Q: I am 33 years old and had my ovaries removed last year. At that time, my doctor put me on Premarin, which I took for six months. I became more and more depressed; in fact, my whole life has changed since my surgery. He then switched me to Estrace. My questions are, is Estrace safer than Premarin and what is the difference between the two? Also, is it possible for me to just not take estrogen supplements at all?
A: I am sorry that age 33 you had to have your ovaries removed. Your young body needs estrogen, and it sounds like you haven’t found the right balance yet. There are many different estrogen replacement regimes, and oftentimes trial and error is necessary to find the right one for you. Basically, Estrace is 17 beta estradiol, and is extracted from yams. Premarin is extracted from pregnant mares’ urine, and is called conjugated equine estrogens. It is a mixture of different estrogenic compounds, which may have slightly different properties than pure estradiol. Another modality is the patch, which constantly secretes estradiol. It is placed on the abdomen or buttocks and you change it once or twice a week, depending on the brand. The Climara patch, for instance, is prepared from soy. One milligram of Estrace is about equivalent to 0.625 mg. of premarin and a 0.05 mg. patch.
Oftentimes, women have to switch from one preparation to another to test which regimen works best. Another question is dosage. Although the does mentioned above are the standard doses used to prevent osteoporosis and heart disease, some women need more for sleep and mood disturbances and other menopausal issues.
You may also want to consider testosterone. Many researchers feel that testosterone may be responsible for libido, and even for a general sense of well-being. Remember: Your ovaries were making testosterone as well as estrogen. There is a preparation called Estratest, which has both estrogen and a small dose of testosterone in it, which you may want to consider. Don’t worry about side effects – the amount of testosterone is very small, and unlikely to masculinize you in any way. I would try it, because you will know in a few weeks if you’re getting better results.