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Hormone Replacement Therapy E4 Women

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

Postby SusanJ » Wed Apr 15, 2020 7:33 am

A new study that says women who use Hormone Modifying Therapy (HMT) in breast cancer have a lower risk of Alzheimer's.

Furthermore, when the data were analyzed according to specific HMT agent, patients receiving tamoxifen or an aromatase inhibitor had significant reductions in risk of Alzheimer disease compared with those not receiving HMT, whereas those receiving raloxifene did not.

Overview here.

From the paper, an overview of what HMT does:

Hormone-modulating therapies (HMTs) include the selective estrogen receptor modulators (SERMs; tamoxifen and raloxifene) and aromatase inhibitors (steroidal, exemestane; nonsteroidal, anastrozole and letrozole). These drugs have been used for the treatment of estrogen receptor–positive breast cancers and have been shown to decrease estrogen’s effects at the level of the breast tissue.13 Tamoxifen is used in both the treatment and the prevention of estrogen receptor–positive breast cancer and is a common therapy for premenopausal women and an option for postmenopausal women.12

[Emphasis mine.]

They found more specifically:
For patients 65 to 69 years of age, there was no significant difference between patients receiving HMT and patients not receiving HMT in the risk of NDD or AD; SDs overlapped in the 5-year analysis. In contrast, increasing age was associated with a greater reduction of risk for all NDDs in women receiving HMT; SDs did not overlap in the 5-year analysis and were divergent.


But here's their theory - while decreasing estrogen in breast cells, tamoxifen and aromatase inhibitors have divergent effects in the brain, ultimately increasing estrogen.
If tamoxifen and aromatase inhibitors are acting to increase estrogen-related actions in brain tissue, the argument for the protective association of estrogen with AD-related outcomes is strengthened.

Full paper here.

W350113
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Re: Hormone Replacement Therapy E4 Women

Postby W350113 » Wed Jun 17, 2020 11:20 pm

Hi There! I could use some guidance. I wanted to see what you all recommend on HRT for Apo E4 and, wow, there are a lot of pages here to review. My functional medicine doctor is recommending HRT and suggested I read the book "Estrogen Matters" by Avrum Bluming MD (Oncologist) and Carol Tavris (PhD). It is a very interesting read and Dr. Bluming cites tons of research and the bottom line is, post-menopausal women should take Estrogen, and the sooner after menopause, the better. He suggests a window of greatest impact/protection when HRT is started within the first 10 years after menopause. There is a chapter devoted to estrogen and the brain but he does not discuss estrogen in particular for people with the Apo E4 allele. Also, he is not a proponent of bio-identical estrogen. He says that the compounded bioidentical hormones are "prepared by a local pharmacy in response to a prescription written by the physician and are not standardized pharmaceutical products and not regulated by the FDA." I think that this is his major concern though he does mention a study (Dr. Roberta Brinton Exp Neurol. 1997; 147:211-20) that demonstrated Equilin, a form of estrogen found only in Premarin, had the greatest stimulation of neurons in the cortex.

I have a very bad LDL profile (my LDL-P is 1747) with the "optimal range" being <1020. I am heterozygous for the 2 MTHFR genes (one of the bad alleles on each gene) and have struggled with a high Homocysteine. I have stress (my 85 y.o. mother has Alzheimer's disease and has lived in my home with 24/7 care for over 5 years), I have prediabetes (though I have brought my HgbA1c down to 5.5 and I'm working to get it lower). I have had insomnia since menopause almost 7 years ago and definitely noticed a change in my memory since that time.

I'm really hoping that HRT will be helpful and preventative but there are so many conflicting studies out there.

This is, at times, overwhelming and I know that so many of you have done so much research and reading on this very topic and I'm wondering what you do for HRT. Do you take it and, if so, what type?

Thank you so much!
Lia

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Thu Jun 18, 2020 7:39 am

W350113 wrote:... he is not a proponent of bio-identical estrogen. He says that the compounded bioidentical hormones are "prepared by a local pharmacy in response to a prescription written by the physician and are not standardized pharmaceutical products and not regulated by the FDA."
Lia

Hi Lia! I'm not sure when the book was written, but there are quite a few FDA approved bioidentical options for estradiol and at least one for progesterone. The only ones available that I know of for testosterone are for men, so I do get that compounded by a well respected compounder used by local hospitals. He would need to have some other reason to be against bioidentical hormones, and without having dug deep, I've thrown my chips in with the researchers who specialize in bioidentical hormones and find them safe. (I'm not a poker player so my analogy may be broken 8-) )
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby SusanJ » Thu Jun 18, 2020 9:25 am

W350113 wrote:This is, at times, overwhelming and I know that so many of you have done so much research and reading on this very topic and I'm wondering what you do for HRT. Do you take it and, if so, what type?


I used compounded estradiol/estrone/progesterone for a few years and switched back to an estrogen patch because I couldn't get my estrogen levels out of the basement, while the progesterone levels were fine. I currently use a twice-weekly patch providing 0.025 mg/day (Milan generic) and a 100 mg generic micronized progesterone capsule per day. My progesterone is nicely in the mid-ranges of what Dr. Bredesen likes, but my estradiol is in the lower range, but better than what I was able to achieve with compounded creams.

I started using HRT right around menopause (a little before) on the patch & pill until I moved and changed to a functional medicine doctor who used compounded versions, and then switched back to patch & Pill about 4 years ago when I changed doctors. I've been on HRT for about 10 years, thankfully due to a very forward-looking gynecologist, who also suggested getting a heart scan when I was in my 50s. No problems with use the Rx versions, other than being on the low end of the estrogen range.

Good luck in your decision, and let us know how it goes!

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Thu Jun 18, 2020 1:27 pm

SusanJ wrote:I currently use a twice-weekly patch providing 0.025 mg/day (Milan generic) and a 100 mg generic micronized progesterone capsule per day. My progesterone is nicely in the mid-ranges of what Dr. Bredesen likes, but my estradiol is in the lower range, but better than what I was able to achieve with compounded creams.

Wow, I'm on .075 estradiol patch and only at 51 pg/mL, rock bottom of Bredesen's range in The End of Alzheimer's. I also take 100 mg progesterone pill a day and am also rock bottom for that Bredesen range at 1.71 ng/mL. This also presents a possible problem with the estradiol/progesterone ratio which Dr. Bredesen targets in at "10:100." (I can't understand that ratio in the context of pg/mL and ng/mL.) I was so happy 100 mg progesterone didn't make me sleepy during the day I just stopped analyzing the whole kit and caboodle!

Susan, have you considered using a higher dose patch to tolerance? Mylan like others goes to .1 mg. There are a number on the market now. I was using Alora but it itched quite a bit. When the drugstore didn't have it I switched to the generic (BIHRT) patch aptly named "Estradiol patch." No itching. There are others.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby W350113 » Thu Jun 18, 2020 3:36 pm

Thank you so much Susan J and Circular for the detailed information!! It REALLY helps me to know what to ask for when I have my meeting next week! I am really looking forward to seeing how I feel on HRT and am hopeful that I'll be able to sleep again!

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Re: Hormone Replacement Therapy E4 Women

Postby SusanJ » Fri Jun 19, 2020 9:49 am

circular wrote:Susan, have you considered using a higher dose patch to tolerance?


ATM, I'm still focused on heavy metals and gut health. I might take another look at hormones once other things are in better shape and maybe the whole "to tolerance" thing will be easier to sort out.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Fri Jun 19, 2020 4:26 pm

SusanJ wrote:
circular wrote:Susan, have you considered using a higher dose patch to tolerance?


ATM, I'm still focused on heavy metals and gut health. I might take another look at hormones once other things are in better shape and maybe the whole "to tolerance" thing will be easier to sort out.

Makes sense, and I was just reading in the long HRT thread that estrogen too high is a problem too (no surprise). I likely wouldn't want to be high in Dr. Bredesen's range myself, but somewhat off the floor and I'd be more confident. I say that not knowing what if any science even underlies the range he recommends or whether there's someone with a better range for us for some evidence-based reason.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby DianeSC » Mon Aug 17, 2020 11:37 am

I've been taking HRT for many years and I am age 67. Is there a time to stop or will it be lifelong therapy for ApoE 4's?

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Re: Hormone Replacement Therapy E4 Women

Postby slacker » Thu Aug 20, 2020 1:12 pm

DianeSC wrote:I've been taking HRT for many years and I am age 67. Is there a time to stop or will it be lifelong therapy for ApoE 4's?


Hi Diane;

Most of us struggle with this and there is no one size fits all approach. Dr Stavia's thoughts on the subject are in her Primer.
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