Life with HRT: Other hints and tips

Remember to take them

For many of us, surgical menopause represents the first time in our lives when we've been required to take a prescription day in, day out, consistently. Hormones aren't like vitamins, where skipping a day doesn't matter a great deal in the overall scheme of things. Hormones, in surgical menopause, give the best results when taken not just every day, but at the same time every day. Hormones need to become an iron-clad, rock-steady habit. How is a busy gal in a chaotic world going to accomplish that?

The most useful approach we've found is to try to link taking your hormones with some other, already established habit. If the very first thing you do every morning, without fail, is to go start the coffeemaker, keep your estrogen pill bottle on top of the coffee canister or in the box with the filters or somewhere you have to move it to make that coffee. If every night before you go to bed you rub in that certain hand cream, rubberband your progesterone cream to it. Tie a note to your toothbrush. Tape it to the handle of your underwear drawer. Hide your deoderant behind it. Unplug the hairdryer and tie the cord in a loop around it. Somewhere in the right part of your day is a habit already established, and that's where you need to look. That doesn't mean you can't ever change, but just that linking to something already established helps you establish the new habit. Once your day is incomplete without your hormones, believe us, you'll remember.

For those on patches, we don't have any great ideas unless there's something you're already doing twice a week or once a week to link with. The once-a-week patches can at least be changed on the same day. For the twice a week crowd, best results and mileage are found changing at 3 1/2 days, meaning you need to find one morning habit and one evening habit. That's not impossible, and messing your timing up once or twice will help motivate your search for the right memory aid. A calendar can help, but only if it's unavoidably unmissable and you get in the habit of checking it. Some women report success with taping a small checkbook register-size calendar to the medicine cabinet door or their deoderant container or someplace else that's a part of their life. Some write reminders on the bathroom mirror with dry-erase markers or soap. Some write the date their patch gets changed on the patch itself, although if you don't spend a lot of time looking at your butt, that might be less helpful. We even know of one woman who uses a multi-day pill keeper for her vitamins (already established habit) and drops her patch in there in the correct day's slot with the pills. Don't be afraid to be creative with these, because the wackier they are, the more their amusement value will go on attracting your attention.

Refill your prescription

Now it seems obvious that you'll see that you're at the bottom of the bottle and realize you need more, so you'll go out to the pharmacy and pick up a refill. Great, if it works that way. What are you going to do if it's backordered because of that blizzard in the Midwest disrupting freight shipments? What are you going to do if the new order clerk didn't keep enough on hand but they'll get a shipment in on Monday? What are you going to do if it's a holiday, your doctor is in the Bahamas, and you're out of cash and forgot your PIN? These, and more, have all happened to women we know who waited till they ran out. And that doesn't address those of us who get prescriptions by mail order because our health insurance only works with a house pharmacy or because we don't have a compounding pharmacy close by.

Okay, enough drama: the point is, for something like this, it's always good to pick up a refill before you're out. If you take pills, take a week's worth, put them in a bottle in the fridge, and when you get to the bottom of the bottle on the dresser, it's time to reorder. You can do the same thing with creams by decanting a week's worth into an old jar and using the switch to that supply to trigger a reorder. If you use patches, stick a note in the box two patches up from the bottom. If you use an online calendar service or a scheduler that provides auto-warnings, fill in the correct dates and have it email/popup you a reminder. And then another one the next day in case you got busy and forgot. In time, you won't need this help, but it's a good idea to use for the first year or two until it becomes totally second nature. Some women should always do this (you know who you are). Make it easy for yourself: use tools.

Carry your HRT

Some of us go to the gym every day and work out and don't want to use our transdermal hormones till after we shower; some of us may need to go someplace overnight or carry a light overnight kit in our briefcase on a business flight. If you use hormone creams or gels, lugging along a jar and a measuring spoon or, suspiciously, a syringe may not be too convenient or discreet (although even in this hyperparanoid era, we've not yet gotten any flack for carrying a needleless syringe with our toiletries). One of the best tips we've seen is to use contact lens cases to carry pre-measured doses of creams. They're tiny, cheap, seal tight, and look totally innocent and private. What a concept!

Traveling with HRT

So you've got yourself all trained at home, you have all your hormones stashed in just the right convenient places so you never forget a dose, and life is good. And then you need to travel. A few special measures can be helpful in bringing your hormones along smoothly.

If you travel a lot, especially without much warning, you may want to make certain that you always have on hand enough of a supply to cover a trip. Of course, a surprise trip can catch anyone short. Still, if you have your prescription refill reminder stash, you have enough of a cushion to at least arrive at your destination with enough. As soon as you get there, find a major pharmacy (or a compounder, depending on what you use at home) and explain your problem to the pharmacist. They should be able to call your home pharmacy (you carry their phone number with you, right?) and get an okay to dispense a small amount of your prescription to tide you over till when you expect to return home. If you run out while on your trip, you can do the same thing. A reputable pharmacist understands the importance of continuing your hormones, and should be willing to help you out.

When you cross a lot of time zones, it can be difficult to guess how to handle your dose times so as not to get too low or take it so soon you have an excess (no one enjoys a guest or business associate in hormonal meltdown). For a short trip of a day or two, it may be simplest to just count off the number of hours between doses and maintain that spacing, no matter when in the day it falls, knowing that you'll backtrack again to your usual time when you return home.

If you are going to be there long enough that you want to acclimate to the local clock (and back again on your return, don't forget), the gentlest approach is to slide by just an hour or two a day. You'll have to decide whether you feel best increasing or decreasing the time span, and you'll need to take into account the amount and direction of the time difference. The hardest changes are those of half a day or so. In those cases, the easiest thing may just be to pick a halfway point in the next day and a half, take part of your dose, and then take another partial dose at the end of the day and a half. Then you should be set up to go back to the full dose on the new schedule. It gets complicated to reason this out, but it's usually better than just skipping it for a day.

If your trip is unexpectedly extended and you run out in another country, take your bottle/container to a local pharmacist. Your hotel or business associates or embassy/consulate may be able to steer you to one that has more expertise in dealing with foreigners. When you can speak with a pharmacist (not an aide), explain the situation. Many times there is a local equivalent that they can sell you enough of to tide you over. If your bottle label just has a brand name, like "Estrace" or "Premarin," you may need to print out on a piece of paper the generic name for the drug ("estradiol" or "conjugated equine estrogens") so that a pharmacist can find a local equivalent. Obviously, you'll need to know this before you go. Our experience has been that writing drug names communicates much more easily than trying to say them and have the pharmacist understand/recognize them across the barrier of accents (even when you both think you are speaking the same language). If you are taking compounded hormones, you will have more difficulty. The best bet, if you need to switch hormones from compounded to commercial in a pinch, is to ask for estradiol (or oestradiol if you are in a UK-English-speaking country). If you are taking progesterone, you should know that it can be very difficult if not impossible to find in many places, such as Australia and the UK. It may also be impossible to obtain testosterone in a female-suitable dose or without a prescription, given how tightly it is controlled many places.

When you are traveling internationally with prescription drugs, it is important to carry them only in labeled containers—that is, containers with the original pharmacy label on them. It doesn't hurt to carry a photocopy of your prescription for each drug with you when you travel places where scrutiny by customs may be intense and…um…uninformed. That also makes it easier to get an emergency refill on the trip as well. It's a good practice to copy your prescription before handing it over to the pharmacist just so you have it on hand for this sort of eventuality. If your pharmacist normally dispenses your hormones in the handy gallon jar and you need something more petit for a trip, ask if they can make up a small travel container, with label, for you to use on these occasions. We would also advise against traveling with your creams in syringes, or, even worse, carrying an empty syringe to measure creams if you are going to places where customs scrutiny is intense. If you must, make sure the syringe has a pharmacist's label on it.

One last caution: carry your hormones in your carryon when you fly or check your baggage on a public carrier. If the containers are too large, carry enough to get you through 2 days and carry copies of your prescriptions, so that when your hormones are sitting in your checked bag in one hemisphere and you are in another, you have a little room to recoup. It's a lot easier to buy a new toothbrush or go without clean underwear than it can be to replace lost hormones.

Sadly, not all TSA agents working in US airport security have the math background to convert units. One of our members was actually turned away with a 3.5 ml prescription bottle by an agent who kept chanting "3 ounces, only 3 ounces, no more" and trying to take her prescription away. Despite polite attempts to explain that this was a different scale of measurement and demonstrating the size difference compared to items containing 3 ounces, the agent was unpersuaded. Finally, she had to demand to see a supervisor, which resulted in considerable delay, body searches, and hostility before the supervisor, rather than admitting any error, agreed to "make an exception" for her. There's not necessarily any way to prepare for this sort of encounter other than to remember to leave time to deal with the kind of issue where formalities can go awry. Or ask your pharmacist to label your bottle in decimal ounces.

Do you have any other tips or hormone-management-challenging situations you've solved with particular brilliance that you'd like to share with us? If so, email Framboise and she'll take a look at adding them to this collection.