FAQ

FAQ’s

How long do I need to stay on the HRT?

Short answer:  As long as it takes.

Long Answer:  Because all women are so different, women will vary tremendously in how long they will be menopausal.  While on HRT, women will not know when they are over it, and the path tests will not reveal the end of menopause either. The only way to know is to stop the hormones and see what happens. If the symptoms return, it means you are still menopausal and need to continue on the BHRT. If there are no symptoms on stopping the BHRT, then it may mean menopause is over. The symptoms can vary on the time it takes to return – in some women they may start immediately, and some may only return months after stopping the HRT. Recent research is encouraging women to stay on HRT long-term, as it reduces the risk of osteoporosis, heart disease and memory and brain function deterioration. (See under “Menopause recommendations” above.

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What is the difference between BHRT or natural HRT, and the standard HRT?

See the chapter headed: Natural HRT and Synthetic HRT – The facts for a full explanation. To claim natural hormones are better and safer then the alternative, we have to go on research and evidence, acceptable to the medical profession.  This means proper studies from the top medical institutions by the acknowledged experts in the field.  This is what I have provided.

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Are there any side effects related to taking troches?

Side effects are extremely  uncommon but do occur even with natural hormones. The most common side effects are gum irritation from the troche, occasionally fluid retention when initally commencing the troche. I recommend rinsing your mouth out after using the troche. Sometimes you can react to some other substance in the troche – like the sweetener (either Stevia, a herb, or saccharin, which some chemist use). Breast tenderness is quite common, and is related to excess oestrogen. Bloating and fluid retention is due to excess Progesterone. Irritability, acne andexcess hair growth may mean too much testosterone.

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Are their any other methods of taking bio-identical hormones apart from troches?

Hormone can also be incorporated in a slow release capsule. This tends to be used if women have a gum irritation from the troche or if they find the taste of the troche unpleasant.Hormones can also be incorporated in a cream but from experience I have found troches and capsules are more effective than creams and dosage can be more accurately controlled. See section labelled troches on this website.

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I have read several books and articles suggesting saliva testing is more accurate than blood testing to monitor hormone levels?

This is an interesting question and depends which doctor you consult for bio-identical hormones. From my own experience over the last 10 years I have used both methods but from personal choice now favor blood testing. Blood tests have to be done at specific times as the level of hormone in the blood does vary according to when the troche or capsule is taken. All the major menopause associations are against salivary testing of hormones.

Salivary testing of hormones is not covered by Medicare in Australia. The reason is that the expert committee appointed to make these decisions have come to the conclusion that there is no validity to salivary testing of hormones, no scientific evidence in favour of it, and so it is a waste of money.

This is the opinion of the American College of Gynecologists:

The American College of
Obstetricians and Gynecologists XXXXX SW
PO Box 96920
Washington, DCNNN-NN-NNNN

There is no evidence that hormonal levels in saliva are biologically meaningful. Whereas saliva is an ultrafiltrate of the blood and in theory should be amenable to testing for “free” (unbound) concentrations of hormones, this has not proved to be the case (4). The problem with salivary testing and monitoring of free hormone levels is twofold: 1) there is no biologically meaningful relationship between salivary sex steroidal hormone concentrations and free serum hormone concentrations and 2) there is large within patient  variability in salivary hormone concentrations (5–9). Salivary hormone levels vary depending on diet, time of day of testing, the specific hormone being tested, and other variables (6, 7, 10–12).

Here is one of many research papers showing the reason why:

Ann Clin Biochem. 2009 May;46(Pt 3):183-96. doi: 10.1258/acb.2008.008208. Epub 2009 Jan 28.

Salivary steroid assays – research or routine?

Source

Department of Chemical Pathology, Southampton University Hospitals Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. pjwendo@btinternet.com

Abstract

Salivary concentrations of unconjugated steroids reflect those for free steroids in serum although concentrations may differ because of salivary gland metabolism. Samples for salivary steroid analysis are stable for up to 7 days at room temperature, one month or more at 4 degrees C and three months or more at -20 degrees C. When assessed against strict criteria, the evidence shows that salivary cortisol in evening samples or following dexamethasone suppression provides a reliable and effective screen for Cushing’s syndrome. Sequential salivary cortisol measurements are also extremely helpful for the investigation of suspected cyclical Cushing’s syndrome. There is potential for the identification of adrenal insufficiency when used with Synacthen stimulation. Salivary 17-hydroxyprogesterone and androstenedione assays are valued as non-invasive tests for the home-monitoring of hydrocortisone replacement therapy in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

The diagnostic value of salivary oestradiol, progesterone, testosterone, dehydroepiandrosterone and aldosterone testing is compromised by rapid fluctuations in salivary concentrations of these steroids. Multiple samples are required to obtain reliable information, and at present the introduction of these assays into routine laboratory testing is not justified.

This is the view of the US FDA (Food and Drug Administration, a body set up to protect and promote peoples health):

 Is saliva testing helpful for people taking menopausal hormone therapy?

Some compounding pharmacies and other promoters of “BHRT” claim that estrogen levels in a person’s saliva can be tested by practitioners to help practitioners estimate the amount of hormone a person needs and purportedly to “customize” the hormone therapy for individual patients. There is no scientific basis for using saliva testing to adjust hormone levels. Instead, practitioners should adjust hormone therapy dosages based on a patient’s symptoms.

Here is more evidence:

Maturitas. 2002 Jan 30;41(1):1-6.

Caution on the use of saliva measurements to monitor absorption of progesterone from transdermal creams in postmenopausal women.

Source

Steroid and Immunobiochemistry Laboratory, Canterbury Health Laboratories, P.O. Box 151, Christchurch, New Zealand. john.lewis@cdhb.govt.nz

Abstract

OBJECTIVES:

To determine the levels of progesterone in plasma, red cells and saliva as well as pregnanediol-3-glucuronide excretion in postmenopausal women using transdermal progesterone creams.

METHODS:

A double-blind placebo controlled study was carried out using 24 postmenopausal women. Creams (placebo, 20 or 40 mg progesterone/g) were applied twice daily for 3 weeks followed by 1 week without before a further 3-week treatment. Morning samples were collected at 0, 1, 3, 4, 7 and 8 weeks for analysis.

RESULTS:

There were small increases in plasma progesterone levels and pregnanediol-3-glucuronide excretion compared to the placebo group and red cell progesterone levels never exceeded plasma levels during progesterone cream use. Saliva progesterone levels were very high and variable in the progesterone cream groups compared to the placebo group and presented a paradox to the usual relationship observed between plasma and saliva progesterone in premenopausal women.

CONCLUSION:

The absorption of progesterone from transdermal creams is low and we caution against the use of saliva measurements to monitor progesterone absorption. The low systemic absorption of progesterone may not be due to peripheral conversion by 5 alpha-reductase(s). We also conclude that the low level of progesterone associated with red cells suggests they are not important in the delivery of progesterone to target tissues.

More :

Climacteric. 2000 Sep;3(3):155-60.

Effect of sequential transdermal progesterone cream on endometrium, bleeding pattern, and plasma progesterone and salivary progesterone levels in postmenopausal women.

Wren BG, McFarland K, Edwards L, O’Shea P, Sufi S, Gross B, Eden JA.

Source

Sydney Menopause Centre, Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia.

RESULTS:

Hormone assay indicated that physiological levels of estradiol were achieved, but progesterone levels were insufficient to induce any detectable change in the endometrium. Only one patient experienced bleeding during the study period. Levels of salivary progesterone were so variable as to be considered completely unreliable in determining the potential influence on biological activity.

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My doctor says “Bio-identical HRT” is untested and unsafe, and compounding chemists are not to be trusted.

Here is a comment from the FDA (Food and Drug Admin) USA:

Pharmacy Compounding

 

1. What is pharmacy compounding?

FDA regards traditional pharmacy compounding as the combining or altering of ingredients by a pharmacist, in response to a licensed practitioner’s prescription, to produce a drug tailored to an individual patient’s special medical needs. In its simplest form, traditional compounding may involve reformulating a drug, for example, by removing a dye or preservative in response to a patient allergy. In the case of menopausal hormone therapy, an FDA approved progesterone product contains peanut oil. Progesterone compounded without peanut oil in response to a prescription for a specific patient who is allergic to this ingredient might allow the patient to safely use the drug.

2. Is combining two or more drugs considered compounding?

FDA would consider the combining of two or more FDA-approved drugs into a single medication, in a manner not described in a drug’s FDA-approved labeling, to be compounding if it is done by a pharmacist in response to a licensed practitioner’s prescription and produces a medication tailored to an individual patient’s special medical needs.

3.  Is pharmacy compounding beneficial for patients?

It can be.  Traditional pharmacy compounding enhances patient treatment with individually-tailored drugs when a physician deems that an FDA-approved drug may not be available or appropriate for that patient’s care.  Thus, traditional compounding is an important component of patient care.

I have presented many studies from many experts on this website proving that BHRT is safe, has been fully tested and researched, and has the approval of most of the top Menopausal and endocrine societies. How much more does your doctor want? This nonsense about “compounding chemists” is hard to understand. These chemists are your normal chemists who have passed all their exams like any other chemist. They are regulated and checked regularly by the authorities like any other chemist. We trust our chemists when they prepare medicines for us. When I was a child, my doctor would write a script such as ” 1 ml xyz, 2 drops abc, 1 gm cde. Prepare with 5ml glucose solution Make up 100 ml. Take 5 ml daily” Most scripts were compounded then – we did not have the ready made mass produced factory produced products of today. Finally, how difficult is it to weigh and make up 2mg Oestrogen? Not much room for error.

This brings us to a bigger issue – the misinformation and lies about the whole BHRT and natural hormone industry. Much of it is run by people with ties to various pharmaceutical companies, esp those producing synthetic HRT. They often shower doctors with gifts and presents to buy their loyalty. I have seen this same play many times over the years in medicine -vested interests desperate to preserve their influence. This website is devoted to try and help women get a clearer picture of the science behind the various choices they make when using hormones.

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Does testosterone have side effects?

The most common side effects observed with testosterone are hair growth and acne. In my experience these side effects occur in approximately 3 out of 10 women. These effects are reversible on ceasing the testosterone. 70% of women who take testosterone have no side effects.

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Are there risks factors with respect to breast cancer from taking bio-identical hormones?

For medicolegal purposes we have to assume risk factors for bio-identical hormone replacement are similar to those associated to using synthetic HRT. However there are some studies suggesting bio-identical oestriol which is used as the majority of the estrogen in troches is perhaps safer than synthetic estrogen. This combined with blood testing to ensure the minimum amount of estrogen is used to control symptoms would perhaps confer an increased level of safety when using bio-identical hormone replacement. Further studies are probably necessary to confirm the above information. See the section labelled Safety of BHRt, and the section on BHRT and comparison to synthetic HRT on this website.

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Does it matter which compounding chemist I use?

Yes, it matters greatly. They are not the same. It takes a commitment to have invested in the best equipment, buy the top quality ingredients, have professionally trained staff. Not all chemists do this.

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My doctor says I do not have to have progesterone because I had a hysterectomy. Is this correct?

Strictly speaking, your doctor is correct. One of the main actions of progesterone is to protect the uterus from some of the potential harmful effects of estrogen. However, the synthetic progestogens have some nasty side effects, including risk of breast cancer and stroke.  The natural progesterone does not have this risk. We now know that natural progesterone has very positive effects on the nervous system, which makes it worth having anyway. My attitude is that if the normal balance of hormones in women over the years has included estrogen, progesterone and testosterone, then the body will function best with that balance restored.

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Wont taking HRT just delay menopause, and cause me to have it anyway when I stop the HRT?

Just as putting coloring in your hair as you go grey (grrr), does not change the process of greying – just covers it up – so taking HRT does not change the process. It still happens anyway.  All you are doing is masking the nasty effects of menopause until it goes away.  HRT helps to make the process bearable.

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I am on BHRT and have just had a period – the first for some time? What does it mean?

Bleeding in menopause happens sometimes, with or without hormones. Mostly it is nothing to be alarmed about, and is often a once only event. Sometimes starting any form of HRT can precipitate a bleed. This is your body reacting to having hormones again after a long drought. However, bleeding in the menopause is sometimes the first sign of something more serious, such as uterine cancer, so we never take it lightly. An ultrasound is essential to exclude any mischief internally.

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How do I use the progesterone cream:

It all depends on whether you are still having periods or not.

If having periods, then you will start on about day 10-12 of the cycle (Day 1 is the day you start bleeding) with 1/2 ml daily until day 16. Then 1 ml daily until day 20. Then 2 mls daily until day 26. Your next period should start soon after and you repeat the whole cycle again.

If you do not have a period, then you use 1ml daily. If a period appears all of a sudden, then use as above.

If, at any time, a period comes early or during the cycle unexpectedly, stop the cream and restart the cycle all over again.

Rub the cream into the forearms, shoulders, upper chest, abdomen, upper legs. Move it around from day to day. Do not put it into areas of cellulite (Hips mainly) as it will not absorb well into cellulite.

Remember, progesterone is very safe used in this way, so the doses can vary, as can the dates, in order to get the best response.

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I worry about you retiring and you will have no-one to replace you.

No-one is indispensable (although I would like to think I am!). However, my health is good, I enjoy the work I do, and intend to continue to do this for many years yet. When the time comes, I will look around and hopefully, find someone to replace me. There are other doctors that practice BHRT so that is another option people have.

Any more questions on BHRT, please feel free to comment below.

  1. Progesterone used cyclically is often very helpful in PMDD>

  2. Hi Dr Holloway,

    I’m 39 years old, and had surgery to remove endometriosis two years ago. Thankfully, it was very successful and my pain is greatly reduced. However, I have subsequently been diagnosed with PMDD, which is terribly debilitating. I’m seeing my Professor next week to discuss the possibility of a hysterectomy, as this seems to be the most promising way to stop the PMDD symptoms. However, I have read that hormone therapy can be very benefical in treating PMDD. I would be most grateful for your opinion.

    With thanks,

    Melissa

  3. Hello Dr Holloway,
    Please give me your thoughts on the MTHFR mutation A1298C.
    Thank you

  4. Some women react adversely to progesterone, by getting depressed – this is rare but can occur.

  5. Hi Dr Holloway,
    I just started BHRT a couple weeks ago. I have pellets for oestrogen and testosterone and take 200 mg capsules progesterone at bed time. It took a few days to receive the prog caps by mail, but after taking them a few days I felt so depressed and like I was about to go crazy. I experienced this only one other time and that was after my last child was born. I suffered post partum depression so bad I checked myself into the psych hospital. My doctor is going to supplement the capsules with trochee during the day. Honestly, I stopped taking the capsules and mixed them with lotion and I feel better but not like they are relaxing me. I am afraid to take the troche because I do not want to feel the depression feelings again. What could I do or do you think the progesterone would do this? I felt fine in the evening after taking it but the next morning about an hour after starting work I would feel very down and almost suicidal and hopeless. 😦

  6. Perhaps, but there may be a few months wait.

  7. Hi Dr Holloway, I just tried to make an appointment with you, but they told me you are not taking any new patients till March 16. I am at my wits end with what I think is hormone issues. I am 44.5 years. Currently I am on 3 antidepressants a day since the birth of my child 6 and half years ago and I still feel tired unmotivated and have gained so much weight I hate going out. I cant lose the weight. I was once 63 kilos and now I am 86. I hate it, seriously thought of lap band surgery. Can you assist me at all, have had thyroid blood tests and hormones tests with local GP about 18 mnths ago still come up saying all fine.

  8. LDN may be of benefit, as well as the BHRT. You will need to make an appointment to see me to sort it out.

  9. Dr Colin
    I have been reading some of the posts by the many people who have come to you for advice on their many ailing health issues.
    I have just gotten the courage to write you about myself. Last year I had gone through such a terrible pain different to fibromyalgia and I thought there has got to be a way to out of my suffering. I had 2 ultrasounds done and received new that I have endometriosis . Currently I had done laparoscopic surgery for endometriosis and removal of complex cysts in my ovaries was prescribed provera tablets in 100mg ( I am 41 years old ). I was given 3 alternate options to choose from on treatment for endometriosis but was advised that eventually I should get a hysterectomy done as it has spread thru some of my organs. I have bald patches on my scalp and now have thinning hair doesn’t look good on a young 40 year old. I don’t know if it’s to do with testosterone or something else. With research I had done I found that there is a natural hormone to provera (synthetic progesterone-should be labelled as progestin). I was wondering if you can give me a list of doctors in Sydney. I live around Liverpool Area. Hope you can help me.
    I’ve had fibromyalgia for approx. 18 years ( a lot of chronic pain ) and now am able to manage my disease with diet. No gluten as much as possible very difficult to do as everything we buy may contain it), at least 2 serves a week of red meats and the rest are eggs, chicken/poultry, fish (wild salmon, trout and mackerel) mostly vegetables and fruits, which I juice with a slow juicer. Unfortunately this drastic change on my diet has resulted in weight loss ( I am only tiny as well . But even with the loss weight I had noticed that most of my chronic pain and thyroid issues was almost gone . I also take various supplements as now a days we can never really get the necessary vitamins on just the food we eat.
    These are the vitamin & mineral supplements I take daily a good multi vitamin which contains biotin in it, a good quality b-complex, vitamin E (on its own), vitamin D3 1000mg once this runs out in a 2 weeks I will replace with 5000mg, antioxidants for ovarian health, lots herbs like fresh turmeric, ginger, cayenne peppers, cinnamon tablets & more. I will continue with my diet as I believe that most of my inflammation is down. I only wish that I can go to someone who can actually test for the SED rate test. Food is now my medicine and I have a long journey ahead of me. Hope that you continue to help others. Hope to hear from you.

    Regards
    Carmen

  10. Try reducing the dose by 1/4 every other day. Next script i will go back to the lower dose.

  11. Good Morning Dr Holloway, I am using the higher dose of troche (prescribed by you) and have them made at a new compounding chemist.for just over a fortnight. I have been seeing you for HRT for about 2 years, and this new higher dose was prescribed due to my continued low readings. I am experiencing lower abdominal pain (near my ovaries) and spotting (period finished 6 years ago). Am I safe to assume his will settle and is due to new higher dose, new chemist? Or…what would you advise me..apart from patience. Thank you.

  12. Best to stop Cold turkey.

  13. Hello Dr. Holloway, How do you stop taking the trouche please – cold turkey or gradually. If gradually, how is it done? Thankyou Jenni

  14. If you are having periods atill then you have use the cream as the dose varies through the month. this is not possible with troches.

  15. Have the Path test earlier than planned and see me earlier. Check “FAQ” on my web-site re “bleeding on on BHRT”

  16. Hi Dr Holloway, I recently started taking your bioidentical hormones. After 2 weeks, I had bleeding for 3 days ( like one of my normal periods) and now 2 weeks later I am getting spotting again. I also have quite bad bloating. Should I continue on the troches, or should I come and see you earlier than planned – my appointment is on 20th October.

  17. Hello Dr Holloway,

    Just reading here you prefer the trouches to cream, I was wondering if that’s the case are there particular reasons you put people on the cream instead of troches? You have put me on a cream which I’ve only been using for one month.

    Kind regards
    Tracey

  18. I ask all the compounding chemists I use to only use Stevia as the sweetener. The bloating will normally settle in a few weeks, and is caused by the progesterone in the troche. If the bloating persists, then a reduction in Progesterone is needed.

  19. Hi…..just wondering which sweetener u use in yr troches….(hoping its stevia). And how long is the bloating expected to last?? Ive been on them for about 6 weeks now. Such an improvement with my hot flushes!!! Thank u. Ur a life saver Dr Holloway!!!!

  20. Ring Stenlake compounding Chemist Bondi and ask for yur neareast BHRT doctor.

  21. Where can I get hormone pellets in Sydney? What is the process for getting them??

    Thank you

  22. You will need an increase in your oestrogen dose – hot flushes are generally a sign of not enough oestrogen.

  23. Hi Dr. Colin,

    While the troches are working tons better on almost all my symptoms, I have recently been experiencing terrible night hot flushes. 4-5 per night! Do you have any suggestions? Thank you!

  24. They cannot replace the NHRT. They do not work very well either, but are better than nothing. You cannot be sure what is in them, they are one-size fit all, and they are tablets, which means liver metabolism, which increases the side effects.

  25. Hello Dr Holloway. I have gone off the troche as a trial. I am experiences the hot flushes and other symptoms and have tried an over the counter Menopause pill (for a couple of months to give it a fair chance) and it has been totally ineffective! Can you give a comment on such herbal medications such as Harmony Menopause (blend of herbs) or Remifemin. Other women claim they do work, but how do they compare to NHRT? Thank you.

  26. I agree, as do 90% of my patients.

  27. My Naturopath took me off the cream and put me on troches. He said the cream just accumulates in the adipose tissue and that you can’t rotate enough proper locations to dispel the accumulation. He also said you can’t regulate the amount as easily.

    I feel tons better on the troches than I did on the cream.

  28. in answer to my other question i asked about doubling up on my troche i found out it wasnt being absorbed properly. was very grainy in my mouth. back to having the one months supply per troche. but am still experiencing insomnia. am contemplating changing to a cream as with troche you loose about 50 to 70 % ive been told. as youll know ladies you swallow a lot of it in your saliva. so not getting the full benifit. hoping the cream will give better relief for insomnia if im getting full dose especially progesterone which i heard was the one that helps you sleep. gives you back the ability to fall into a deep sleep. . but in an answer to another ladies question about the effects of coming off troches i found a few times that i missed my dose by 24 hrs i was going thru withdrawals. kidney pains from hell. so am not eager to experience it again. missed a dose 3 times and each time have experienced the same . maybe its just me but please to other people just be aware.

  29. There is no problem coming off HRT. Just stop it – gradually if you prefer – it does not matter. However, the symptoms may return if you are not yet over menopause.

  30. I read that coming off HRT can be very stressful on the body. How can I come off the troches safely when it’s time? Will I need to wean off and how?

  31. A level of 70 is low, and may contribute to your insomnia. It is strange that doubling up led to such a low level

  32. i have been using troches for about 12 months now. i asked the chemist to double up on the ingredients so in fact my months worth became 2 months worth do in effect cut my cost in half. but i noticed about the same time as my doing that that my sleeplessness kicked back in and was back on sleeping pills. it was a part of my menopause. never suffered insomnia before menopause. in the first 6 months the sleep actually improved to the point i actually got off the sleeping pills. it was like i didnt go into rem sleep. always at that level where you were waiting to go to sleep.my question is by doubling up on the ingrediants in the troche has it impeded with the absorption? could that be the reason for the insomnia coming back. i got results back from blood tests today and while i am on 4 mg of estradol my level in my blood showed less than 70 . which accoding to my doc was next to nothing. .

  33. Look in the Carina day and night pharmacy website for list of doctors using Bioidentical HRT.

  34. Also can you recommend someone qualified in the area of female hormonal balance in the upper mt gravatt area?

  35. Nevermind I see your details now. Sorry 🙂

  36. We would love to consult with you. How can I make an appointment with you? I don’t see any contact details.

  37. Nuvaring consists of etonogestrol and Ethinyloestradiol. The side effects of etonogestrol are quite extensive (shown here):
    Implanon in Detail – Patient Information: Side Effects

    Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

    Call your doctor at once if you have any of these serious side effects:

    warmth, redness, swelling, or oozing where the implant was inserted;
    sudden numbness or weakness, especially on one side of the body;
    severe pain or cramping in your pelvic area (may be only on one side);
    sudden headache, confusion, pain behind the eyes, problems with vision, speech, or balance;
    chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
    swelling in your hands, ankles, or feet;
    jaundice (yellowing of the skin or eyes); or
    symptoms of depression (sleep problems, weakness, mood changes).

    Less serious side effects may include:

    pain, numbness, or tingling where the implant was inserted;
    minor bleeding or scarring where the implant was inserted;
    breast pain;
    acne, freckles or darkening of facial skin;
    menstrual cramps, changes in menstrual bleeding pattern;
    increased hair growth, loss of scalp hair;
    weight gain;
    nausea, mild stomach pain;
    vaginal itching or discharge;
    headache, back pain, nervousness, dizziness;
    runny or stuffy nose, sore throat, cough; or
    problems with contact lenses.

    This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

    Read the entire detailed patient monograph for Implanon (Etonogestrel Implant) »

    I prefer not to use synthetic hormones such as this due to these side effects. If you would like to consult with me, make an appointment (mention this post) If there is any difficulty in getting an appointment, email me direct and I will see what I can do.

  38. Hello,

    My wife was prescribed the nuvaring by a specialist for hormone imbalance. The nuvaring worked to balance her emotional Health (anger, depression, anxiety) as well as her extremely heavy periods and pain for awhile atleast. After 2 months of using the nuvaring, the miracle effects have worn off. Emotional rollercoaster has come back, strange discharge from the vagina, lower pain, acne and difficulty losing weight and weight gain. She watches what she eats, eats 1000 calories a day and works out atleast 3 or more times a week.

    These are the exact symptoms she exhibited before the nuvaring. Its like going thru pms on a daily basis.

    Can you please help us? Is it possible for us to make an appointment with you? We live in brisbane upper mt gravatt.

  39. Thank you for such a quick response! Could it be the change from cream to troche? That it is actually working now and I have initial bloating and fluid retention until I settle down?

  40. Stevia is a herbal sweetener, and a troche would only have a small amount in each one. I cannot imagine there would be many calories in them. Can any readers of this blog help out here?

  41. Is there a way to find out the caloric and carb count of the stevia flavored troches? I was recently switched from cream to troche by my naturopath and in 2 weeks gained 5 lbs. I have done nothing differently in that time period.

  42. Thanks Dr . Holloway. Will make appointment with my doctor.

  43. There is no evidence this is caused by the progesterone. See your doctor urgently as there may be some other reason for this.

  44. I’ve been on bioidentical hormones 5 months. I was taking torche progesterone. I started having awful pressure in my head, like my brain was being smashed against my skull. What would cause this? Will be starting the cream tonight. Will the cream be better? Thanks

  45. Hi Dr Halloway i am 41 and currently on HRT although i dont think the combination is right for me.. however i have been to so many DR’s , who smply want to rush me out the door or send me for copious amounts of blood tests. recently i had surgery to remove 1 ovary. i thought this would help with my crazy hormones and some of the hotflashes. night sweats, rages, strange smells anad skins sensations but it didnt it just made things worse.. the HRT im on certainly helps all these things (thank GOD) but i still just dont feel right, with extreme periods of depression and the sads.. anyway im booked to see you in March 2014 but wondering if you can suggest anything to make life more bareable.. thanks

  46. One of the reasons could be one of the ingredients in the troche- usually the sweetener. The compounding chemists normally use either Stevia, a natural herbal sweetener, or saccharine – a synthetic sweeterner which causes most of the reactions you mentioned. Ring your chemist and ask which sweetener they used, and avoid it in the future. SOmetimes the flavouring(strawberry etc) can also cause a reaction.

  47. Dr Holloway, I have been experiencing a very sensitive tongue -[when eating] almost like i have burnt it from having had a cup of coffee that is too hot – also quite dry mouth. Any clues?
    Thank you

  48. It varies, but is about 2 months at present. If you are desperate, email me (colinh1@optusnet.com.au) and I will try to fit yoiu in earlier

  49. What is the approximate waiting period from the time a patient phones for the initial appointment?

  50. Thanks Dr. Holloway. Glad to know its not the “P”.

  51. No. There could be some other reason for the palpitations. Progesterone does not cause it. It is possible (though I have not had anyone else have this)that you are reacting to the sweetener or flavouting used in the troche. Ring the compounding chemist who made it up and ask them. Otherwise, see your GP to see if there is another cause.

  52. I have been on 200mg of progesterone Torche for almost a week. Is it normal to have heart palpatations?

  53. I have been on 200mg progesterone Torche for almost a week. I am experiencing heart palpatations. Is this normal?

  54. You are most likely low in oestrogen as well. Read “mrenopause-recommendations” on my web site for the current thinking about oestrogen, and my blog “Oestrogen – Villain or heroine?”

  55. I was using a natural progesterone cream that worked wonderfully for my menopause symptoms for 3 months and then quit working. Why did it quit working?

  56. These symptoms are not caused by hormones,so you will need investigations to find out the cause of your symptoms – it could be many things. Try stopping the troche altogether and see what effect that has. Also, use the form I gave you to check your hormone levels to be sure they are approriate.

    Dr Colin Holloway

  57. I currently take 280mg troche… I have been taking this for 3 mths. The week I have been experiencing palpitations that effect my breathing, anxiety, light headed. Of course I have seen a dr today & have had blood tests, ECG & will be having a Us – electricardiograph next week. I feel awful. This Day 20 today of taking my troche. My period has been very erratic as expected so my doses of torched have been erratic as well. My question is can prog troche dose now become the wrong dose for me all if a sudden ? Have tried to book in with you but finding it difficult to get in
    Kind regards
    Jacqui

  58. Both these conditions have many causes – from hormonal, to diet, genetics, lifestyle and certain medications. A thorough investigation is necessary, with a plan put in place to fix the abnormalities causing these conditions

  59. Samantha Ryan

    How long do the hormones take to work and can they help with acne and infertility from PCOS?

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