Hormone Replacement Therapy E4 Women

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
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KatieS
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Re: Hormone Replacement Therapy E4 Women

Postby KatieS » Fri Mar 07, 2014 9:31 pm

This is my first post as a newly discovered E3/4 on 23andme. After having discontinued a tapered dose of the Combipatch, almost two years ago, I restarted the ultra-low dose estrogen only patch (Menostar 0.14) six weeks ago. Today I consulted a Stanford neurologist who is studying Alzheimer's, as to his recommendation related to estrogen. Basically, he said I could take it until age 65, but they don't really know. I mentioned that my mother had been on estrogen from age 47 to her current age of 96, still cognitively intact. He said, but "you're basing a treatment on a sample of 1".

Reading over your comments and articles have been so helpful. I have other genes that also increase my risks 3 fold, not just double from the E4, so I intend to peruse the site regularly.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Fri Mar 07, 2014 10:31 pm

Welcome Kitano. Thanks for including your doctors comments. I was actually surprised he said okay until 65. I thought the accepted period was 5 years or so from menopause, if no conflicting risk factors. I'm 51 so would like to think I don't have to be overly worried until 65. Maybe they will know more by then, but it seems they would need some super long studies, like I should be in one.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby KatieS » Sat Mar 08, 2014 6:56 am

Thanks, Circular. He said the estrogen studies have not pulled out the E4 carriers with their data. So I'm thinking just like you, maybe in 4 years, this will occur and we will know more if estrogen benefits are worth the risk. Note I am on an ultra-low dose patch which produces a steady low level. Estrogen spikes like from alcohol might be responsible for the increase in breast cancer. Plus, I'm thin (BMI=19), so my lifelong estrogen level has been low.

I will be volunteering for the Stanford study (fMRI, labs and full neuropsychological testing) annually, although I will not know of the results. We all need to contribute so doctors have evidence to direct E4s.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Sat Mar 08, 2014 8:15 am

I think I'm BMI 19 or 20 too, but always tested normal estrogen levels until menopause. Interesting about spiking. I use. Bioidentical cream but have been thinking of switching to a patch. Do you happen to have a study you like about the spiking problem? Maybe I should look and show my doc.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby KatieS » Sat Mar 08, 2014 3:02 pm

Circular, I don't think that with the cream you will have any significant systemic absorption of estrogen, so this would not benefit decreasing Alzheimer's risks of E4, if you believe that estrogen can do this ; the evidence is not in yet. The patch is designed to provide a steady level over a week or 3-4 days, depending on which patch you use. Estrogen spikes with alcohol use, such that even a few drinks per day can increase your breast cancer risks. So I concluded that spiking should be avoided. If you take an oral estrogen the same time of day, the blood levels should not spike without overlapping dosing. The patch bypasses the liver, so it goes directly into the bloodstream. Actually, I don't know if we can trust if there is a difference, other than the patch is considered to have less clotting complication risks. I'm no expert on this, so maybe someone else has more studies.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Sun Mar 09, 2014 1:25 pm

That's interesting about he alcohol Kitano. Luckily I really have no desire for that so I don't have to worry :-), but I hear what you're saying about the spiking factor. Thanks for your input. I do think I absorb the hormones in cream form though because my blood levels are now higher and symptoms much improved? But I wouldn't be surprised if the absorption levels fluctuate more than with a patch. I think I'm leaning toward a patch. Where do you put it?
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby KatieS » Sun Mar 09, 2014 5:35 pm

If you are sensitive to even using the cream and have higher blood levels, I would stick to an ultra-low dose patch. As another thin woman, I think we're accustomed to less estrogen. No fat to increase the estrogen level!

My patch goes on my lower abdomen, where I can easily inspect it. Just do not put the patch on your breast.

Has your doctor supported using estrogen given your E4 gene? Is this more widely accepted? I waiver as the data is not clear yet.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Mon Mar 10, 2014 8:24 am

Thanks for the heads up about using a low dose patch. My doc also acknowledges the uncertainty for E4. She was intrigued by last year's article showing estrogen appeared to help E4 but not E3. Not breaking other studies down by phenotype could explain some of the contradictory evidence. Still TBD though. I'm guessing other genes play a role here too, just to complicate things.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby Julie G » Mon Mar 10, 2014 2:48 pm

A belated welcome, Kitano. I just read your post at 23 and Me & have a better idea of where you're coming from. I have a dumb question, but have you taken the time to go back and read this thread? There is some pretty compelling evidence in favor of using HRT for E4 carriers. It's not conclusive, but that is where many experts are leaning. Perhaps print out some of the studies and show to your doc. My Mother (presumed 3/4) who is 76 JUST resumed HRT and feels great.

Any reason why your doc is recommending unopposed estrogen?

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Re: Hormone Replacement Therapy E4 Women

Postby KatieS » Tue Mar 11, 2014 9:18 am

Actually it was these posts that persuaded me to push my doctor to prescribe Menostar! But the evidence is not in. When I put in my various genes based on PLOS One study of Hormone Treatment: Estorgen Receptor Polymorphisms and Mortality: A Prospective Cohort Study (3/23/12), I have decreased risk of all-cause mortality, but a 3 -fold increase in cancer-related mortality. I'm just concerned about increasing one risk for another. If you are lucky to have the decreased risks for both, then I think the decision is easier. A very important note, is that this study was looking at hormone replacement, which is not unopposed estrogen, so like the Woman's large study, the data is skewed from progesterone and cancer risks.

The Stanford neurologist thinks it's an overgeneralization to look at my 96 y/o mother who has been on estrogen almost 50 years, since "she is a sample of ONE". This is the same guy who had headlines a few years ago, that estrogen might "put the brakes on Alzheimers for those E4 subset". He claims the studies still need to pull out these E4s to see if this in fact is the case. So in the meantime, barring side effects, I think I'l remain on the ultra-low dose, and hope that in the next few years, another study will confirm this benefit for E4s.


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