Hormone Replacement Therapy E4 Women

[circular]

So I increased Alora patch from .05 (yielding lab of just 50) to .075. About six weeks later I’ve clearly gained weight and feel bloated. Would this be due to the estrogen alone or to estrogen dominence? I have to decide whether to lower the estrogen dose again or raise my progesterone.

Is 50 a good enough estradiol level? I’ve had the impression that while we’re rather in the dark about it, levels more around 100 are currently recommended by Dr. Bredesen and Dr. Hathaway (don’t have those notes handy). Sorry I don’t have the US units handy either.

[circular]

I forgot about using the biomarker spreadsheet for guidance from different healthcare professionals. Unless it needs updating, I was in range at 50 ng/mL according to Dr. Hathaway and Dr. Gundry (40-50 ng/mL), but it’s at the very low end of Dr. Bredesen’s 50-250 range. (Dr. Hathaway increases range to 49-60 at age 60.) I wonder how Dr. Bredesen might customize this based on individual context. Based on my symptoms at a higher dose and Dr. Hathaway and Dr. Gundry’s recommendations, I think I’ll go back to my prior dose.

[slacker]

My estradiol is hanging around the 40 ng/mL level. I could use a higher dose of estradiol patch, but I'm already on 200 mg of progesterone, and barely have the right ratio of estradiol to progesterone for protection against endometrium dysplasia. So I'm staying put. No side effects, unclear if helping I haven't had a yowzer moment of pristine clarity or incredible energy with any of my interventions. Perhaps some small welcome benefits.

[Batwoman]

I know...it's a lot to take in. You're still young and may not need HRT for a while. My guess is that you'll know when you need help The symptoms were VERY severe; kinda happened overnight for me...with years of lesser symptoms leading to a crash.

The good news is that you're aware of the benefits of HRT for E4s and will be prepared when you need help.

I just thought I'd comment that Bioidentical hormone replacement might be a great idea even if those menopausal symptoms aren't severe. I reached menopause at about 50, had some spectacular hot flashes, but nothing too awful and it just eased up over time. I certainly had some memory problems at the time also, but much of that went away. It turns out that I'm Apo E 4/4 with Mild cognitive impairment that was obvious to me at age 64. I was prescribed replacement therapy at the age of 66 and I'm doing quite a bit better. Admittedly, I have no family history of reproductive cancers, so neither I nor my doctor are worried too much about that aspect. Of course, I've changed many other things as well. I do love the effects of the therapy. My skin, my sex life, etc. are much improved.

[Stavia]

Sleep and brain fog, my experience:

When I went into menopause age 53, the only symptom was waking every sleep cycle and not being able to get back to sleep easily, if at all. Had a car accident after weeks of this. Took a leap of faith and started HRT 50mcg patches, within 2 nights sleep was restored back to sleeping through the night.

Fast forward to a few months ago. My sister got breast cancer recently. I started reducing to cutting a 100mcg patch in 3 ie 33.3mcg. There was a lot else going on, I was ill for months with nasty asthma, and I was struggling to keep going day by day and my sleep started going off again. Started diet coke again for the caffeine and zopiclone to sleep. Had a very rough winter.
Four weeks ago my GP said I should reduce the patches further to 25mcg to reduce the breast cancer risk. I felt even worse, everything was an effort, awful brain fog my sleep was terrible. Needing zopiclone every night. I started worrying there was something very wrong.

2 days ago, after only 3 hours sleep, I remembered the initial menopause. Slapped on another 25mcg patch mid afternoon. Decided no zopiclone. Slept 6 hrs. Last night slept 8 hours and woke up wit

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[Stavia]

...no brain fog whatsoever. Feel normal again. Totally normal. All those wasted weeks unnecessarily of feeling awful. (Sorry, Tapatalk bugged)


Lessons:

I am clearly very oestrogen dependent in terms of sleep and cognitive function. As a 4/4, this might be applicable to other 4/4s.

It is a very subtle effect initially. Difficult to tease out from other stuff.

[Julie G]

So wonderful to hear this, Stavia!!! I understand the desire to reduce and I think it makes good physiological sense. Our reproductive systems were not meant to work into perpetuity... BUT if menopause is a symptom of aging and aging is one of the greatest risk factors for AD, it's kind of tempting to biohack this one. I'm personally planning to begin cutting back v-e-r-y slowly after 10+ years on bHRT.

Do we have evidence that bio-identical hormones contribute to cancer risk?

[sarahb12]

I think, in general, we should listen to our bodies feedback. We are just beginning to understand differences between people based on genetics. I'm glad I rejected birth control pills based on subtle differences that I couldn't even verbalize, but knew they made me feel worse. Now knowing that I have the COMT variant that makes it hard to break down estrogen and harder to break down horse forms of estrogen, I have a clue why they made me feel worse.

My guess is if you have brainfog without bHRT and BHRT helps, bHRT is the better choice. But maybe not for everybody. And minimalist approach is probably the least risky. Minimum dose that does the job.

S

[Stavia]

So wonderful to hear this, Stavia!!! I understand the desire to reduce and I think it makes good physiological sense. Our reproductive systems were not meant to work into perpetuity... BUT if menopause is a symptom of aging and aging is one of the greatest risk factors for AD, it's kind of tempting to biohack this one. I'm personally planning to begin cutting back v-e-r-y slowly after 10+ years on bHRT.

Do we have evidence that bio-identical hormones contribute to cancer risk?

Julie there is zero robust evidence about bio-identical hrt and long term real outcomes whatsoever. There aren't any big enough and long enough trials with 17Beta-oestradiol alone. Its all currently a theory (possibly true, possibly wishful thinking) that its safer. BUT what we do know from the Women's Health study is that oestrogen in all forms alone, without progesterone, does not increase breast cancer risk.

Day three now and I feel like a new person. Omg the wasted months.

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[Stavia]

I think, in general, we should listen to our bodies feedback. We are just beginning to understand differences between people based on genetics. I'm glad I rejected birth control pills based on subtle differences that I couldn't even verbalize, but knew they made me feel worse. Now knowing that I have the COMT variant that makes it hard to break down estrogen and harder to break down horse forms of estrogen, I have a clue why they made me feel worse.

My guess is if you have brainfog without bHRT and BHRT helps, bHRT is the better choice. But maybe not for everybody. And minimalist approach is probably the least risky. Minimum dose that does the job.

S

Absolutely Sarah. Its all n=1. I wanted to share this because I'm unexpectedly blown away by the difference in how I feel, sleep and how much sharper my cognition is within 2 days with a dose increase from 25mcg to 50mcg. I suspect there is a threshold effect in my brain, and if it is a 4/4 effect, others may be helped by my experience.

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