Hormone Replacement Therapy E4 Women

[slacker]

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.

The utrogestan biodentical progesterone tablet looks like a winner, depending on mg dosing options. Not sure what form of estrogen is used in the oestrogel gel or Ovestin cream. (I didn't look at the link) If estradiol, they could work, depending if they come in more than one dose or strength. The Vagifem is an estradiol topical product, but it is designed for vaginal use and studied for vaginal dryness only. I'm not sure if the dose would be equivalent to that of estradiol used on the skin for menopausal symptoms such as hot flashes. I'm sure there is some amount of systemic bioavailability (body wide availability) with the vaginal product, but it is probably pretty small. There is some concern about using vaginal estrogen without progesterone in women with an uterus, due to theoretical risk of increased endometrial cancer.

[Stavia]

We use utrogestan and ovestin here.
The former comes in 100mg capsules of micronised progesterone. I prescribe it often in conjunction with estradiol patches.

Ovestin is oestriol. 2x to 3x a week there is no evidence of endometrial hyperplasia. It's used extensively here for decades for vaginal symptoms in menopause. It doesn't need progesterone with it. I prescribe heaps of it. It's not an option for using more for HRT to get higher systemic levels as its oestriol. Vagifem is vaginal oestradiol. I guess it could be considered off label to achieve systemic levels sufficient for HRT but it'd be kinda messy

[Orangeblossom]

Thanks for the replies. I also looked at the NICE guidelines and noticed it said that there is no need to have a date to stop treatment with an informed patient who wants to continue....so possibly might be able to stay on it for as long as you want to.

It seems they might give patches if there is a need and could possibly manage that as have had quite a bit of small bowel removed so may be issues with absorption orally- in fact with contraception they recommended a minera coil due to that. So expect may be able to get the patches. They are meant to be better aren't they.

Just been reading about how oestrogen can be neuroprotective and possibly reduce IL-6 and inflammation, with regard to AD. And that men actually keep having oestrogen due to their hormones, I didn't realise that.

Although overall I'm as much concerned about osteoporosis as anything- hip and spine fractures can be devastating and sometimes fatal. So looking at the overall picture on health really.

[TheBrain]

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."

My GYN recommended a hysteroscopy. I have the procedure scheduled for later this month. Ugh... He didn't say a word about the ovarian cyst, so I gather he's not concerned about it. I meant to ask him if he'd be willing to order blood work but forgot. So I asked my primary care physician if he'd be willing to order some tests. He is. Next week, I'll be testing my thyroid hormones (fT3, fT4, TSH), sex hormones (estradiol, estrone, free and total testosterone, and progesterone), and advanced lipids (using Quest's Cardio IQ panel).

I shared with my GYN Dr. Sharon Hausman-Cohen's article (which I quoted from in a previous post): Are Mold Toxicty and Chronic Inflammatory Response Syndrome (CIRS) Causes of Memory Loss and Alzheimer's Disease. As expected, the information was new to him, but he did want a copy of the article.

[Orangeblossom]

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."

My GYN recommended a hysteroscopy. I have the procedure scheduled for later this month. Ugh... He didn't say a word about the ovarian cyst, so I gather he's not concerned about it. I meant to ask him if he'd be willing to order blood work but forgot. So I asked my primary care physician if he'd be willing to order some tests. He is. Next week, I'll be testing my thyroid hormones (fT3, fT4, TSH), sex hormones (estradiol, estrone, free and total testosterone, and progesterone), and advanced lipids (using Quest's Cardio IQ panel).

I shared with my GYN Dr. Sharon Hausman-Cohen's article (which I quoted from in a previous post): Are Mold Toxicty and Chronic Inflammatory Response Syndrome (CIRS) Causes of Memory Loss and Alzheimer's Disease. As expected, the information was new to him, but he did want a copy of the article.

It could just be a functional cyst, (common and benign)? I had one of those, it just went away. Hope all goes OK. Sounds like you are getting good care. Kind thoughts.

[TheBrain]

Thanks, Orangeblossom. I did a bit of reading about ovarian cysts, and the fact that it's unilocular (nearly so, at least) and small, the chance of malignancy is quite low. I have had a cyst come and go before, so I imagine this one will go as well. I can't say I'm completely unconcerned about it, and I do intend to ask my GYN about it (I do best when I write down all my questions for doctors before my appointment!).

[Jonita]

I just joined today. I have been reading everything I could find on postmenopause hormone replacement for older first time users. I discovered last year that I was a 4/4 and set about learning about it. I have been following the Bredesen book as much as I can but the HRT throws me. I am so confused. I am 78 and considered to have good health for my age. I breezed through menopause and the only problem I have had is bleeding a couple of times in the past but checked out OK. I started seeing a doc that encouraged me to begin the estradiol .25 mg, progesterone 100 mg, DHEA 10 mg, testosterone .25. I have been on the program for 3 months, have symptoms and feel not so good. Doc not helpful. I am open to comments.

[slacker]

I just joined today. I have been reading everything I could find on postmenopause hormone replacement for older first time users. I discovered last year that I was a 4/4 and set about learning about it. I have been following the Bredesen book as much as I can but the HRT throws me. I am so confused. I am 78 and considered to have good health for my age. I breezed through menopause and the only problem I have had is bleeding a couple of times in the past but checked out OK. I started seeing a doc that encouraged me to begin the estradiol .25 mg, progesterone 100 mg, DHEA 10 mg, testosterone .25. I have been on the program for 3 months, have symptoms and feel not so good. Doc not helpful. I am open to comments.

Welcome Jonita;

Starting HRT (and stopping) must be an individual decision, especially as we age. Are you having any cognitive issues? Are the hormones the only things that have changed since you started a program 3 months ago? Are you using estradiol pills or patches? What kind of symptoms are you having? Are they new in the last 3 months? We all need a doctor who is on the journey with us, and will help us along, especially when there are bumps in the road.

You've found our gi-normous thread on female hormone replacement. It is daunting. There is a more abbreviated and summarized version in our primer, which you can find here. You may need to page down a bit to find the hormone replacement section. The Primer is a great resource for much more than just hormone replacement. If you do decide to stop the hormones, it is best to wean off the estradiol slowly.

When you get a chance please tell us more about yourself in the "Our Stories" Forum. You've found a caring community who will support you as best we can.

[Jonita]

Thank you for responding Slacker. I am not having cognitive issues. My mother's three sisters were diagnosed with AD and my mother with Lewy Body. I did not know my father so no information there. I have three sons so this is not just for me but to enlighten them also. The are all 3/4s. The problems I started having last week was very tender breasts, backache and definitely the PMS emotions. I contacted the doc and was told to "just stop taking all of them." I was bewildered. Is it safe to just abruptly quit or should I taper off. All weekend I have been searching for answers and getting more confused. Seems that some state that not only am I too old to start HRT but I have been post for too long?? Bredesen doesn't address anything about HRT and ages.

[Jena S]

I just joined today. I have been reading everything I could find on postmenopause hormone replacement for older first time users. I discovered last year that I was a 4/4 and set about learning about it. I have been following the Bredesen book as much as I can but the HRT throws me. I am so confused. I am 78 and considered to have good health for my age. I breezed through menopause and the only problem I have had is bleeding a couple of times in the past but checked out OK. I started seeing a doc that encouraged me to begin the estradiol .25 mg, progesterone 100 mg, DHEA 10 mg, testosterone .25. I have been on the program for 3 months, have symptoms and feel not so good. Doc not helpful. I am open to comments.

Welcome, Jonita! We are so glad to have you here on our forum. I envy your passion for learning more about HRT to help you in your journey and hope you find useful, insightful, and scientific-based conversation in this forum! You will find a group of amazing, and informative, people on this forum who can provide you both research-based information and personal experiences. In order to get you started, make sure you check out the Primer (viewtopic.php?f=33&t=1418]Primer) which has an array of information written by one of our founders who is an MD. Also, make sure to tell us more about yourself in the forums as we will love to get to know you! Again, welcome