Right now, the menopause/perimenopause and hormone space has a gap:

• Doctors: short visits, limited time, and communication with clunky patient portals
• Social media: oversimplified, fear-based, dramatic, and often wrong information
• Courses: static, kinda boring, outdated quickly
• Forums: emotionally loud, medically messy, and full of misinformation

Women are left trying to piece things together on their own.

​The Progress Your Hormones Community is a doctor-led educational online community where Dr. Maki and I (Dr. Valorie) teach women how to understand perimenopause, menopause, and hormones.

Topics include:

• Symptoms and what they mean
• Hormone replacement therapy (HRT)
• Women’s health and longevity
• Lab testing and how to interpret results
• Supplements and support

What You DO in the Progress Your Hormones Community

• Attend live or recorded teaching sessions on:
  • HRT: forms, dosing concepts, routes, timing, testing
  • Hormones, labs, supplements, and women’s health/longevity
  • Symptoms and solutions/approaches
  • Questions and discussion from other community members
• Read and participate in guided discussion threads
• How to interpret lab work
• Ask questions about women’s health and hormones
  • As a group discussion
  • On a live event
  • Privately anonymous or as a DM

Why does this community exist?

Because women deserve a place to understand what’s happening before they panic, self-blame, or get talked into something that doesn’t fit.

To get answers quickly and accurately, without having to sort through conflicting information alone.

Questions? Reply to this email if you have any questions

I do not have AI write my articles.

Why?

Bc I like spending hours writing.

Bc AI does not sound like me and I hate the werid dashes it puts in

Bc I find AI is not accurate (seriously, you need to fact check anything you ask AI)

Bc my AI tends to coddle me

Bc I just don’t feel like it is authentically me.

- Xo DrValorie

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Estradiol: Patches, Creams, Dosing… Oh My!

Why switching estrogen isn’t a simple swap

Estradiol Patch vs Estradiol Cream

Dr. Valorie Davidson

What is the Difference?

• Estradiol patch?
• Estradiol cream?

I have gotten so many questions from women who are confused about:

• What is an estradiol patch?
• Is the estradiol patch the same as transdermal estradiol cream?
• Estradiol patch dosing
• How the estradiol patch dose seems vastly different from a transdermal estradiol dosing
• Is one better than the other?

For this article, I will break down:

• How the estradiol patch really works
• How transdermal estradiol works
• The difference between the estradiol patch and transdermal estradiol HRT

I know there are so many ways to dose HRT, such as creams, gels, rhythmic dosing, rings, troches, and pellets.

But so this article is not ginormous or confusing with multiple topics, let’s stick to the difference between:

• The estradiol twice-weekly patch
• Estradiol transdermal static dose HRT

Those of you who know me know I love a good story, so let’s meet Colleen.

Colleen:

‘Does this stuff even work? Is this just expensive lotion? I thought that I was going to feel better, and that is a hard NO. I feel worse.

Hi, I’m Colleen, and I am going to tell you my story.

My menopausal symptoms have been the worst.

I couldn’t think, all my joints hurt, hot flashes/night sweats/heat flushes galore, and my sleep was awful. My words wouldn’t even come out of my mouth right.

I went to see my gynecologist for an exam, and told her all about my menopause issues. She gave me a 0.05mg estradiol patch.

I didn’t want to complain bc the heat flushes/hot flashes disappeared instantly. I could sleep and talk normally. My joints felt so much better after starting the patch. Perfect right? ​
​

Well, not so perfect. Immediately after starting the estradiol patch, I gained 10 pounds, and my breasts started to hurt terribly. I felt kinda ‘buzzy’, like wired for no reason. My nipples itched like crazy, and I just felt so bloated and puffy.

My mom freaked out and told me to stop, and that I was going to get breast cancer. I can understand why she is scared; my aunt and grandmother had breast cancer. I don’t have the genetic markers for breast cancer, but my mom was very upset and would not stop bugging me about stopping the hormones.

Truthfully, I just felt so puffy, and even after over 6 months, none of my symptoms improved.

I used the estradiol patch for almost 8 months, thinking my body just needed to get used to it. It didn’t.

My gynecologist is amazing, but she is busy, and I couldn’t get to talk to her about it.

So I went to my general doc and told him I didn’t want to take the estradiol patch. Maybe it was too strong, or maybe just not a fit for me. I wanted to continue HRT, just not the patch.

He said he is working with hormones and wanted to switch me to an estradiol cream. Doc said bc I am on a 0.05 mg estradiol patch, I could take a 0.5 mg estradiol cream. I would take half of the cream ( = 0.25mg) in the morning and the other half at night. Or I could take the whole dose, 0.5 mg in the morning.

At first, I tried to stay optimistic. I wanted this to work. I wanted hormones to be part of my life, just not in a way that made me feel swollen, wired, and uncomfortable in my own body. But within what seemed like a few days (maybe a week), I was worse.

The joint pain came back.

​
The night sweats returned.

​
My sleep fell apart again.

​
My brain felt foggy.

I started to wonder if the patch had somehow “shocked” my system. Or if I were one of those women who just “can’t do hormones.”

What no one explained to me was this:
Switching from a patch to a cream is not a simple swap.

No one talked to me about dose equivalency.

​
No one warned me that 0.5 mg of estradiol cream may not come close to what my patch had been delivering systemically.
​

Apples and Oranges:

This is a common theme with HRT. Not all HRT is the same. Colleen’s practitioner was well-meaning but unsure how to convert the estradiol patch to a transdermal topical cream.

Why did this happen? Colleen was on a 0.05mg estradiol patch; wouldn’t the cream be the equivalent dose?

No, it is bc the patch and estradiol cream are like apples to oranges when it comes to dosing.

WHI Horror:

This also happened when the WHI came out in 2002. Women who were on Premarin or Provera were abruptly taken off.

Some were given estradiol or biest (combo of estriol and estradiol) cream as an alternative.

A common Premarin dose was 0.625mg. So women were given 0.625mg of estradiol transdermal cream. This was not the same.

An oral estrogen like Premarin is completely different from a biest or estradiol cream.

So many women were ‘under-dosed’ and felt awful, and all their menopausal symptoms came back.

This ended up giving estradiol and biest cream a bad rap. When it was a dosing issue.

Well then, we need a conversion table!

There is no universally valid conversion table for converting estradiol patch doses to estradiol cream doses.

Because the delivery kinetics are different between the patch and the cream. We are trying to compare continuous diffusion (patch) vs intermittent absorption (cream). These are two different pharmacological behaviors.

BUT, one is not better than the other. It depends on the person. Some women love the patch, and others hate it and love the cream.

If you’re wondering:

• Why a 0.05 mg estradiol patch can feel so strong, while a 0.5 mg estradiol cream can feel like it’s doing almost nothing, that’s not your imagination.
• This is where the conversation usually stops, and where frustration begins.

In the paid version of this article, I go deeper into the actual math, pharmacology, and clinical reasoning behind estradiol patch vs cream dosing, so you can understand why these switches fail and how they’re meant to be evaluated.

Upgrade to the full newsletter here and get the rest of the story.

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Simon Says:

Simon Says: Want to sleep better? Take a warm shower or bath 1-2 hrs before bed. Studies have shown that warm water exposure can help you fall asleep faster and improve sleep quality. Warm water vasodilates your blood vessels, helping move heat from your core to your peripheral extremities. A drop in core body temp is a cue to your body that it is time to sleep.

I peed my pants!

Okay, I’m being dramatic. But I really did. Not a lot, but enough.

You would think after working with women and their hormones for 20+ years I would not be so shocked at myself.

But to get it, I think you have to live it.

And now I understand what they mean about ‘leakage.’ I get it.

Sorry, not to be so graphic or TMI. But urinary stress incontinence is a real thing when you hit menopause.

There are ‘mechanical’ factors, such as pregnancies, weight changes, connective tissue changes, pelvic floor strength, etc.

But estrogen and progesterone are important factors for urination.

Okay, so it might have been the ‘perfect storm’. On Saturday, I was rushing around, just drank a ton of water, cleaning up the house, organizing, getting distracted, not wanting to go upstairs to use my bathroom, checking my texts, the dogs need water, is the mail here? Where is my phone? Squirreling and just generally being a little kid, trying to ‘hold it’ while I get one more task done.

But it could be my HRT. Not all HRT is perfect or may need slight adjustments.

Hormones can help or hinder urination.

• Progesterone can increase renal blood flow and relax smooth muscle, which in some women makes urgency or leakage more noticeable.
• Lower estrogen levels can reduce urethral tissue support and closure pressure, making the seal more prone to leaking.

I was in the luteal phase of my rhythmic dosing HRT, where the progesterone was increasing, and the estradiol was decreasing. I know perimenopausal women are more likely to notice stress incontinence in the luteal phase of their cycles. And with menopausal patients, I will prescribe estriol topically to help strengthen the urethra and help with GSM (​​genitourinary syndrome of menopause).

Maybe it’s my HRT (which I am going to monitor and test).

Or maybe I need to work on my core.

Or maybe I just need to slow down and listen to my body and realize that not everything needs to be done all at once.

xodrvalorie

Disclaimer

All content found in this newsletter, including text, images, audio, video, or other formats, was created for informational purposes only. The purpose of this website and blog is to promote consumer/public understanding and general knowledge of various health topics. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concern regarding this topic, then it is time to find a new doctor.