Hormone Replacement Therapy E4 Women

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chrissyr
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Re: Hormone Replacement Therapy E4 Women

Post by chrissyr »

Thanks for the input, Slacker! I have a few vacation days, and #1 on my list was to read this entire thread, #2, dr appt (today!) (World travel at some other point ! ;)
The post with Gillian Einstein interview emphasized that the sudden and precipitous drop in estrogen is the factor. Although she also says that estrogen is protective for the brain. I'm probably going to go for it... but want to make sure I don't mess with something that is actually going OK! For sure, an easier decision if I were closer to menopause or having serious symptoms of a crash.
Another interesting factoid was from a short article I clicked on below G. Epstein-- saying that levels of AD in men and women are the same aged 55-85 overall, but increased in women between 65 and 75. (you all probably knew that, I'm getting up to speed slowly!)
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Re: Hormone Replacement Therapy E4 Women

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CarrieS wrote:
chrissyr wrote:Carrie, can I ask what your decision was? I am in a similar boat--- have been 5 year since menopause. No major symptoms that I am aware of, I guess it was a gradual decline. But my estradiol level is low now (1?) I still have not done anything about this, and would love to do nothing!
Sigh. I was battling a crazy itchy, full body rash of unknown origins at the time so the doctor decided that "he would fix that first" before looking at my hormone test results. Of course, thousands of dollars and loads of anguish later, it turned out to be what I had originally suspected, a skin parasite that I had picked up during traveling. I've only gotten back to being "myself" this last month after 6 months of hell and have lost all faith in that doctor (he was NOT the one that humored me and treated me for a parasite). I figure that my big lesson was to trust my intuition and listen to what my body is telling me so right now, I'm coasting and enjoying feeling great again. I'm sorry that I don't have helpful news for you.
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.
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Re: Hormone Replacement Therapy E4 Women

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slacker wrote:
Lucy5 wrote:My FMD has not suggested the Genova test for me, possibly because she knows I'm careful about cost. I think the Genova test is rather pricey and not covered by insurance. She has been monitoring my serum estrone (E1) as a surrogate for the actual estrogen metabolites. After starting my bHRT, my estradiol was "ideal", but estrone was too high. I started taking a supplement called Estrosense, specifically for DIM, to assist with improved estrogen metabolism. My estrone improved but not enough. After halving my bi-est dose, my estradiol was of course too low, but estrone was still too high. I am now taking Calcium D-Glucarate as well to help with estrogen metabolism. Seems like a lot of supplements to increase the safety of the bHRT, but I'm along for the cognitive improvement ride for now. It's possible that CIRS biotoxins are driving part of my estrogen metabolism problem.

I've attached a PDF of Genova Diagnostics' Steroidogenic Pathways; The estrogen part is in the bottom right hand corner. You can see COMT in 2 of the 3 estrone metabolism pathways. If I remember correctly, the 2-OHE1 path is preferred to reduce the chance of breast cancer. As you can see, it takes more than B vitamins to have the machine running smoothly. Hope this helps!

Genova Steroidogenic-Pathways-Chart.pdf
Slacker, could you possibly expand on the statement you made, which I’ve highlighted in bold? I’m wondering if CIRS is contributing to my hormonal woes. I recently had a pelvic ultrasound, which showed endometrial thickening (again). I see my GYN for follow up next week, but he doesn’t know anything about CIRS. I am post-menopausal.

I’ve been on bHRT (estradiol patch, oral progesterone, compounded testosterone cream), and my estradiol went quite high (over 200), though my bHRT doctor was quite happy with my level. A few days after being told to stay on my current dosages, I started spotting, which lasted a couple of weeks. He had me cut my estradiol patch in half (so I went from .05 to .025 per day). The bleeding stopped, but I’ve been suspecting that my endometrial lining had probably gotten too thick. Well, it has.

On my own, I stopped the testosterone. It didn’t help with any of my symptoms and didn’t seem worth it.

Another likely confounding factor is that I’m homozygous for two COMT SNPs (V158M and H62H), which I gather affect estrogen metabolism. (Susan, I see your link above about the paper that elucidates estrogen metabolism. I will attempt to make sense of it this weekend.)

Back in 2016, I did Precision Analytical’s Dutch hormone test. The results were very complicated, but my doctor at the time understood them well. I recall that my estrogen metabolites were too high and that’s why he started me on DIM and Calcium D-Glucarate.

I seriously doubt that my GYN understands COMT SNPs or Dutch hormone test results. My (now former) bHRT doctor has never even heard of the Dutch test. He just uses traditional blood tests to evaluate hormone levels. I have a new bHRT practitioner in mind but was hoping to wait until I need more refills to see her. (Her initial patient appointment costs $250, and my insurance won’t cover most of it.)
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Re: Hormone Replacement Therapy E4 Women

Post by Lucy5 »

Hi TheBrain,
First, just a quick note to clarify that the quote attributed to moi above re: Genova testing wasn’t actually mine, but I think (?) written by our friend slacker a few months ago. My doc just recently suggested I do the test and I am planning to go forward with it.

Regarding endometrial thickness, I’m getting yearly ultrasounds to keep an eye on mine, esp since I’ve chosen to cycle in prometrium every 3 mos which isn’t a recommended protocol (as I’m sure you know), but one I’m doing for now as I don’t tolerate progesterone very well. Just had an ultrasound and turns out my endometrium has gotten a bit thicker and is now outside the optimum range. My gynocologist, who is highly respected here, is not at all concerned if there’s no spotting, throwing out a number of stats supporting his view. He did emphasize if there is mid cycle spotting, esp along with thickening, then an endometrial biopsy is def called for. It’s a quick office procedure that I wouldn’t hesitate to do. I was kinda surprised by his opinion, tho, and really need to do some research to find out where those stats he referenced came from. I’ve always been one of those people who doesn’t like to borrow trouble -if a doc says I’m fine, not to worry - I’m generally all in. But I’ve become more questioning of late :?
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Re: Hormone Replacement Therapy E4 Women

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slacker wrote:My FMD has not suggested the Genova test for me, possibly because she knows I'm careful about cost. I think the Genova test is rather pricey and not covered by insurance. She has been monitoring my serum estrone (E1) as a surrogate for the actual estrogen metabolites. After starting my bHRT, my estradiol was "ideal", but estrone was too high. I started taking a supplement called Estrosense, specifically for DIM, to assist with improved estrogen metabolism. My estrone improved but not enough. After halving my bi-est dose, my estradiol was of course too low, but estrone was still too high. I am now taking Calcium D-Glucarate as well to help with estrogen metabolism. Seems like a lot of supplements to increase the safety of the bHRT, but I'm along for the cognitive improvement ride for now. It's possible that CIRS biotoxins are driving part of my estrogen metabolism problem.

I've attached a PDF of Genova Diagnostics' Steroidogenic Pathways; The estrogen part is in the bottom right hand corner. You can see COMT in 2 of the 3 estrone metabolism pathways. If I remember correctly, the 2-OHE1 path is preferred to reduce the chance of breast cancer. As you can see, it takes more than B vitamins to have the machine running smoothly. Hope this helps!

Genova Steroidogenic-Pathways-Chart.pdf
Slacker, could you possibly expand on the statement you made, which I’ve highlighted in bold? I’m wondering if CIRS is contributing to my hormonal woes. I recently had a pelvic ultrasound, which showed endometrial thickening (again). I see my GYN for follow up next week, but he doesn’t know anything about CIRS. I am post-menopausal.

I’ve been on bHRT (estradiol patch, oral progesterone, compounded testosterone cream), and my estradiol went quite high (over 200), though my bHRT doctor was quite happy with my level. A few days after being told to stay on my current dosages, I started spotting, which lasted a couple of weeks. He had me cut my estradiol patch in half (so I went from .05 to .025 per day). The bleeding stopped, but I’ve been suspecting that my endometrial lining had probably gotten too thick. Well, it has.

On my own, I stopped the testosterone. It didn’t help with any of my symptoms and didn’t seem worth it.

Another likely confounding factor is that I’m homozygous for two COMT SNPs (V158M and H62H), which I gather affect estrogen metabolism. (Susan, I see your link above about the paper that elucidates estrogen metabolism. I will attempt to make sense of it this weekend.)

Back in 2016, I did Precision Analytical’s Dutch hormone test. The results were very complicated, but my doctor at the time understood them well. I recall that my estrogen metabolites were too high and that’s why he started me on DIM and Calcium D-Glucarate.

I seriously doubt that my GYN understands COMT SNPs or Dutch hormone test results. My (now former) bHRT doctor has never even heard of the Dutch test. He just uses traditional blood tests to evaluate hormone levels. I have a new bHRT practitioner in mind but was hoping to wait until I need more refills to see her. (Her initial patient appointment costs $250, and my insurance won’t cover most of it.)
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Re: Hormone Replacement Therapy E4 Women

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Duplicate post
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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Lucy, thanks for your reply. I've twice tried to fix the quoting issue (I knew it was slacker, and not you, I was attempting to quote), but what happened is that I created two new posts! So I'll stop so I don't create any others.

I totally understand why you've become questioning of late. I've become that way myself. If someone is post-menopausal, then what might your doctor mean by "mid-cycle spotting"? And when you cycle in progesterone every 3 months, how long do you take it?

I've been taking 200 mg oral progesterone every night. I don't have any issues with it, but I do wish it made me sleepy like it does so many other women.

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.
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Re: Hormone Replacement Therapy E4 Women

Post by Lucy5 »

No worries on the quote at all...just didn't want to take credit for slacker's post ;)
TheBrain wrote: If someone is post-menopausal, then what might your doctor mean by "mid-cycle spotting"? And when you cycle in progesterone every 3 months, how long do you take it?
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.
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: Really glad to hear that both the hysteroscopy and pap results signaled the all clear for you. That must have been such a relief!!
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Re: Hormone Replacement Therapy E4 Women

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TheBrain wrote:
slacker wrote: It's possible that CIRS biotoxins are driving part of my estrogen metabolism problem.
Slacker, could you possibly expand on the statement you made, which I’ve highlighted in bold? I’m wondering if CIRS is contributing to my hormonal woes. I recently had a pelvic ultrasound, which showed endometrial thickening (again). I see my GYN for follow up next week, but he doesn’t know anything about CIRS. I am post-menopausal...

I seriously doubt that my GYN understands COMT SNPs or Dutch hormone test results. My (now former) bHRT doctor has never even heard of the Dutch test. He just uses traditional blood tests to evaluate hormone levels. I have a new bHRT practitioner in mind but was hoping to wait until I need more refills to see her. (Her initial patient appointment costs $250, and my insurance won’t cover most of it.)
Uh, I was hoping that Lucy could answer your question! :lol:

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.

You made a few other comments today, and I will try to respond/reflect in those posts...
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Re: Hormone Replacement Therapy E4 Women

Post by slacker »

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
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