Hormone Replacement Therapy E4 Women

[slacker]

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

Thankfully you figured it out and are back on track.

[NF52]

...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.

Wonderful news that is surely applicable to more than N=1, Stavia. My formerly 53 yr-old, newly-menopausal self had no hot flashes and thought suddenly awful sleep and brain fog was just due to teens and job, and would have welcomed missing about 5 years of good sleep. My mega-dose of estrogen was all in utero, as a "DES-baby". Timing is everything!!

[TheBrain]

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.

Stavia, thank you for sharing your experience. I’m sorry you suffered for months, but I’m so glad you’re feeling better and back to yourself. One question: If you’re taking oral progesterone as well, did you increase your dose to accommodate the increase from 25mcg to 50mcg of estradiol?

[Stavia]

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.

Stavia, thank you for sharing your experience. I’m sorry you suffered for months, but I’m so glad you’re feeling better and back to yourself. One question: If you’re taking oral progesterone as well, did you increase your dose to accommodate the increase from 25mcg to 50mcg of estradiol?

Nope, I dont tolerate more than 25mg oral progesterone (sedation) but I have a Mirena.

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[Bobbi]

I've had estrogen positive breast cancer and am taking anastrozole . I'm confused about how to balance my need to suppress estrogen due to the cancer versus supplementing it due to Alzheimer's risk. Any thoughts? Thanks.

[Gillyp]

A warm welcome to our community Bobbi. Thank you for posting such a great question. I would certainly ask your doctor for his/her advice but the way I would look at this is that if you've had estrogen positive breast cancer, then the focus should be keeping estrogen as low as possible. There are so many ofter things that you can do, to reduce your risk of Alzheimer, which don't involve estrogen. There is a wealth of information on the site. If you haven't already found it the Primer is a great place to start (viewtopic.php?f=33&t=1418). As a community we're here to support each other and learn together so I hope you continue to post your questions and share with us. Again welcome.

[Bobbi]

Thank you so much for the warm welcome. What you say makes a lot of sense and I appreciate it.

[circular]

I've had estrogen positive breast cancer and am taking anastrozole . I'm confused about how to balance my need to suppress estrogen due to the cancer versus supplementing it due to Alzheimer's risk. Any thoughts? Thanks.

I wonder if looking into the diets and lifestyles of traditional Japanese women would help. I think they were relatively low in both breast cancer and dementia before westernization. Please confirm since I may not have that right. Many of us here avoid soy products, but eaten in their traditional, fermented forms may have its place. I’m sure there’s more to it than that. If you do explore this, I’d love to have you report back on your findings.

[Plumster]

Question: Do most of you take a DHEA supplement, in addition to estradiol and progesterone? I am low in all three.

Also: How is progesterone measured? I know it needs to be 1-20 ng/mL optimally, but my doctor says it's "impossible" to measure progesterone with a lab test. My test shows it's 0.30 ng/mL despite supplementing 100-200, but to her, it's not a number that tells us much since progesterone is "everywhere" in the body. Are there different kinds of tests? What am I or she missing?

I am COMT++ but I am going to try Estradiol despite of this, starting today (I eat healthy, exercise a lot, don't drink, and am hoping that my family history of no cancers of any kind will make this doable).

[slacker]

Question: Do most of you take a DHEA supplement, in addition to estradiol and progesterone? I am low in all three.

Also: How is progesterone measured? I know it needs to be 1-20 ng/mL optimally, but my doctor says it's "impossible" to measure progesterone with a lab test. My test shows it's 0.30 ng/mL despite supplementing 100-200, but to her, it's not a number that tells us much since progesterone is "everywhere" in the body. Are there different kinds of tests? What am I or she missing?

Hi Plumster;

I'm working with a functional medicine MD who appears to be very experience with bio identical hormone replacement. I was initially placed on topical estradiol, and oral versions of progesterone, pregnenalone, and DHEA. My estrone blood levels have been too high, so I was eventually was taken off DHEA with some improvement in the estrone. Some FM doctors use estrone as a surrogate for estradiol metabolites that have the potential to increase the risk of breast CA. I suspect that this is theoretical with no rigorous clinic trials.

Are you working with a bioidentical female hormone expert with additional post residency education, or a conventional MD? This will probably make a difference in the kind of monitoring you receive on hormone levels. I don't think that conventional doctors test hormone levels; they increase or decrease dosing based on symptoms (ex. hot flashes) and side effects (ex. tender breasts, vaginal bleeding). A conventional provider prescribes progesterone with any form of estrogen to avoid endometrial cancer in women with a uterus. Sure, progesterone is "everywhere" in the body, but so are glucose and vitamin D and we use blood tests to monitor these levels. I've been instructed to have my blood drawn first thing in the morning for consistent measurements . I've heard that some functional medicine doctors using saliva test for female hormones, but in my limited experience, this is more for women who are still menstruating and have fluctuating levels with their cycles.

So....I really don't have any advice on how to facilitate better communication with your current doctor. May not be a good match.