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Hormone Replacement Therapy E4 Women

Insights and discussion from the cutting edge with reference to journal articles and other research papers.
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Juliegee
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Re: Hormone Replacement Therapy E4 Women

Postby Juliegee » Wed Jun 03, 2015 7:39 pm

Rep, I'm not aware of a study like that; maybe others are... I recently had a conversation with Dr. Roberta Brinton, probably one of the best authorities on HRT/dementia. I'm pretty sure she suggested that the "window of opportunity" was ONE year. She recently did an Us Against Alzheimer's teleconference and said women need to start HRT within one year of the onset of menopause to gain neuroprotection. Is that what others recall?

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Re: Hormone Replacement Therapy E4 Women

Postby KatieS » Wed Jun 03, 2015 9:11 pm

Dr. Diaz Brinton (USC) advised "intervene early before the brain actually changes, not beneficial after menopause". But then she said, if a woman does not have any symptoms (like me!), they are not candidates for HRT. Peri-menopause can extend years, so it would seem to depend upon the woman as to the year cut-off. She definitely would go with plant-based, bioindentical estrogens, with this caveat: "more is not better and can lead to the opposite effect". She is researching pregninolone "allo", a hormone that is very high during pregnancy.

Other references I tried to dig up were not specifically related to E4s, but Silverlining has excellent references that do relate to E4s in the beginning of this topic.

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Re: Hormone Replacement Therapy E4 Women

Postby Juliegee » Wed Jun 03, 2015 9:54 pm

I finally found the thread where Dr. Roberta Diaz Brinton talked about the “window of opportunity”: viewtopic.php?f=6&t=1140 Here's a few tidbits from the thread that might help:
Juliegee: Dr. Brinton repeatedly emphasized the fact that estrogen is an energy (glucose) modulator. Some women, not all, experience that loss of that estrogen more acutely with severe symptoms of hot flushes, cognition problems, insomnia, depression- a general inability to function. According to her, THOSE women are the ones who can benefit from HRT. She says there is a window for beginning therapy -when symptoms begin- that can provide benefit. There is no benefit in using HRT if a woman is asymptomatic OR beginning post-menopause. For women who had experienced cancer, HRT was not recommended..

Kitano: Julie, you're correct about the short-term. She stressed that it was not beneficial after menopause as the brain had already changed unless you were in a small minority of women still having menopausal cognitive symptoms. I guess I just must have interpreted that to be a short-term intervention at the first symptom of menopause. It would be interesting if she in fact thinks that asymptomatic E4 women would not be candidates for estrogen.

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Re: Hormone Replacement Therapy E4 Women

Postby rep » Thu Jun 04, 2015 12:45 am

So, my last period was in late 2009 but I have remained symptomatic - depression, insomnia and still some hot flashes this year. ???
Cognition was tons better before menopause.

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Juliegee
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Re: Hormone Replacement Therapy E4 Women

Postby Juliegee » Thu Jun 04, 2015 12:53 pm

Rep, you know I'm not a physician and no one can say with absolute certainty whether you can still benefit at this stage. My educated guess is that you (like myself) are among the subset of women who would have been a candidate for HRT given your symptoms. Considering that they are continuing...it may be worthwhile to resume HRT and see how your cognition, sleep, mood, etc. are affected. Unless you are genetically at a higher risk of gyn cancers, it seems like a reasonable trial to make.

Hope your appt. goes well, my friend.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Fri Jun 05, 2015 10:49 am

There is a new study looking at the timing of estrogen administration and corroborating other work suggesting that early is better, at least with regard to atherosclerosis ....

Menopausal Hormone Therapy: Putting the Timing Hypothesis to the Test
Andrew M. Kaunitz, MD reviewing Hodis HN et al. Menopause 2015 Apr.

http://www.jwatch.org/na38013/2015/06/0 ... hesis-test
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Sun Jun 07, 2015 12:49 am

I thought there hadn't been enough long-term studies to support such specific, unequivocal advice as Dr. Brinton is offering? If I were symptomatic I would take it, and I am and I do and I don't plan to stop unless I get breast cancer. Of course if taking it doesn't help the symptoms, then I think maybe I'd reconsider. It's just my gut feeling about it for me in what I thought was an absence of truly reliable data on the subject, based on well-designed longitudinal studies?
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby Stavia » Sun Jun 07, 2015 1:17 am

Circ I agree with you. IMO there is not enough evidence to support specific unequivocal advice and I worry about dogmatism in this area.
However as I have said before, not taking HRT is an action as well. I have been on it for 6 months now because I was waking every hour and am doing well and feeling well. I plan to review at 5 yrs or sooner if new evidence comes to light.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Fri Jun 12, 2015 1:22 pm

Thanks for that confirmation Stavia.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby Juliegee » Mon Jun 22, 2015 8:55 pm

Here's a new paper by Dr. Roberta Brinton exploring how reduced estrogen deteriorates cerebral hypometabolism in perimenopause. As E4 carriers start in a disadvantaged place, this looks very significant for us. I'd love to see full-text.

Perimenopause as a neurological transition state
http://www.nature.com/nrendo/journal/v1 ... 15.82.html
The estrogen receptor network becomes uncoupled from the bioenergetic system during the perimenopausal transition and, as a corollary, a hypometabolic state associated with neurological dysfunction can develop. For some women, this hypometabolic state might increase the risk of developing neurodegenerative diseases later in life. The perimenopausal transition might also represent a window of opportunity to prevent age-related neurological diseases.


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