and things are getting worse. I eat a gluten and dairy free diet due to intolerances, and no sugars due to an issue previously with candida. I have found a new doctor who deals with natural hormone therapies. He has diagnosed me as oestrogen dominant. I have been put on ¼ troche or progesterone in the morning and evening. I have also started DIM therapy to reduce my oestrogen. My progesterone is at a normal level, but cannot cope with the amount of oestrogen I have.
    I am putting on more weight with the treatment, feeling depressed (so much so that my antidepressant tablets aren’t even working), feeling suicidal, and nauseas. I am in pain and my breasts are growing more by the day.
    I am willing to put up with and push through any of these horrible side effects, if I know that there is going to be a positive outcome. I don’t use any chemicals and have paraben free cosmetics etc. I have been on the troches for 4 months now and the DIM three weeks. (Take it one week on and one off). This has been the worst week of my life and I have been off work twice. I am a teacher and I was not mentally able to face work as I was distressed. I wake up every morning and something else doesn’t fit me, or my breasts are larger.
    Please can you help me and let me know if this will be over soon? I know everyone is different but I am desperate to know a ball park figure of how long this will take to fix? I want to get well and am doing all I can. Is this weight gain because of the progesterone? DIM? Is it normal? Will it go away?
    I would appreciate any advice, please help me.
    Chelsea Sidaway

  122. Testosterone, DHEA and pregnenolone are best taken as a troche. Thyroid is best as a tablet/capsule. The time does not matter much, but not while eating.

  123. Dr. Holloway,
    I am currently on Testosterone 2mg/0.1 cc, taken at night. I have just received DHEA/Pregnenolone troche 15mg/50mg and Thyroid lactose free capsule (0.5 grain (30 mg). I was told there is a special way to take these. Can you tell me the best way to take these including time to take them and administration of the troche? I have never taken hormones before.

  124. Progesterone can cause some mild constipation and bloating. You may need testosterone for your libido and energy as well.

  125. I have had constant bloating for quite some time now,along with fatigue,no libido and anxiety.
    In the past only yaz has eliminated all my symptoms. I have been prescribed progesterone trouches,1/4 45mg once daily with no help with the bloating. Can hormones cause the digestive process to slow and thus cause my symptoms ? Elimination diets have not worked and bloods are normal. Except low progesterone. Thank you

  126. Yes, they will absorb vaginally. However, there will be no need for a sweetener or flavouring

  127. Brenda – what became of your acid reflux issue? I started capsules of progesterone and the estradiol – separately. My stomach burned so bad, I quit both. Now I have the troche waiting at the pharmacist and I’m afraid to take it. My gut is finally feeling better. I think I’d be more of a candidate for creams. There’s not much on your question on the internet anywhere – I’ve looked for myself. I had a lot of loose stool too, which the doctor said was a “bug”.. But, I’m really doubting that.

  128. Is it ok to takes troches vaginally?

  129. 100 mg testosterone is fairly high dose, in my opinion. CHeck with your doctor. Troches are fine (see my article “troches” under bio-identical hormones.

  130. You will probably need more oestrogen – discuss with your doctor.

  131. You may need to contact your doctor to discuss this.

  132. I’m on my 1st 13th day of my troche and for the past 12 days since starting I’ve slept worse and the fatigue during the day is horrible can’t function and crying all the time I feel like I’m in hell. My doc prescribed half right before bed only

  133. debbie herrick

    IV been taking this for 6 weeks now and it’s the best thing eve iv had my 6 week blood test and everything is back to where it should be i dont have to see the doctor for 6mths no more hot flushes and I’m sleeping so well I recommend this to everyone

  134. I had a hysterectomy September 6, 2011 because I had stage 1 uterine cancer at the age of 40. After six weeks, my doctor put me on 200 mg of prometrium at night. About 20 months ago I started having terrible anxiety and panic attacks. I somehow pushed through each day. I recently saw a doctor who did blood work. My estrogen was <.6, my testosterone was 0.2 and my progesterone was 12. The doctor prescribed a troche biest 1 mg Estriol 80: Estradiol 20 and 2 mg testosterone to be taken in the morning. I still take 200 mg of prometriumium at night. I have only been taking for one week, but have more hot flashes, night sweats and feel really anxious right after taking the troche. Do I need to give this all more time?

  135. Dr Holloway ,
    I have just been prescribed 100 mg testerone troche …. I am 56 . Very athletic and active and am a breast cancer survivor of 14 years … As I’m estrogen receptor negative and have used DHEA in the past I just want to make sure switching to a troche is ok ….

  136. Thankyou for taking the time to answer me, I’m still confused as my Dr said to raise my progesterone to 150mg but said I don’t need estrogen as I am estrogen dominant. I just want to note that my estrogen is at 115pmol and progesterone 6.8 nmol via blood testing. Hot flashes and anxiety still very bad and it’s been two months of bio prog. What should I do I’m so confused 😦

  137. Thankyou for taking the time to answer me. I contacted my Dr and he said i needed to raise my progesterone troche to 150mg and no estrogen as he says i am estrogen dominant. My anxiety and hot flashes are getting out of control and i am scared and confused. Please help me

  138. Most doctors are scared of oestrogen because they believe it may cause breast cancer. However, if you read my blogs and web-site, youi will know that is not true if used correctly.

  139. You would be better with an ostrogen about 200. and a progesterone of at least 20. Also, it is worth doing a testosterone, as this does wonders for women, if low. (Search “Testosterone for women” on my web-site.)

  140. Ten years ago I had a partial hysterectomy, I still gave my ovaries, I had my hormones tested and my estrogen was 115 and my progesterone was 1.8 I started on 75mg progesterone troche at night for 2 weeks and now 1 week on 100mg at night. I gave noticed some improvement but I’m still having trouble sleeping and staying asleep and my anxiety levels are still high. Is thus normal?

  141. furthermore is there any reason a Dr would leave oestrogen out? A little strange.

  142. Thank you for taking the time to answer. I read you do distance consultations can I email you about arranging this?

  143. What is missing is oestrogen. Only oestrogen will stop the hot flushes, plus many other benefits to women. Search “benefits of oestrogen” on my web site to see all the good it does women.

  144. Dr my GP has prescribed in capsule form currently 40mg Preg 40Mg Dhea I also use a testosterone cream. I am still having symptoms – night sweats/hot flushes they have become less intense but are still a nuisance! This was increase from 20/20 originally. I am concerned my Dr has no experience in this as she rang the pharmacy and asked them whilst I was there! I don’t know if this is a high dose but do you think I could/should have it increased. ? It is very hard in my area where I live to find a Dr who prescribes Dhea.

  145. The word menopause means no periods, so it might be normal. There are other causes of no periods, so check with your gp.

  146. Can it also throw off my cycle? I have been taking it for 5 weeks and noticed my menstrual cycle stopped. Should I be worried

  147. Progesterone is a relaxing and should help sleep. Try taking 1/2 troche in the evening (instead of 1/4 twice daily) as it may help.

  148. Hi Dr Holloway

    I’ve just started on troche 175 mg of progesterone 1/4 twice a day. Only been on it 6 days but have found that my sleep pattern has changed I wake in the middle of the night and can’t get back to sleep tossing and turning for hours. Is this normal? I am perimenopausal and obviously estrogen dominant I have the the symptoms but I slept well.

  149. Prometrium is a pill, and has a fixed dose. Troches, with a flexible dose, may suit you better.

  150. I too am experiencing the same thing. anxiety is horrid. had a hysterectomy 4 months ago. tried pills, patches, and now i am on a pellet 75E. nothing has changed. two nights ago i tried taking 200mg prometrium per doctors order and my anxiety went through the roof. I am extremely sensitive to all medications and have had bad reactions to other medications when given the generic form due to whatever it was filled with. would really like to have an answer too. is prometrium just not good for my body or is it the filler and would troches make a difference?

  151. The dose varies from person to person. so there is no such thing as a correct dose. Some women need high doses to get the same effect as others on low doses. This is due to our genetic makeup and how each person disposes(metabolises) medications differently.

  152. I do not think the reflux has anything to do with the progesterone capsules. Stress, spicy diet, a leaking stomach valve is more likely to be the cause. Effective treatments are now available.

  153. Brenda Thomason

    I am taking the the troche Bi est 50:50/Test mini 0.15/.5 mg and two 50 MG capsules of time released progesterone. I did have progesterone in the troche, but was too fatigued, so she discontinued it in the troche I am 53 and have been on them for 2 years All of my symptoms of perimenopause are great; however, I have developed acid reflux. I am wondering if this has anything to do with the progesterone capsules? Have you ever heard of the connection? I am seeing my internist for the acid reflux and he wants me to take Prilosec. I am not wanting to do that.

  154. Can you tell me what is considered a high dose of progesterone in a troche. I am currently taking 75mg from Day 12-21 and then 150mg from 22- 28. Is this a high level?

  155. Thank you.

  156. I would not worry too much about the raised SHBG. What matters is the end result – how you feel. A raised SHBG may just mean you will need more hormones to overcome the binding effect.

  157. Depends on the situation. Horses for courses. The cream is better in some circumstances (having regular periods for example) and troches better at other times (menopause for example.)

  158. Hi Dr . Holloway. Donna here. In your opinion is bioidentical progesterone cream more affective than the torche? Thx

  159. HI Dr. Holloway, I have been on estradiol troches now for 4 month and at the end of Dec I got my levels check and my estradiol has come up nicely, but my SHBG is high. It is 171 and it should not be over 100. Have you seen this with troche use? I also drank 16 oz of green tea each day for the 3 1/2 weeks prior to my testing. I have now since read that green tea raises SHBG. So this could be the cause, but I have also read that troches can raise SHGB. Do you have any suggestions as this high SHBG is binding with all my other hormones too to make them inactive.

  160. What doctors in Portland oregon can I get testosterone troche’s from?

  161. Renay Van Moolenbroek

    Hi Dr Colin
    Where do I start. I am nearly 41 and I am going through Menopause.
    I was 25 when they gave me a Hysterectomy, they left a small amount of my ovary but end up having to have that taken out as well.
    For these last 15 years I have struggled terribly. Every doctor I have been to has told me it’s depression and wanted to put me on tablets.
    2 years ago I found a doctor who dug deeper and found I should be on some sort of HRT, I have been on Livial, Premarin, Ovestin and now on Patches, each time I have had a blood test my Estrogen hasnt come up, it sits on 37 to 39.
    The last visit she wanted to put me on Pristiq and told me that would help, I havent taken them as this is not my problem.
    The following are my symtoms:
    Hot Flashes
    Loss of sexual desire
    Weight gain
    Terrible Anxiety to the point where I have to go to the hospital because I think I am having a heart attack
    And the list goes on……
    I want something natural as I worry what these drugs are doing to my body on top of the Menopause
    I am coming to Brisbane around the 14th March and would like to come and see you, if this is possibly I would be very glad.
    Thank You

  162. Hi once again Dr Hollaway. Sylvia again. Period ended up just a showing and by that night period seemed to be gone. I will write down whats happening and will be seeing you end of the month. Not concerned. Kind regards

  163. Hi Dr Holloway, I am in 23rd day into my first month of troche. I have been feeling amazing. I did write to you telling you this that I am soo happy. This morning I actually got period pains and thought ooh am I getting my period?? last period was 19th October 2013. I did get it today and I think you said this could happen. Can you tell me if this is all ok? will it come back to stay???

  164. Yes I have already done that either they have closed books or a very long waiting period ! That is why I am looking elsewhere ! Perhaps Sydney if someone can point me in the right direction

  165. You are suffering the same as many other women do – the inability to find a sympathetic doctor who knows about natural HRT. I suggest you look for a compounding chemist in your area and ask them to recommend a doctor who uses the Bioidentical(natural) HRT.

  166. Hi Dr I have been dealing with menopause for the last 2 years with trial and error of products. The night sweats and hot flushes are over the top! I even succumbed to trying HRT (Advil?) for a short time. My Dr guaranteed I would not get my period of which I did. I am a horse lover and really against the mare lots and would rather suffer than they. My personal trainer told me about dhea and I was willing to give it ago. Trying to find a Dr in my area to prescribe this is very frustrating. I have managed to track down someone who would prescribe dhea and the dose is 2% dhea 4% progesterone 0.8% testosterone cream. She waffled on with all this scientific stuff about what my body is doing during menopause for 45 minutes!! I am not sure I can go back to her as it did my head in a bit. This dose is not working very well but has had some effect after I have decided to use it twice a day. I am still suffering night sweats at least waking up 3 times a night and a few day time flushes. I am guessing this dose is too low?? I felt when I left the surgery that she really didn’t want me to have dhea as she made me choose at the end of the session. Do you or is there somewhere online that can help me? I would have thought a blood test at least would tell me what my hormones are doing? She didn’t order one. Very frustrated.

  167. They may be an option. You will need a comprehensive hormone profile, and depending on the results, may benefit from having the deficiencies corrected.

  168. Having had breast cancer (eosterogen positive )15 years ago I am struggling with poor sleep patterns, my energy levels are at an all time low,I am increasingly becoming more unhappy, mood swings are constant and libido is poor. Overall not a nice place to be in right now. I am 55 years old. Might troches be an option for me?
    I tried them briefly about 7 years ago but the nurse at the breast screening clinic said they were not a good idea for me. Please what are your thoughts!

  169. Anytime after a meal, as long as you do not eat or drink with the troche in your mouth. A good tip is to rinse your mouth out with water once the troche has dissolved, then you can kiss with safety.

  170. Dr Holloway,
    How long before or after a meal should I take my troche? Also, can I drink water after taking it? Lastly, how long before I can kiss my husband after taking one as to not pass on the hormones to him?

  171. You are correct of course. After taking a troche, your levels increase for a few hours, stabilise for the next 6-8 hours, then gradually decrease. The best way is to take them is twice daily. However, use of them over many years shows that it does not seem to make a big difference, as women taking them once daily did as well as those taking it twice daily. So it proves that theory and practice don’t always match. If someone has insomnia as a major symptom, then taking the 1/2 troche once at night helps with sleep, as progesterone has a calming and sedative effect.

  172. Hi Dr. Holloway, I am wonder if you could explain this: Since your own hormones only last about 8 to 12 hours, your natural hormone replacement should be dosed about every 12 hours to give adequate, even blood levels.

    Why would we not want to mimic our own hormones and take troches only once a day? and not take them 2 times a day. I was under the understanding that estrogen peaks at 6-9 am then decreases until the next morning? There is not a lot published on this so I am trying to find out more information as I am taking my troche in the am only. I also thought that the SHBG would carry the hormones through the 24 hours until I take another dose. If we take another troche 12 hours after the first one, then we get another peak and that is not what our body does naturally. Taking it after 12 hours can give me too much stimulation for sleep.

    Thank you.

  173. Thanks Dr. Holloway. I appreciate it.

  174. Progesterone does not effect your blood pressure either way.

  175. Does progesterone Torche raise/lower your blood pressure? I take lisinopril 40 mg & 25mg metoprolol in the am, and 25mg metoprolol in the pm.

  176. Thank you Dr Holloway, I will keep you updated when I can find the right chemist and GP.
    Best wishes, Olive McConnell.

  177. Find your nearest compounding chemist (google it if necessary, or the telephone directory) and ask them to advise you of the nearest doctor using Bioidentical hormones.

  178. I have had a total hysterectomy would troche hrt suit me, where can I get it in Ireland.

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