SusanJ wrote:Alysson, I run about 50 pg/mL for estradiol. I could only hit that by using the patch (vs compounded cream). And in reading Ben Lynch's new book, he makes a convincing argument to fix methylation last, so you might leave that on the later pile.
Thanks, Susan. I'd be happy with 50 mg/ml. Thanks for mentioning Ben Lynch's convincing argument to fix methylation last. I actually bought that book; maybe I can now get myself to start reading it. I have no doubt it will help me.
Slacker, I found I was having brain fog among other brain effects after 8 months on Prometrium, so I tried cycling the progesterone and the brain effects subsided. No bleeding after about a year of doing this, and my levels of both are fine. Hathaway mentioned cycling in her slides. (Slide 63)
I'm wondering if my brain symptoms will improve when my progesterone lowers to a more reasonable level. Brain fog is definitely one of them, but mental fatigue is my worst. I've had some really good days recently but then some worse days even more recently. I've been thinking it's from detoxing from mycotoxins.
Thanks for posting a link to these most informative slides. I like the idea of cycling progesterone. I'm going to try that.
My compounding pharmacist is a proponent of taking a "hormone holiday" one day per week. I'm wondering if I could do that for my estradiol patch. My estradiol shot up to 23.4.9 pg/ml while I was on the .05 mg/day patch.
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!
slacker wrote:TheBrain, I may be misinterpreting your question about estradiol increasing as a consequence of dropping Prometrium to 100mg (but here goes anyway); your estradiol will not go up with less prometrium. Since you are on a lowish dose of estradiol, you may not need 200 mg of prometrium to balance estrogen dominance and protect your endometrium. However, if you increase your estradiol dose, you may need the 200 mg of prometrium.
Slacker, you interpreted my question perfectly. Thanks for answering it.
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!
TheBrain wrote:
My compounding pharmacist is a proponent of taking a "hormone holiday" one day per week. I'm wondering if I could do that for my estradiol patch. My estradiol shot up to 23.4.9 pg/ml while I was on the .05 mg/day patch.
My estradiol was higher on one blood draw because I didn't get it drawn at the best time - about 12 hours after using my daily topical biest. Where were you in your patch cycle with the 234.9 pg/ml result?
SusanJ wrote:
Slacker, I found I was having brain fog among other brain effects after 8 months on Prometrium, so I tried cycling the progesterone and the brain effects subsided. No bleeding after about a year of doing this, and my levels of both are fine. Hathaway mentioned cycling in her slides. (Slide 63)
Thanks Susan! I misread your original comment about hormone cycling, and thought you were stopping both hormones for 1 week. Now that I know I'm just looking for a rational for progesterone break, I see it's covered on slide 57. And good review of the potential side effects from progesterone, in addition to brain fog. Dr Hathaway also has a helpful slide on timing of testing - slide 59.
All I know is that I wasn’t doing the hormone holiday when I got that high result. By “patch cycle,” I assume you mean which day I was on for my weeklong patch (such as Day 5). I haven’t been tracking that. Well, actually, I can check my online calendar. I do have my appointments in there, and I change my patch the same day every week. Let me check that after dinner, and I’ll report back.
I’ll have to check Dr. Hathaway’s slides again, but I think she recommends getting the blood draw halfway through the patch cycle. That was the first I heard of that. My bHRT doctor and his nurse never said anything about that. Oh, I see the answer is on slide 59. Thank you.
Update: I checked my calendar. I applied a new estradiol patch the day before I had the blood draw and got the high test result. So I was on Day 2 of my patch cycle.
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!
TheBrain wrote:
Update: I checked my calendar. I applied a new estradiol patch the day before I had the blood draw and got the high test result. So I was on Day 2 of my patch cycle.
That would explain your higher level, especially if you place your patch in the morning, and get your blood drawn in the morning. There is no perfect solution for getting tested at 1/2 way point in a 7 day cycle, especially if labs that require fasting are also being drawn. Getting tested on day 3 or 4 would be best for getting an average reading in a 7 day cycle, with day 3 being on the high side, and day 4 on the downward slope.
I'm on a twice a week patch now, so must decide on whether to test 2 or 3 days after putting it on in the morning. I'm considering switching to a pm placement 2 and a half days before the am blood draw, but doubt that I will remember to implement correctly! For me, KISS is best!
Thanks, Slacker. I had no idea the release of estradiol using the patch varied so much day to day. I thought the released amount was close to the same every day. It would be nice if the bHRT doctor or nurse would explain such details. I hope I like my new bHRT doctor more.
Is that why you are going with a twice a week patch? I can see the challenge with testing in that case. I would agree: KISS is best!
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!
TheBrain wrote:Thanks, Slacker. I had no idea the release of estradiol using the patch varied so much day to day. I thought the released amount was close to the same every day. It would be nice if the bHRT doctor or nurse would explain such details. I hope I like my new bHRT doctor more.
Is that why you are going with a twice a week patch? I can see the challenge with testing in that case. I would agree: KISS is best!
So instead of continuing to guess, I pulled out the twice weekly estradiol patch package insert, and voila! In section 12 on page 5, figure one, you can see the steady state estradiol level over 3 and a half days - relatively flat, less so in the first 12 hours. Table 2 shows maximum, average, and minimum estradiol concentration over 84 days for the various doses of patch. Bear in mind that the data comes from a sample size of only 17 post menopausal women. YMMV.
I am on the twice a week version because that's what my doctor prescribed! It's possible that the peaks and trough levels are less extreme, or more evened out, than the once a week.
Good find, Slacker! With your medication, yes, the dosing is relatively flat, but less so in the first 12 hours. I'll see if I can find online the package insert from my estradiol patch (Alvogen, .05 mg/day, though I've been using 1/2 a patch per day).
I had the hysteroscopy yesterday. My GYN did not find a thickened endometrium. In fact, it was on the thin side. I suspect I had a thickened endometrium, but then I was taking too high a dose of progesterone (200 mg at bedtime) relative to my estradiol dose (.025 mg/day). And that thickening dissolved (perhaps around the same time the bleeding stopped). If I did have a thickened endometrium, I'm back to suspecting it was caused by the conversion of testosterone (from compounded testosterone) to estradiol due to my CIRS.
Or else I never had a thickened endometrium, and the person who reviewed the results of my pelvic ultrasound got it wrong.
My GYN did manage to do a D&C and take some samples. He wants me off all bHRT until I see him in two weeks. Maybe I'll have my first hot flash.
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!
I had my GYN appointment today, as a follow up to my hysteroscopy. All is well with my uterus, and I’ve not had a hot flash while being off bHRT. I’m restarting bHRT tomorrow with an estradiol patch and oral progesterone. I’m skipping the compounded testosterone because I think that’s what caused my problems in the first place. But I will be looking into seeing a new bHRT practitioner soon.
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!