I have recently done much research on HRT and am rapidly approaching the feeling that HRT via gel (transdermal) application is probably the best route for absorbing any hormones. Seems they were not readily available stateside until recently. Read some real horror stories about implants.

Research on Google seems to confirm that when applied by gel (rather than swallowed) the gel is absorbed by the skin, then released gradually into the body.

My gyna doc does not get involved in hormone balancing etc. Not sure why, she is hopsital based. So I am hoping to find a supplier of Saliva Test Kits in Thailand, so I can check levels. Seems a whole lot easier than blood testing.

Seem to remember reading on this forum somewhere that bio-ident hormones were found in Bkk by someone, but cant find the link.

Anyone contemplating hysterectomy will find loads of info atsss.hystersisters.com really helpful and supportive website, with fantastic ladies, rather like this one!

Thanks to anyone who can help.

I'm not aware of any source for salivia tests, but you can get nayural hormone in gel form as follows

estrogel - available at many pharmacies, comes in a large red tube. I have seen another brand too but its less common.

progestogel (natural progesterone) - this I have found only at the pharmacy inside the Villa Supermarket, Sukhumvit Soi 33-35.

I use both and I find that with experience it is easy to titrate the dosage based on how you feel, no need for testing. With the gels it is possible to use very small amounts and tio titrate dosage much more finely than with an oral preparations. With the estrogel I simply use the least amount absolutely necessary to control symptoms. With the progestogel I'm a bit more liberal as it's thought to be quite safe.

Of course, if you are using estrogen and have an intact uterus, you must use progesterone at least for 10 days each month.

Also available in most pharamcies are natural estrogen creams for vaginal use, indicated if there is vaginal dryness.

Hi Sheryl - Thanks a million for your reply which I only caught up with today. Doc has me on Primolut N tabs two 5mg a day, not agreeing with me, so VERY grateful for info on progestogel. We have to go to BKK on Wednesday, so will try to find the Villa Supermarket then.

I was using the red tube of ostrogel to relieve horrible meno symptoms, but increased endometriosis, so after some kind of D&C now having only progesterone. Estrogel is banned from 19th until 30th of the month.

I'm thinking of having a laprascopic hysterectomy, and it sounds easier than the full slice you open thing, but still very unsure what to do.

Real info overload on the net, excellent pro's and con's. It is so confusing. Anyhow, many thanks indeed for the info, it is VERY much appreciated.

Primolutr is indeed the bad stuff, disagrees with many women. I think you'll find a big improvement whe you switch to natural progesterone.

Villa market is on Sukhumvit around Soi 33-35. Skytraibn stop Prom Phong. Tghere is also a branch on Ploenchit but not sure they have a pharmacy or carry the Progetogel.

If you canot find Progestogel (it's a while since I bought it) then next best is the utrogestan which I bought just the other day at the pharmacy on Sukhumvit near Soi 2.

Good luck

Does anyone know of the availability of any these in Pattaya? I have used the oestrogel with good results, but bought it in BKK.

Thanks,

Beachbunny

Delighted to hear from you again Sheryl, thanks a million!

We went to both pharmacies in Bkk recently, (and several others) looking for Progestogel or similar. Everyone said "No". One lady pharmacist checked her copy of Mims, and as it was not there, phoned her supplier, who said it was withdrawn from sale in Thailand, as it did not sell well. Most women went for the synthetics. More likely most doctors went for them if you ask me! She did sell me some Flava Soy capsules, which apparently have natural estrogen, but are of course taken orally, and therefore apparently less effective, since they must undergo digestion.

Have also discovered that my problem is estrogen dominance. So need to take Progesterone to balance it. Trouble is the synthetic variety made me ill, as apparently it does many others. In desperation, I have been checking online tonite for suppliers of mail order bioidentical hormone gels, and there are plenty.

Found one in India, very good prices, generic not brand names, and US$10 extra for shipping regardless of size of shipment. I am tempted to try one and see if it works! But they have lots of stuff on their site which seems to have the properties of 'snake oil'. So maybe further research required. I was impressed with their section which gives advice to women about gels and how to use them, they said pretty much the same as you Sheryl. I have been trying to reach my gynae (a man at Bumrungrad Hospital) who seems uncontactable, to tell him about the problem, but I am pretty sure they dont have the natural, as opposed to the synthetic gel, anyhow.

Like the second lady, I too used the estrogel (in a red tube, available from all Boots and probably most other pharmacies in Pattaya, got mine in Royal Garden Plaza Boots, second floor), but whilst it did relieve the more nasty of the menopausal symptoms, it also gave me this problem of estrogen dominance, which can lead to an overgrowth of the endometrium, and can lead to endometrial cancer, unless used correctly. I had to have something like a D&C to correct it.

I was also told that estrogen is produced by fat cells, so those of us who are carrying excess tonnage have more! How unfair.

Again Sheryl, you were spot on when you said if whoever is using the gel has an intact womb/ovaries, then they MUST use Progestogen for 10-12 days a month to counteract the Estrogen.

I got so desperate with the symptoms, I did some checking on the web and found out that Estrogel should control the symptoms of menopause, and did not realise it could be so bad to take it alone. Within 3 days, most menopausal symptoms has gone, it was absolute bliss! No more itching or flushing, and at last some sleep again!

I am only just getting to grips with the terminology and it seems fairly complicated. But after everything I have read about synthetic hormones, I am definitely not taking any more! They are apparently not altered to make them work more efficiently, but only so that the pharamceutical companies can patent them, and make loads of money. Someone explained it to me like a key -- the natural hormones fit the lock perfectly, whereas the altered molecules do not, like a key which is not exactly right. And this too apparently is the reason for side effects.

We have to go to BKK again 6/7th November (exams for number one son) so we will check again for the other suggestion Sheryl. You are brilliant! Do you mind me asking -- are you a doctor or pharmacist?

Thaivisa is a great resource for us ladies, I am grateful to have such helpful people a click away. Thanks again.

I'm a nurse.

You can definitely get utrogestan (micronized natural progesterone in oral form) at the large pharmacy on Sukhumvit near Soi 2, I just bought it there a week or two ago. While I don't like it as well as the gel (you can't titrate the dosage as easily) it is definitely better than nothing & better than a synthetic progestin.

Suggest you do that for now. I bought a large supply of Progestogel back when it was availabl;e at Villa, when I get home (I'm away right now) I'll check and see if I can spare a tube for you. I travel back and forth to Cambodia and can get more there. I'll let you know. meanwhile suggest you buy up a stock of utrogestan in case it too goes off the market. The problem is that Thai women are unaware of natural progesterone and its advantages, so no market demand.

Another thing would be to try the supplier. I think it is allowed in Thailand, since they used to have it, it's just that they stopped importing it due to low sales. In which case if you place a bulk order you might be able to get the supplier to bring some in. Possibly a bunch of us on this forum could go in together to buy some. As I am away right nowe I don't have the supplier's name but it is the same as for the utrogestan, same company in Belgium makes both products and there would be one or more Thai companies whioch import from them.

I'm a nurse.

You can definitely get utrogestan (micronized natural progesterone in oral form) at the large pharmacy on Sukhumvit near Soi 2, I just bought it there a week or two ago. While I don't like it as well as the gel (you can't titrate the dosage as easily) it is definitely better than nothing & better than a synthetic progestin.

Suggest you do that for now. I bought a large supply of Progestogel back when it was availabl;e at Villa, when I get home (I'm away right now) I'll check and see if I can spare a tube for you. I travel back and forth to Cambodia and can get more there. I'll let you know. meanwhile suggest you buy up a stock of utrogestan in case it too goes off the market. The problem is that Thai women are unaware of natural progesterone and its advantages, so no market demand.

Another thing would be to try the supplier. I think it is allowed in Thailand, since they used to have it, it's just that they stopped importing it due to low sales. In which case if you place a bulk order you might be able to get the supplier to bring some in. Possibly a bunch of us on this forum could go in together to buy some. As I am away right nowe I don't have the supplier's name but it is the same as for the utrogestan, same company in Belgium makes both products and there would be one or more Thai companies whioch import from them.

Hi Sheryl

Delighted to say that we found the "Utrogestan" caps (100mg) after trying many pharmacies. For those in or near Pattaya, the pharmacy is called "Fascino". There are two branches in Pattaya, a small one (which does not carry any), and the huge new store opposite Tesco/Lotus on Pattaya North Road. It is a large building with a drive in and out, set back a little from the road. They have everything in there - including hospital beds, crutches, bedpans and just about anything one is likely to need for long or short term illness. They do stock Utrogestan, but not the gel.

Agree Sheryl that the gel would be better. Easier to keep the dose to the bare minimum. The asistant was checking to see if they were allowed to order Progestergel, which is in the current Mims. They are going to let me know. They dont stock it as a rule.

I was sorely tempted to buy up their stock, but then thought better -- guess I should make sure it works, before buying lots. Then I guess it also has an expiry date to consider. But now comes the next problem.

Doctor in BRG prescribed progesterone from 19th to 30th of each month. Since tomorrow is 30th and I only took for two days the Progesterone he prescribed (PrimolutN/Norethisterone) at 5mg morning and evening, dont know whether to take the Utrogestan today and tomorrow, or not.

And since my use of Estrogel caused a thick lining the womb last time, I am unsure whether I can use it again now or not. Wonder if it would be ok to take tonite and twice tomorrow (the U caps) then use the Estrogen gel until 19th of Nov, when I should take the U caps again until 30th. Just not sure what to do and my obgyn (a guy) is away at a conference.

Since this Uterogestan is a natural product, I think will take it for 2 days, so it will counteract the estrogen, which I was using for severe meno symptoms, but have not since the D&C thing. Flushing and itching is coming back, but some fantastic sleeping pills (Midazolam/Dormicum) are ensuring that I do get off to sleep. Also discover on the box that these caps may be taken vaginally too. Think I will take orally for these two days, but wonder which method produces the most available progesterone in the blood. Must Google it to find out.

On buying in bulk, a great idea. I have an old copy of Mims( 2004) and the entry for Utrogestan says it is "Labs Besins (BJC Trading)". It is a Thai Mims so will also Google them to see if I can find their website. Delighted to see that Progestogel is also made by Besins (BJC Trading).

Not much joy in finding an online saliva test - thought I probably could find a mail order supplier, but they mostly seem to want to sell you the kit, but then process the results through a lab. I am concerned that maybe my testosterone level are also effected by the menopause. Wonder if that too is available in gel form, like estrogen and progesterone?

Anyone interested in sharing a bulk buy plse let me know. Meanwhile, I will enquire if it is possible.

Safe home Sheryl.

In terms of what to do with the progesterone now, it depends on 1)whether you still menstruate and 2) whether you took any estrogen in this cycle.

If you still menstruate, I would just wait for your period and then start anew. If you don't menstruate but did NOT take any estrogen this cycle, then I would just start a new cycle.

But if you don't menstruate (without taking hormones) and DID take estrogen, then best to take the utrogestan and I would continue it for 10 days or until there is menstruation, whichever comes first. This is important to shed the lining that may have built up in the uterus.

You have a difficult situation in having endometriosis and menopausal symptoms. As you probably know, completing menopause will cure the endometriosis (provided no estrogen replacement). Therefore you should avoid estrogen as much as possible, using only the smallest amount necessary to keep symptoms bearable. If possible, forego it althogether and use only progesterone.

My sources recommend that in women with endometriosis progesterone be started earlier in the cycle, i.e. starting somewhere between day 8 and day 12 and continuing to day 26-30 (select based on either your natural cycle or whatever is easiest to remeber). Some sleepiness when you first start it is normal and may go away after a few days. If you feel persistantly sleepy it indicates the dose of progesterone can be reduced. Of course, that is hard to do with the utrogestan form. By the way, take it at night, it will help you sleep.

With the estrogen, I would recommend using it only as necessary to minimize symptioms, meaning it does not have to be every day, and the dose can be as little as a fingertip. In your particular case, because of the endometriosis, the less estrogen the better.

Re the progestogel, did you try at Villa in Bangkok? That was the only place I ever found it. If you do decide to order in bulk I'll join in.

As I have said before, in my experience how you feel is the best indication of your hormonal balance and salivia tests are not necessary. Ultimately one wants to get through the menopause and off all hormone supplements, stabilized at the new, lower levels. Supplementation is just to help you through the transition and control symoptoms caused by rapid flunctuation. There is no need to treat a number (level shown in a test) if you feel OK. Hence little point in measuring the level, since you are going to treat based on symptoms not test results. With experience most women become very adepts at detecting even small hormone flunctuations.

Regarding testosterone, it is metabolized to estrogen in the body and thus a bad idea for anyone with endometriosis or other problems related to estrogen dominance. In addition, there are concerns about the longterm safety of it in women, In the Nurses health Study (the best and largest study of womens health), women taking it had increased incidence of breast cancer. Side effects include anger, irritability, weight gain, facial hair etc. The only reason to consider using it would be if you had problems with your libido that were seriously affecting your life.

In terms of what to do with the progesterone now, it depends on 1)whether you still menstruate and 2) whether you took any estrogen in this cycle.

If you still menstruate, I would just wait for your period and then start anew. If you don't menstruate but did NOT take any estrogen this cycle, then I would just start a new cycle.

But if you don't menstruate (without taking hormones) and DID take estrogen, then best to take the utrogestan and I would continue it for 10 days or until there is menstruation, whichever comes first. This is important to shed the lining that may have built up in the uterus.

You have a difficult situation in having endometriosis and menopausal symptoms. As you probably know, completing menopause will cure the endometriosis (provided no estrogen replacement). Therefore you should avoid estrogen as much as possible, using only the smallest amount necessary to keep symptoms bearable. If possible, forego it althogether and use only progesterone.

My sources recommend that in women with endometriosis progesterone be started earlier in the cycle, i.e. starting somewhere between day 8 and day 12 and continuing to day 26-30 (select based on either your natural cycle or whatever is easiest to remeber). Some sleepiness when you first start it is normal and may go away after a few days. If you feel persistantly sleepy it indicates the dose of progesterone can be reduced. Of course, that is hard to do with the utrogestan form. By the way, take it at night, it will help you sleep.

With the estrogen, I would recommend using it only as necessary to minimize symptioms, meaning it does not have to be every day, and the dose can be as little as a fingertip. In your particular case, because of the endometriosis, the less estrogen the better.

Re the progestogel, did you try at Villa in Bangkok? That was the only place I ever found it. If you do decide to order in bulk I'll join in.

As I have said before, in my experience how you feel is the best indication of your hormonal balance and salivia tests are not necessary. Ultimately one wants to get through the menopause and off all hormone supplements, stabilized at the new, lower levels. Supplementation is just to help you through the transition and control symoptoms caused by rapid flunctuation. There is no need to treat a number (level shown in a test) if you feel OK. Hence little point in measuring the level, since you are going to treat based on symptoms not test results. With experience most women become very adepts at detecting even small hormone flunctuations.

Regarding testosterone, it is metabolized to estrogen in the body and thus a bad idea for anyone with endometriosis or other problems related to estrogen dominance. In addition, there are concerns about the longterm safety of it in women, In the Nurses health Study (the best and largest study of womens health), women taking it had increased incidence of breast cancer. Side effects include anger, irritability, weight gain, facial hair etc. The only reason to consider using it would be if you had problems with your libido that were seriously affecting your life.

Many thnks for yr msgs Sheryl, I did contact the distributors of Progestogel in BKK who emailed back that the Progesterogel is not for menoause and only has a local efffect on breast tissue. So now I am really confused! But no need, because I probably cant get it anyhow, not here. We are going to KL in a week or so, so I will try there. Went back today to Facino to buy more of the Uterogestan but they sold out ! They say more next week, and hope will put some aside for me, we'll see.

Decided to start a new cycle as you say, and only taken a pea size dot of estrogen gel, hoping it will stop the dreadful itching all over, sweats and moodiness which is unlike me. I have missed the odd period, but then get them sometimes, without estrogen. Guess I am in middle of it?

Fascinating when to start the progesterone. Interesting and seems very logical for me, in light of the build up of tissue. Taking hormones is a last ditch attempt before having it all ripped out. Prefer not to, but we'll see.

Many thanks for information on testosterone - sounds scarry, not needed either. Quite agree, really trying not to use estrogen at all. Trying with a pea size every other day. Soon as symptoms are bearable, will stop.

Yes, tried Vila first - very helpful pharmacist, really seemed to be one, but no, they did not have it and had not for awhile. This is the lady who phoned the supplier who said they were not importing any more, since very few sales.

I am still hoping that the distributor in Bkk will let me know what the minimum order is, minimum cost per order and time frame, but so far no luck. Will certainly let you know when I get an answer, and would prefer gel as easier to reduce. Wonder if the two gels are the same concentration? Maybe that is what they mean when they say it is not for menopause?

So grateful for all your help Sheryl, thanks a million.

Re them syaing it is not for menopause -- they are referring to what it is officially approved for in country of license and/or Thailand. Many drugs have what are called "off label" uses. For the longest time people were using -- and docs were prescribing -- Retin-A for wrinkles while the approved use was only for acne. In the case of progesterone, no one has tried to get it approved for use in menopause as no one has undertaken the sort of double blind studies required because there is insufficient profit motive and a vested interest on the part of the makers of the synthetics who currently have the market cornered -- not because their product is good (far from it) but because most women and most doctors don't know the alternative. Anyway, pay no attention and feel free to use it as described previously. It is certainly a great deal safer than a synthetic progestin.

As you probably know, a total hysterectomy (which is what they'd need to do in the case of endometriosis) will make your menoapusal symptoms worse, although it will relieve the endometriosis...unless you use HRT, in which case even without uterus & ovaries you may have endometriosis. So you are indeed in a Catch 22.

Fortunately progesterone will not aggravate the endometriosis. Now, if you can just get it...

Let me (and other interested readers) know what the distributir says. I'd be willing to order a years supply or so for myself. Anyone else want to go in on it?

Re them syaing it is not for menopause -- they are referring to what it is officially approved for in country of license and/or Thailand. Many drugs have what are called "off label" uses. For the longest time people were using -- and docs were prescribing -- Retin-A for wrinkles while the approved use was only for acne. In the case of progesterone, no one has tried to get it approved for use in menopause as no one has undertaken the sort of double blind studies required because there is insufficient profit motive and a vested interest on the part of the makers of the synthetics who currently have the market cornered -- not because their product is good (far from it) but because most women and most doctors don't know the alternative. Anyway, pay no attention and feel free to use it as described previously. It is certainly a great deal safer than a synthetic progestin.

As you probably know, a total hysterectomy (which is what they'd need to do in the case of endometriosis) will make your menoapusal symptoms worse, although it will relieve the endometriosis...unless you use HRT, in which case even without uterus & ovaries you may have endometriosis. So you are indeed in a Catch 22.

Fortunately progesterone will not aggravate the endometriosis. Now, if you can just get it...

Let me (and other interested readers) know what the distributir says. I'd be willing to order a years supply or so for myself. Anyone else want to go in on it?

Hi Sheryl

Many thanks for your fantastically informative and helpful reply. Very good of you to take the time, and I hope it is helpful for many of the TV ladies, not just me.

Dont understand how endometriosis can continue without a womb or other bits, must do some more research. But if, removing the bits wont necessarily make it go away, why do it? It is so comlicated. And I am really grateful for all your insights and tips, truly appreciated.

I will certainly let you know the progestogel conclusion. I am hoping to get it in KL in ten days or so, and maybe Fascino in Pattaya will get another supply. Meanwhile I am waiting to hear back from the supplier about availability and minimums of an order.

Thanks again and all the best.

Dont understand how endometriosis can continue without a womb or other bits, must do some more research. But if, removing the bits wont necessarily make it go away, why do it? It is so comlicated.

In endometriosis, there are pieces of endometrial (uterine) tissue scattered around the abdomin which grow and bleed in response to hormonal stimulation; this is what causes the pain and other symptoms. Just removing the uterus won't help as the extruterine tissue will continue to grow cyclically and bleed in response to hormonal stimulation. The ovaries have to be removed, in order to cut off the hormonal stimulation. This of course will in turn cause severe menopausal symptoms and if estrogen replacement is given, the extra-uterine tissue may again grow. It is seldom done when a woman is already starting menopause as completing the menopause will accomplish the same thing naturally.

In women who still hope to have children they sometimes will surguically remove as much of the extrauterine endometrial tissue as they can find in order to relieve symtpoms while preserving fertility. The effect is usually temporary as some uterine tissue is likely to be missed and start growing, but it may reduce symptoms for a few years, providing time to bear children.

Pregnancy also relieves endometriosis by shutting of the ovarian cycle for a while, allowing the extrauteirne tissue to wither. However, women with endometriosis often have trouble conceiving.