Hormone Replacement Therapy E4 Women

[Sandy57]

Hello Susan

Thanks for the response. Sandy has always been on a DAILY dose. Started out at 200 mg and a .05 patch. Did pretty good on this regiment. I wanted estradiol level higher, so did DR. B; so we increased the dose, got nice estradiol numbers, but GYN did not like the progesterone level. She used the Muses lab report as her criteria. Muses thought a level of 4 was crazy high. In fact said at the time that they did not know how to deal with such a high level. Huh?????? Oh well.

So GYN backed down the progesterone to 100 mg with a .1 patch and she did ok. Estradiol levels were good with a high of about 75, but some occasional break through spotting. She did this for about a year. Then when we went to renew the prescription and her (retiring GYN ) said she had to have another pelvic ultrasound, because of the spotting. Very conservative, but warranted for sure in this case.

That is when we found the increased lining thickness, fibroid enlargement, and increased uterus size. Followed up with the biopsy which came back negative, thankfully. So now she is on 200 mg DAILY and a .05 patch. So double the progesterone and half the estradiol.

I am looking at pulsing, but not sure how to do it with the increased thickness. Even though not cancer or hyperplasia, we still do not want the breakthrough spotting, which has been gone with the increased progesterone. Finding the magical number of days to be on and off will be tricky. We go back to new GYN who did the biopsy on the 14th. Again what I will state is the change and reduction of her levels has been significant clinically. Just got back her estradiol level back and it is all the way down to 25 from a median range of 55. Progesterone went to 4.5 her highest ever. This ratio sucks for her clinically, so I upped the estradiol to.75 until we see GYN. She will be ok with it because she told us to go back to the protocol which had the higher estradiol patch.

Any suggestions welcomed. I read the slides from Dr. Hathaway and think the HRT is critical for sure, but adjusting levels easier said than done.

Mahalo Frank

[Sandy57]

Circ my younger sister.

Always diplomatic or a better way to say it "professionally correct " when dealing with sensitive female issues. Even when I practiced, I was always sensitive to female issues and hand positioning during adjustments , manipulation, or other modalities that I used for treatment. Your hands have to be in some very critical spots for effective treatment at times, and I always made sure the patient was comfortable. I had a female assistant for very sensitive work; for the patients comfort level and my protection as well. Routine adjustments, modalities, and checkups not so much.

I was very professional with checkups and history taking also. Doc Stavia will tell you, some patients you have to pry information out of, others will tell you their life story, some with intricate detail. All part of the territory as a doc.

However, I am not easily shocked or embarrassed and do not let any issue go untreated because it is sensitive. If I could not help a patient or it was out of my expertise, I would refer quickly. Especially emotional health, male prostrate and female GYN issues. They were the ones that got refereed the most. Therefore, not an expert on those medical issues.

That being said I was not suggesting you had any condition, only that according to DR. Hathaway's slides; maybe that was your docs choice based on other patients that were prescribed estriol. Finally happy for you that is not an issue, and I would follow up to see if their is a better HRT for your individual case. You seem to be doing well and you continue fine tuning which I am proud of. What air purifier did you get, if any? I heard there is one now that is revolutionary, just haven't had time to dig, plus I have the IQ airs, so I am broke. Hahahah

Your bro Frank

[SusanJ]

Frank, I agree, getting the ratios right is not an easy task. Certainly, if it weren't for the Hathaway link, I wouldn't have put 2+2 together to pulse the progesterone for a longer time.

Hope your GYN can help figure this out.

[deborahk]

I wanted to share this interview with Dr Gillian Einstein. Being Patient interviewed her about where research is heading linking hormones to memory loss. She also talks about the impact of varying degrees of estrogen loss in menopause. http://www.beingpatient.com/menopause-and-memory/

[Sandy57]

Mahalo deborahk

[circular]

Thanks deborahk! I was interested that she mentions: 1) individual differences in reactions to the hormone drop, 2) that in terms of AD risk menopause without BHRT comes after age and ApoE 4, and 3) her lost ovaries research shows immune shifts. I would love to know of these immune shifts are downstream of the lost estrogen or independent of it. I lost my ovaries after menopause and when already on BHRT. My white blood cell telomeres recently tested at biological age two years beyond my chronological age. That isn't terrible given my health history, but now I wonder if the bilateral oophorectomy did or is going to whack my immune system around a bit. So far I'm healthier not sicker since the surgery so that's a good sign. I realize you probably don't have the answers, but given ApoE 4 and immune hyperactivity, this would be an interesting aspect of hormone withdrawal for us to learn more about.

[deborahk]

@circular let me pass your comments on to Dr Einstein and see if she can answer for you.

[circular]

How nice deborahk! Thanks!

[LasVegasGirl01]

I know that this is a complex and evolving area but am interested in your thoughts and comments.

I had an oophorectomy in January 2012 at age 45. I took very little estrogen in the first year. In 2013 I started on .025mg Divigel per day and have continued on this dosage.

I just had my Estradiol level checked and it came back as below 25pg/ml (the lab did not provide the exact level).

I scanned through Dr. Ann Hathaway's slide presentation and I am thinking my level should be somewhat higher for neuroprotection. I am e3/e4.

Any thoughts on the minimum Estradiol level I should have to experience neuroprotection?

I also read the 47 page thread on "Hormone Replacement Therapy E4 Women" that was written by the community members starting in November 2013-current. What a valuable and informative resource!!

Do you think it would be risky for me to increase my Estradiol dose now 5 1/2 years after my oophorectomy? Or would a slight increase in my Estradiol be ok since I have been taking .025mg of Divigel daily for 4 1/2 years. I am wondering about the "window of opportunity" concept and whether I have passed the window and an increase in Estradiol would do more harm than good for me.

I know that estrogen alone is unlikely to cause an increase in breast cancer but I am still trying to take the lowest does of estrogen possible for neuroprotection due to high risk of breast cancer on my mom's side of the family.

Thanks so much for your input. I have learned so much in the past few months since I joined this forum. I feel so grateful to be able to benefit from all of the research that you all do and the effort expended to help others.

Amy

[Stavia]

hi Amy, this is an excellent question.
Anne Hathaway currently is recommending starting estrogen even after the "window" period, as long as it is bioidentical and transdermal.
Currently the evidence is suggesting that cognitive function is in part estrogen dependent
Optimal level? Now that's tricky. There are no studies comparing different levels. But yours are likely to be subtherapeutic.
Are you on progesterone? If not, you have no increased risk of breast cancer according to the WHI data. Are you at higher risk of breast cancer? Obviously nobody knows if you are BRCA negative.
My sister developed breast cancer 2 years ago whilst on hrt (synthetic) I have chosen to continue with my HRT at therapeutic doses because I believe my risk of AD is far higher than my risk of dying from breast cancer.
I use enough estradiol to stop urogenital symptoms and to sleep well. It happens to be a 50mcg patch. My levels are 136 to 160 picomols per litre equals 37 to 44 picograms per litre. It seems to be enough for me. I wonder if its YMMV when it comes to doseage. 50mcg patch is a usual dose.


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