Hormone Replacement Therapy E4 Women

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circular
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Re: Hormone Replacement Therapy E4 Women

Postby circular » Wed Feb 06, 2019 8:31 am

Plumster wrote: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).

I'm not sure I can be of much help. I just had some hormones rechecked.

I think maybe when we post that a lab should be in a certain range, such as progesterone needs to be 1-20 ng/mL, we should specify whose range we're mentioning. I believe you're referring to Dr. Bredesen, and I think his range is for pre-menopausal women. My post-menopausal progesterone, using 100 mg Prometrium, was at 1.71 ng/mL, at the bottom of Dr. Bredesen's range, but way above the Quest lab range of <.14 for post-menopausal women. Your result of .30 ng/mL sounds more in line with menopausal ranges, but I'm not sure Dr. Bredesen has made a recommendation for us.

I think Slacker makes a good point that many other blood labs conventional doctors rely on are testing things that are all over the body. All I can think is that she believes saliva testing is better because it tests the levels in tissues (at least that's my understanding).

FWIW I don't supplement DHEA, but I think my DHEA-S was in normal range. I should circle back and double check. I need a good adrenal hormone check.

I do supplement pregnenolone because I had consistently low readings and taking it has consistently corrected them.
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Re: Hormone Replacement Therapy E4 Women

Postby Plumster » Wed Feb 06, 2019 8:41 am

Thanks, Slacker. My integrative doctor is qualified enough, I think? She's a MD and fellow of the American Congress of Obstetricians and Gynecologists and did a residency in obstetrics and gynecology at Cedars-Sinai Medical Center. I like her, but I am puzzled by the progesterone comment and when I asked to be tested for pregnenolone, she said she doesn't usually test for it. She tested it anyway and was ready to help, so I think I can work with her.

She's never mentioned estrone. In fact, I think I need to do some more research on my own! Currently she has me on: bio-identical progesterone 100 (14 days) and 200 (15 days); DHEA 5 mg, and bio-identical estradiol patch 0.05 mg/day. I'm 49 and going through menopause (haven't had my period in 5 months).

Circular--I just read your post, thanks. I've understood Bredesen's optimal levels to be for everyone assuming we're on BHRT. I am wondering if I am not absorbing the progesterone? I do have low stomach acid and am having trouble absorbing other things like iron supplements. I wonder if I should switch to transdermal. One sign that I am not absorbing the progesterone is that I have had NO symptoms whatsoever taking them: my sleep isn't better (it's awful) and my mood is consistent at all times regardless of whether I'm taking it or not.
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Re: Hormone Replacement Therapy E4 Women

Postby anne from california » Wed Feb 20, 2019 2:20 pm

I went off bHRT over the summer because of problems with bleeding. Hot flashes have been horrendous, so I've gone back on but at a lower dose--.025 E--which seems to be helping a little. But the progesterone is SUCH a problem for me! I can't tolerate the oral at all. I don't want a Mirena (too many autoimmune issues already at play). And now, I'm reacting to the vaginal dosing the same way I do the oral--with hallucinations, anxiety, insomnia, dizziness. About the only dosing method I can tolerate is transdermal, and none of my doctors will approve it because it's not been shown to provide uterine protection. (It hasn't been shown that it doesn't.) I'm not sure what to do here--does anyone see any options for me other than just quitting hormone therapy altogether?
57 years old, ApoE 3/3, eager to save brain and optimize health.
Thank you all for sharing your knowledge!

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Re: RE: Re: Hormone Replacement Therapy E4 Women

Postby Stavia » Thu Feb 21, 2019 10:54 am

anne from california wrote:I went off bHRT over the summer because of problems with bleeding. Hot flashes have been horrendous, so I've gone back on but at a lower dose--.025 E--which seems to be helping a little. But the progesterone is SUCH a problem for me! I can't tolerate the oral at all. I don't want a Mirena (too many autoimmune issues already at play). And now, I'm reacting to the vaginal dosing the same way I do the oral--with hallucinations, anxiety, insomnia, dizziness. About the only dosing method I can tolerate is transdermal, and none of my doctors will approve it because it's not been shown to provide uterine protection. (It hasn't been shown that it doesn't.) I'm not sure what to do here--does anyone see any options for me other than just quitting hormone therapy altogether?
Anne, an option is to use 3 weeks of progesterone every 3 months, then stop, which will produce a withdrawal bleed. Ie the lining that has grown will shed. Coupled with yearly endometrial ultrasound and pipelle sampling.
This is not medical advice, just information. Discuss with your doctor.

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Re: Hormone Replacement Therapy E4 Women

Postby slacker » Mon Feb 25, 2019 4:32 pm

Just released podcast on hormone replacement, hosted by Dr Peter Attia: https://peterattiamd.com/caroltavris-avrumbluming/. Dr Attia has moved to a membership format for his detailed show notes and references, with the podcast itself still free to all. I have not had a chance to start listening, but wanted to share with the rest of you interested in this topic.

PS. A copy of Drs Bluming and Tavris's book is at my local library, and I've reserved it for pickup!
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Re: Hormone Replacement Therapy E4 Women

Postby slacker » Thu Feb 28, 2019 9:23 am

I'm linking a review article written by Drs Bluming and Tavris from 2009 on how the interpretation of risks of oral hormone therapy has been overblown by the Women's Health Initiative. Full pdf is available as of today. Given the publication date, there is no information on bHRT, but still an interesting read on researcher biases and misuse of statistics.
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Re: Hormone Replacement Therapy E4 Women

Postby shenmen100 » Thu Feb 28, 2019 1:05 pm

Slacker,
I just listened to the Peter Attia podcast and when Peter asks Dr Bluming about bHRT he is not a fan, claiming that all the research about estrogen in the studies uses Premarin which is conjugated and contains many forms of estrogen as opposed to just one or two forms (estrodial,estrone) Dr Bluming claims in the podcast that the current types of bHRT do not even contain the estrogens that help protect cognitive issues for women?? Dr. Bluming does not seem to like compounding pharmacies either, in regard to safety and regulation of products.

In Dr. Bluming's clinical practice which includes post breast cancer survivors he uses only Premarin. Peter did not respond to Dr Bluming about his opinion of bHRT (odd for peter to not respond) so do not know Peter's thoughts about bHRT. I also just got the book from the library and in there when talking about different types of estrogens, Dr. Bluming writes more about his dislike of bHRT over Premarin.

BUT,Dr Bluming does like Prometrium which is the biodentical form for progesterone over synthetics.

I have used the estrodial patch for 10 years, am interested in what others have to say about premarin vs patch ( yes i read the primer) especially in regard to the cognitive claim that Dr Bluming makes.
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Re: Hormone Replacement Therapy E4 Women

Postby shenmen100 » Thu Feb 28, 2019 1:23 pm

I want to add that i was very impressed with both Drs Bluming and Tavris interview with Peter, and they both have spent a lot time and thought about advocating for women to get optimal health care from providers around HRT, and that the harm caused to women from the Woman's Health Initiative's misleading pronouncements are measurable, especially with cardiovascular incidents, I am just curious about the estrogen comments.

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Re: Hormone Replacement Therapy E4 Women

Postby slacker » Sat Mar 02, 2019 3:05 pm

shenmen100 wrote: I am just curious about the estrogen comments.


In the book co-authored by Bluming and Tavris, they state that Premarin contains "at least 10 forms of estrogen." One of these is equilin, "the form believed to be the most beneficial in preserving brain function." The pubmed entry for this article is here. The full article is behind a pay wall.

All the WHI data is with Premarin (CEE). There are European studies with transdermal estradiol, which are not randomized. It's possible that these "off shore" studies have similar numbers of women and length of time to WHI, but I don't have that level of familiarity. I suspect that another reason that Dr Bluming continues to prescribe Premarin is due to his long positive experience with it with his patients.
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Re: Hormone Replacement Therapy E4 Women

Postby shenmen100 » Sat Mar 02, 2019 4:14 pm

Thanks Slacker,
I went back and reviewed the talk by Ann Hathaway at the Reversing Cognitive Decline Course Dec 2017 that I took with IFM, and looked at the studies she cited and this is one of many studies in the last few years that spoke to my questions about estrodial especially trans dermal vs oral estrodial and CEE

Prospective randomized trial to assess effects of continuing hormone therapy on cerebral function in postmenopausal women at risk for dementia.
https://www.ncbi.nlm.nih.gov/pubmed/24622517


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