Hormone Replacement Therapy E4 Women

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

Postby Plumster » Fri Apr 20, 2018 8:58 am

Just wanted to thank you all for this useful info and the links to Dr. Anne Hathaway. I'm 48 and 3/4 and just beginning to realize that, despite being homozygous COMT, I will likely benefit from transdermal estradiol. I will make an appointment with my primary doctor soon.
e3/4 MTHFR C677T/A1298C COMT V158M++ COMT H62H++ VDR Taq ++ MTRR A66G ++

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Re: Hormone Replacement Therapy E4 Women

Postby judith74 » Fri Jul 20, 2018 7:34 pm

An update, if it helps somebody.

Last year, at 44, I began with perimenopausal symptoms (night sweats and my brain just could not stop working at night) but still having periods. My family doctor gave me transdermal estradiol and progesterone, I was extremely happy, the symptoms were gone. But six months later, I bled for a complete month and my gynecologist stopped the HRT. Somehow my body began making more hormones. For six months everything got back to normal, with no more perimenopausal symptoms.

Six months, later I began with night sweats and the not stopping brain again. My gynecologist told me that he is not giving me HTR until I have at least three months without a period; but at least he is giving me testosterone in the meantime. After reading the New York Times article "The Menopause-Alzheimer’s Connection" https://www.nytimes.com/2018/04/18/opinion/menopause-alzheimers-connection.html I tried flax seeds, and it had work amazing! I didn't have much of a hope, because the research says that it doesn't work. But for me, it works great! What I have found is that the flax seeds need to be recently grounded (no more than 3 days) and I need to eat 20 to 30 grams between noon to 6 pm.

I have done this for 3 months now. Everytime that I think I don't need the flax seeds anymore and I don't eat them, I have again the night sweats and I can't sleep. Strictly speaking, It shouldn't work according to available research, but I suppose that the amount that I need is very small, but enough to make my life miserable if I don't balance it. And I suppose that it can make a difference for my brain health too.

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Re: Hormone Replacement Therapy E4 Women

Postby Bettylacy » Wed Jul 25, 2018 9:35 am

:D Waves and smiles to all my APOE sisters and brothers. I'm trying to get to that magic level of 40-60pg/ml of estradiol that Ann Hathaway recommended at the Lo Carb convention last year. I've been using transdermal for most of the >10 years of menopause. But my levels kept coming back <25 so switched to patch and have titrated up to .05mg but my levels are still <25pg/ml (checked 2x vis blood). I have had breast tenderness initially pretty significant now relaxing after 3 months. My question is when is the best time to check the level? I have in my notes that Ann wanted a trough level but whether you get it on the 3rd day or the 4th is presumably going to make a difference in the level. I have been checking mine on the 4th. Also 2nd ? is blood testing the best? Ann thought so. But # of practitioners have mentioned doing saliva which I used to do years ago but found it too variable.

In gratitude of APOE4 info!
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Re: Hormone Replacement Therapy E4 Women

Postby slacker » Wed Jul 25, 2018 12:20 pm

Bettylacy wrote::My question is when is the best time to check the level? I have in my notes that Ann wanted a trough level but whether you get it on the 3rd day or the 4th is presumably going to make a difference in the level. I have been checking mine on the 4th. Also 2nd ?


Hi Betty;

I reviewed Dr Hathaway's slides from August 2017 (here on the website: search on "Hathaway" in this thread). Slide 49 indicates that estradiol should be checked on the middle day of estradiol patch, not trough. Are you on once a week or twice weekly patch? Third or fourth day would be correct for weekly patch, day 2 or 3 for twice weekly. Sounds like your serum level is low regardless. Breast tenderness often indicates too much estradiol. Are you working with a bHRT expert who can help you navigate through this?
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Re: Hormone Replacement Therapy E4 Women

Postby Bettylacy » Wed Jul 25, 2018 4:42 pm

Thanks Slacker for double checking. I am on bi weekly patch so day 2 or 3 would be correct. That is really helpful. I have my first visit with functional medicine dr in a few weeks and have a health coach who I am beginning with. I will check the slide too. Thankyou for f/u so quickly.
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Re: Hormone Replacement Therapy E4 Women

Postby hill dweller » Thu Jul 26, 2018 10:26 am


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Re: Hormone Replacement Therapy E4 Women

Postby WillsMeme » Mon Aug 06, 2018 11:10 am

I managed to be a guest at the AAIC2018 conference in Chicago on July 23 and heard a fascinating presentation by Dr. Walter Rocca and others about HRT and AD. This is the elevator version: Since women are 2/3 of the AD patients, the disparity may be explained in part by the sudden decline in estrogen at menopause. Estrogen is necessary to metabolize lipids. If there isn't enough estrogen, the brain goes into starvation mode and starts to metabolize myelin for fuel. The WHI study that found HRT increased AD risk randomized women who were 10 years past menopause into HRT/non-HRT. But APoE4 women who start HRT at 50 and continue past the age of natural menopause may be protected. I haven't seen anything online or in media about this idea, but I keep looking. Anyone else know anything about this theory?
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Re: Hormone Replacement Therapy E4 Women

Postby Lindajane » Wed Aug 15, 2018 4:27 pm

Thanks for the info Wills Meme. I found this from The WHI study:

"Cognitive and Dementia Risks/Benefits with HT

Several observational studies and meta-analysis had suggested that estrogen prescribed to younger women at the onset of menopause decreases the risk of Alzheimer's disease or delays its onset (63, 64). In WHI, when older women (> 65 y) were studied, there was a significant detrimental effect in cognitive function in women in the E+P trial (65) and only a trend to this effect with estrogen alone (66). It has been hypothesized that the timing of initiation of HT is critical here, as it is for CHD. However, no RCT to date has been able to prove a cognitive benefit. In the recently completed KEEPS, preliminary data have suggested that there is no detrimental effect of HT, and indeed a trend to benefit in certain women (29) although this short-term trial was not designed to assess the effects of HT on cognition and dementia. While we await more definitive prospective trial data, a possible benefit based on the timing of initiation of HT is consistent with the observational studies cited above (63, 64) as well as other observational studies that focused on the timing of initiation (67–69)."

I started biodentical HRT 8 months ago and did not feel as well after starting them. I am 65 (66 next month). I am at least 10 years past menopause and I have been considering stopping the HRT. I wish there was more information for HRT in women 10 years past menopause. I certainly don't want to do something that is going to make things worse!

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Re: Hormone Replacement Therapy E4 Women

Postby KatieS » Wed Aug 15, 2018 4:53 pm

Lindajane wrote:Thanks for the info Wills Meme. I found this from The WHI study:

"Cognitive and Dementia Risks/Benefits with HT

Several observational studies and meta-analysis had suggested that estrogen prescribed to younger women at the onset of menopause decreases the risk of Alzheimer's disease or delays its onset (63, 64). In WHI, when older women (> 65 y) were studied, there was a significant detrimental effect in cognitive function in women in the E+P trial (65) and only a trend to this effect with estrogen alone (66). It has been hypothesized that the timing of initiation of HT is critical here, as it is for CHD. However, no RCT to date has been able to prove a cognitive benefit. In the recently completed KEEPS, preliminary data have suggested that there is no detrimental effect of HT, and indeed a trend to benefit in certain women (29) although this short-term trial was not designed to assess the effects of HT on cognition and dementia. While we await more definitive prospective trial data, a possible benefit based on the timing of initiation of HT is consistent with the observational studies cited above (63, 64) as well as other observational studies that focused on the timing of initiation (67–69)."

I started biodentical HRT 8 months ago and did not feel as well after starting them. I am 65 (66 next month). I am at least 10 years past menopause and I have been considering stopping the HRT. I wish there was more information for HRT in women 10 years past menopause. I certainly don't want to do something that is going to make things worse!

Lindajane, can you describe how you do not feel as well (cognitively? moody? insomnia?) Are you on the estradiol patch and a natural progesterone oral dose at night? Some women have noticed a benefit from the standardized patch as opposed to a compounded estrogen and their estradiol levels boosted. Dr Bredesen provides an example of cognitive impairment due not enough progesterone to balance out her estrogen, which seem to slightly describe my experience.

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Re: Hormone Replacement Therapy E4 Women

Postby slacker » Wed Aug 15, 2018 5:05 pm

Lindajane wrote: I found this from The WHI study:


The WHI study used oral premarin and synthetic progestin. These are not equivalent to "bioidentical" topical estradiol and prometrium. Mostly European studies, from countries who prescribe mostly bioidentical hormones, tend to show much less risk, and often benefit.

That being said, it is difficult to know how long after menopause to start hormone replacement. All hormone replacement requires a balance between benefit and risk. And each woman has a different response to treatment. Decision making needs to be tailored to the individual.
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