Hormone Replacement Therapy E4 Women

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circular
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Re: Hormone Replacement Therapy E4 Women

Post by circular »

I seem to absorb estrogen from both compounded cream and the patch. I found out the patch was covered by insurance so I switched to it. I was also glad to know that I'd have a steadier dose in my system that way. Have been quite happy with it. I also switched from compounded progesterone to the Prometrium. I think I'm sleeping more deeply, but I did also increase my dose. I still use the compounded testosterone cream.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Hormone Replacement Therapy E4 Women

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circular wrote:I seem to absorb estrogen from both compounded cream and the patch. I found out the patch was covered by insurance so I switched to it. I was also glad to know that I'd have a steadier dose in my system that way. Have been quite happy with it. I also switched from compounded progesterone to the Prometrium. I think I'm sleeping more deeply, but I did also increase my dose. I still use the compounded testosterone cream.
I'm glad for your estradiol flexibility! (riff on metabolic flexibility) 8-)

I'm "having the opportunity" to learn about the pitfalls of Big Pharma prescription medicine pricing. The cost of generic estadiol patches twice a week with my insurance is $80 per month. GoodRx coupons can help lower the cost. My local mom and pop pharmacy doesn't take them, because it's the pharmacy that has to cover at least part of the price differential. I found a GoodRx coupon for a national chain, for $37.50 per month. So far so good....but...the pharmacist at the national chain let me know that the price can vary month to month. So who knows what it will cost me at refill time. Another option is to get a co-pay card for a branded estradiol patch, and potentially pay even less. I will start to research this half way through my first month of treatment. I'm in for a 3 month experiment - do my labs improve, and do I feel better?

Stay tuned! (IHTS)
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Re: Hormone Replacement Therapy E4 Women

Post by circular »

Here's a recent interview of Dr. Anne Hathway on nourishbalancethrive. I don't know anything about NBT, but I think think this is a particularly good interview with Dr. Hathway. It got me more curious about the Dutch test, but I'd rather not pay for the data right now. Luckily she gives tips how to redirect the estrogen metabolism down the right pathways. I remember cruciferous vegetables, but I'll have to listen again for the others. I was listening while hiking and the park had posted a sign that mountain lions had been seen there recently. I wasn't completely focused on the interview! (I'd probably have forgotten anyway :roll: .)

http://www.nourishbalancethrive.com/pod ... cognition/
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Hormone Replacement Therapy E4 Women

Post by AnnK »

Lions and tigers and bears...oh my! I wouldn't have been able to focus either :o)

As far as hormone replacement therapy for myself, a 3/4 post-menopausal woman, I crossed that bridge several years ago and decided not to use HRT at that time. FYI - I had a natural menopause after 44 years of menses and currently have no sleep issues. My 85 year old 3/4 Mother has not used HRT either, but she does have insomnia a few times each month and osteopenia (which has improved greatly with Vitamin D3 and Vitamin K2).

One important note -- we both made our decisions to not use hormone replacement therapy prior to knowing our E4 status. I'll take a another look at my decision using an E4 lens. Thanks for the engaging conversations!
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Re: Hormone Replacement Therapy E4 Women

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TheBrain wrote:Carrie, I’m sorry to hear about your parasite saga but so glad it is now behind you. Do you mind if I ask where you traveled to and picked up the parasite?

I see you are a Certified Fermentationist. I gather you did this work with Summer Bock. I did her Probiotic Cleanse.
I traveled to the Dominican Republic (February), California & Portland (April/May) last year. If I compare the time line to when my travel partner picked it up from me during a trip to Greece in September (I developed the rash just before we left and was told it was an allergic reaction), it puts me in April/May but I'm still thinking it was a tropical mite that I picked up in the Dominican rain forest where we stayed because my symptoms aren't totally typical. Apparently, scabies type of mites are quite common in the US and go undiagnosed for months. It saw 6 doctors who poo pooed the notion of a parasite before the last one figured, "why not treat you for one just to see what happens." I'm not sure that I'm completely done with this as I'm noticing slight symptoms but at least I have a doctor who understands what to do. I am grateful for that.

Yes, I certified with Summer Bock.
APOe4/4
Functional Medicine Certified Health Coach
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Re: Hormone Replacement Therapy E4 Women

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slacker wrote:My FMD implied that my elevated estrone level (the "bad" metabolite pathway) could be partially explained by CIRS, which apparently can affect hormone pathways. No explanation, no references, just her opinion/experience. Again, my understanding is the "bad" metabolites can contribute to risk for breast cancer. It's an imbalance of estradiol and progesterone that can cause endometrial thickening and increased risk of endometrial cancer. Again, this is probably a functional medicine or naturopathic perspective, not one taught in medical school or gynecologic residency. Most conventionally trained gynes will not be familiar with COMT SNPs or Dutch hormone tests because it's not part of their training.
Slacker, thanks for this information. When I see my GYN on Tuesday, I'll ask if he'd be willing to test my sex hormones, including my estrone. I just had a 3-D mammogram, and everything is fine there. But I would like to know if I'm overproducing that "bad" metabolite.

I am familiar with estrogen dominance and have had that in the past, based on saliva testing I had done while menopausal. Now that I'm post-menopausal and on bHRT, I suspect my estradiol builds up too much, even from using just 1/2 .05 mg estradiol patch, and despite the fact that I'm taking 200 mg oral progesterone at bedtime. I've noticed breast tenderness the past couple of days and have had a small amount of spotting yesterday and this morning. What's causing all that?

I just did some poking around online. I found the article Are Mold Toxicty and Chronic Inflammatory Response Syndrome (CIRS) Causes of Memory Loss and Alzheimer's Disease.

First, here's the bio of the doctor whose approach is described in the article:
Dr. Sharon Hausman-Cohen is a family and integrative medicine physician and medical director of Resilient Health in Austin, Texas who specializes in treating chronically ill patients, including CIRS and those with cognitive decline, with multiple modalities highlighted by genomic and symptom driven detoxification enhancement and enhancement of mitochondrial energy production.
Dr. Hausman-Cohen received both her master’s degree and medical degree from Harvard Medical School. Here's the URL for her web site: http://resilienthealthaustin.com

The article discusses Dr. Hausman-Cohen's approach to treating CIRS. She learned about treating CIRS from many people, but especially Dr. Ackerley and Dr. Shoemaker. But she is not closely following the Shoemaker protocol. She is ApoE4 aware and modifies treatment accordingly.

Here's part of the section on hormone replacement:
Hormone replacement may be beneficial in the classic ApoE4 Alzheimer’s patient and CIRS patient because the hypothalamic-pituitary axis (HPA) gets “off” do to mycotoxins affecting the HPA axis. Many times testosterone will be very low in female CIRS patients (and estrogen can be high). Testosterone is involved in anxiety, sleep and cognition. So is estrogen. Hormones are not the first thing to address because people are initially overwhelmed. Dr. Hausman-Cohen addresses the inflammation first. Sometimes, though, testosterone replacement by creams or pellets is what really gets the patient back to normal. But you don’t want to start first with hormone replacement in general in CIRS patients. Sometimes testosterone replacement may increase estrogen levels and increase estrogen dominance symptoms. Dr. Hausman-Cohen tries to normalize other metabolic abnormalities first. Then she will replace testosterone and other hormones along with iodine supplementation to keep testosterone from being converted to estrogen.
I know my HPA axis is "off," my testosterone has been too low, my estradiol has been too high, and I was using compounded testosterone cream until recently. I wonder if my supplemental testosterone was being converted to estrogen due to CIRS. Of course, I don't really know, and I doubt my conventional GYN will be familiar with any of this (though I will print the article for him). I'll probably need to see my new bHRT practitioner sooner than later. She herself had mold illness, so she's likely familiar with the mischief CIRS can cause.

But as I've said elsewhere, I will switch to Dr. Rapaport if I'm not getting anywhere with my local practitioners.
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!
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Re: Hormone Replacement Therapy E4 Women

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Lucy5 wrote:I'm using transdermal estrogen (.05mg) and cycling in 200mgs prometrium for 12-14 days every 3 mo. Because I'm not opposing estrogen more frequently, the lining builds up and usually around day 10 of progesterone I'll start "menstruating" which thins out the lining, hopefully enough. My understanding is that spotting during the months inbetween would be a flag that the lining is thickening too much and/or the the extra lining cells are becoming abnormal. Since as far as I know there's limited data on this kind of approach, I'm being careful to test for precancerous signs as needed and crossing my fingers I'm making the right choice.
Thanks for explaining your protocol. It sounds like a reasonable approach, given that you evidently can't tolerate daily progesterone. But it's good to be careful and get your yearly ultrasounds.
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TheBrain wrote: I didn't tell my regular GYN about this second opinion. It sort of felt like I cheated on him.
Had a good laugh at that one, my friend, but I can relate! :lol:
I'm happy you can relate! :lol:
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!
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Re: Hormone Replacement Therapy E4 Women

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slacker wrote:
TheBrain wrote: One thing on my mind is that the last time I had endometrial thickening, I was concerned that my GYN wasn't taking it far enough. Due to cervical stenosis, he couldn't access my uterus to get an endometrial biopsy, so he stopped trying. I ended up getting a second opinion and had a hysteroscopy (that GYN got in there somehow). Everything was fine. I didn't tell my regular GYN about this second opinion. It sort of felt like I cheated on him.

I just had a Pap test by my regular GYN. Apparently, the cervical stenosis has either improved or gone away (due to using an estradiol patch, I'm sure). My "endocervical" tissue was accessible and just fine.
Your cervical stenosis prevented the first gyne from accessing your endometrium to get a biopsy. The second gyne was successful with hysteroscopy, which often uses cervical canal dilation to help get access to the endometrium. There is no dilation with a simple endometrial biopsy. The endometrial biopsy helped rule out endometrial cancer. One of the first signs of endometrial cancer is post menopausal vaginal bleeding.

Endocervical tissue needed for a PAP test for cervical cancer is much closer to the surface of the lower cervix, maybe only needing to go a quarter of an inch for a good sample rather than all the up in the uterus, so cervical stenosis is much less of an issue for adequate sampling.

Hope this anatomy picture helps:
https://12to50.files.wordpress.com/2011 ... oronal.jpg
Slacker, thank you, thank you, thank you! Your explanation brings clarity to me, which I welcome. The anatomy picture definitely helps as well.

My GYN appointment isn't until Tuesday, so I was surprised to see my pelvic ultrasound results appear in my patient portal. My endometrial lining is 10 mm thick, and I have a "nearly unilocular 2.5 cm left ovarian cyst."
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!
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Re: Hormone Replacement Therapy E4 Women

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TheBrain wrote: Slacker, thank you, thank you, thank you! Your explanation brings clarity to me, which I welcome. The anatomy picture definitely helps as well.
Ditto for me, slacker...very helpful post!
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Re: Hormone Replacement Therapy E4 Women

Post by Orangeblossom »

Just had a look at what is available on the NHS in the UK, found this leaflet.

https://www.gwh.nhs.uk/media/163808/wil ... e_2014.pdf

I saw this about it:

"Bioidenticals aren't just for those who can afford to go private. There are bio identicals available on the NHS which your GP could prescribe for you. These include Oestrogel (oestrogen gel), Utrogestan (a bioidentical progesterone tablet), vaginal oestrogen such as Vagifem (estradiol) or topical Ovestin cream. However, although the oestrogens are almost always bioidentical these days, progesterone tends to be in the form of synthetic progestin. In terms of what GPs are able to prescribe, it often comes down to cost, bureaucracy and what's available to them within the NHS."

Does any of that look like a good option, obviously would avoid the Premarin. I noticed a section for women over 60 as well..Thanks for any advice - it's a bit new to me. I might not need if for a little while but just wanted to see if NHS might be any good or would need to do something else.
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