Can I take BHRT with my coronary artery disease?

[Julie G]

{{{Alysson}}} You know that this decision has to be carefully made by you and your doc. I would try to select a practitioner that is open to bHRT for post-menopausal patients, willing to consider your total clinical picture, and open-minded enough to carefully examine relevant evidence with you. Many docs are understandably cautious about using bHRT in patients with known CVD, but when you subtract the "WHI" studies (oral synthetic E2 & P4), the evidence looks really promising. That being said, we need more and larger studies using bHRT. If you ultimately decide to take this route, carefully tracking your CVD risk biomarkers will be even more important. You're also taking many supplements that tend to thin the blood (like fish oil, curcumin, etc.) further reducing your clotting risk.

I'm curious if you've been experiencing menopausal symptoms beyond trouble with sleep. How about hot flushes, worsened cognition, hypoglycemia, etc?

[TheBrain]

For me, the generic patch (Sandoz's estradiol) adheres so much better than my previous Vivelle or Menostar. Never comes off after a long swim or shower.If you wanted to save costs, you can titrate your dose by cutting a larger patch.

This is very helpful, Katie. I'll remember this. I know that my insurance company's formulary is getting smaller each year, or else drugs go up a tier, and I'm in a low tier so insurance wouldn't cover them. The fact that this generic patch (and thanks for its name) adheres so well is good to know.

[TheBrain]

{{{Alysson}}} You know that this decision has to be carefully made by you and your doc. I would try to select a practitioner that is open to bHRT for her post-menopausal patients, willing to consider your total clinical picture, and open-minded enough to carefully examine relevant evidence with you. Many docs are understandably cautious about using bHRT in patients with know CVD, but when you subtract the "WHI" studies (oral synthetic E2 & P4), the evidence looks really promising. That being said, we need more and larger studies using bHRT. If you ultimately decide to take this route, carefully tracking your CVD risk biomarkers will be even more important. You're also taking many supplements that tend to thin the blood (like fish oil, curcumin, etc.) further reducing your clotting risk.

I'm curious if you've been experiencing menopausal symptoms beyond trouble with sleep. How about hot flushes, worsened cognition, hypoglycemia, etc?

I'm thinking about going back to the functional medicine PA I was seeing for the MEND therapy. At my last appointment, she said that because of the MEND therapy, she wasn't able to work with me in ways that she usually does with patients. I genuinely like her, but I was bothered by her not signing my second protocol. That left me hanging. But she told me early on that she likes to do research, so if she doesn't already know what you're sharing, I suspect she'd be willing to learn.

I haven't yet followed up with the MPI-cognition trained physician in Savannah, GA. I intend to, but she is so expensive ($650 for a first appointment), and I simply can't afford her right now. My husband will start social security next year because of my medical costs. He'll be doing it early at age 62, but cash flow has been a major issue.

If I go the route of bioidentical estradiol, it makes sense that I would need to track my CVD markers carefully. Thanks for mentioning that.

In terms of my menopausal symptoms, insomnia is the big one, but so is a lack of energy (but I'm working on that through a course called The Energy Blueprint). I'm not having typical hot flushes, but I do get too warm. If it's during the day, I'll need to take off a layer of clothes or change into something cooler. If it's while I'm sleeping, it'll wake me up and interfere with my sleep. But I'm still dealing with hypothyroidism, so often I get too cold. And if I get chilled to a certain point, I have a hard time getting warmed up. That happened last night at 2:15 am. Ugh...

So it seems more like I have temperature dysregulation going on. I don't know if that's menopausal or something else. I wonder if having hypothyroidism keeps me from having full-blown hot flushes.

I don't think I'm fully keto-adapted because I still get too hungry sometimes, and I don't get that alert, energized feeling that people in ketosis talk about. I think my hypothyroidism is holding me back with that. But ketosis has made the hypoglycemia I experienced for many years a thing of the past.

My cognition is about the same. Not optimal but still better than it had been. I used to easily remember things. Now, I have to make more of an effort to remember certain things. But if I make that effort, I usually do remember.

[TheBrain]

I've been meaning to share my good news: I've been fasting overnight for an average of 14 hours! On rare occasion, I eat a serving of coconut flakes cereal in the middle of the night, which is high in fat. But for the most part over the past two months or so, I'm not waking up hungry in the middle of the night.

I credit the ketogenic diet with this major improvement (even though I don't believe I'm fully keto-adapted yet). Now I have more autophagy going on, and I have noticed an improvement in how I feel as a result.

I'm still waking up and needing to get out of bed. I take my sleep aids (I'm slowly titrating down on my Klonopin dose) and then I do some tapping (emotional freedom technique) before heading back to bed and getting more sleep.

[Stavia]

Excellent news Alysson!!

[circular]

Alysson so glad you're not having that night-time hunger so much! I know how frustrating that one is. I got miffed at Rhonda Patrick in a podcast for making a somewhat derisive comment about people who (paraphrasing), "for some reason just think they can't sleep when they're hungry or something" ... obviously she has not experienced what we have. I find ketosis helps with that too, and recently I found that dramatically shifting my sleep hours helps that as well as sleep duration and quality. If I can get to bed by *8* and up early I seem to do better in a lot of ways. Trying to just go to bed at the default 10 pm and up and 6 never worked for my system. It didn't reset my circadian rhythm I guess. It seems to want to be an early bird although it's been acting for years like a night owl! It's up to me to retrain it, and that's where things fall apart again, that 8 pm target so easily slips to 9 and then 10 and then ... well we won't go there.

Katie, are you staying low on estrogen out of choice or just to keep the progesterone out without risk of breast cancer and avoid the risks of synthetic estrogen. Of course I'm not a doctor and Julie's right, best to work with one you like and trust, but if you're comfortable that bioidentical estrogen may be cardio protective (that I don't know) and that bioidentical pregesterone might even be breast cancer protective, then I'll say that I've had no qualms about using over the counter bioidentical progesterone and estrogen cream at local health food stores. It may not be the perfect solution (similar issues as compounded creams), but with the availability of DTC online testing, one can see what levels they're achieving with these products. These days I have a doctor who does what I'm comfortable with, but if your treatment preference is different from your doctor's (?), it may not be that hard to do what you want and followup with testing yourself. All disclaimers on the table, we do have some options.

[SusanJ]

YAY Alysson!!! It must be very gratifying to see one piece of the puzzle head in the right direction!

[TheBrain]

Thanks Stavia and Susan! Yes, it feels great to finally experience some progress!

Alysson so glad you're not having that night-time hunger so much! I know how frustrating that one is. I got miffed at Rhonda Patrick in a podcast for making a somewhat derisive comment about people who (paraphrasing), "for some reason just think they can't sleep when they're hungry or something" ... obviously she has not experienced what we have. I find ketosis helps with that too, and recently I found that dramatically shifting my sleep hours helps that as well as sleep duration and quality. If I can get to bed by *8* and up early I seem to do better in a lot of ways. Trying to just go to bed at the default 10 pm and up and 6 never worked for my system. It didn't reset my circadian rhythm I guess. It seems to want to be an early bird although it's been acting for years like a night owl! It's up to me to retrain it, and that's where things fall apart again, that 8 pm target so easily slips to 9 and then 10 and then ... well we won't go there.

Thanks, Circular. It's such a relief to not need to eat in the middle of the night. Of course, I've had to increase my food intake during the day because I started losing weight. But that's been going fairly well. I've been taking a course called The Energy Blueprint, created by Ari Whitten. He covers so many strategies for increasing energy. One of them is called NEAT, which stands for non-exercise activity thermogenesis. The goal is to simply move as often as possible throughout the day. I'm now using a standing desk and just being more active in general. With that comes the need to eat more, and I've been able to keep up. So my early satiety is easing up as I've been increasing my activity. I've been such a chronic sitter for much of my adult life (despite being a regular "moderate" exerciser).

Just reading what Rhonda Patrick said in that podcast annoys me!

I'm glad you're finding what works for you, but I can imagine how challenging it is to go to bed at 8. What time do you wake up in the morning when you go to bed at that time? 4 am?

[Nancy]

I have been using the estrogen patch, plus taking the prometrium 100 mg per night for about a month and a half now. I was wondering why my dr has me taking the progesterone every day, while the package insert from the manufacturer says to take it 12 days out of a 28 day cycle. I am having some side effects from the progesterone which are being addressed. Thanks.

[KatieS]

Nancy, I think the higher-dose (200mg) micronized progesterone (Prometrium) is intended for the cycle of half-month, not the lower dose. This higher dose did make me sleepy, but welcomed before bedtime. What side effects are you experiencing?