BHRT talk with Bredesen, Hathaway and Julie G

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BHRT talk with Bredesen, Hathaway and Julie G

Postby babl » Fri Feb 26, 2021 9:40 pm

Did anyone else see this excellent panel discussion on Dr. Bredesen's Facebook page today? I'm glad to see the misconceptions on this topic addressed so intelligently. I've been on BHRT since around the age of 50 (now 56) though only recently found a practitioner who is taking a look at my hormone level numbers, both with blood and saliva labs. I was very interested in Dr. Hathaway's discussion of the estrogen levels she aims for her patients to be at.

Does anyone know, when Dr. Hathaway refers to "estrogen levels" is she referring to the total estrogen level, or the level of estradiol in the blood? When she first discusses the topic she only refers to "estrogen levels" but later in the talk she mentions the level of estradiol.

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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby Tiramisu1984 » Sun Feb 28, 2021 4:36 pm

Thanks for the heads-up! Will watch tonight. I didn't know Dr. B had a FB page.

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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby circular » Mon Mar 01, 2021 8:19 pm

babl wrote:Did anyone else see this excellent panel discussion on Dr. Bredesen's Facebook page today? I'm glad to see the misconceptions on this topic addressed so intelligently. I've been on BHRT since around the age of 50 (now 56) though only recently found a practitioner who is taking a look at my hormone level numbers, both with blood and saliva labs. I was very interested in Dr. Hathaway's discussion of the estrogen levels she aims for her patients to be at.

Does anyone know, when Dr. Hathaway refers to "estrogen levels" is she referring to the total estrogen level, or the level of estradiol in the blood? When she first discusses the topic she only refers to "estrogen levels" but later in the talk she mentions the level of estradiol.

Thank you for posting this. I like hearing what Dr. Hathaway has to say. I think when she says estrogen levels she's referring to estradiol, and she mentioned she prefers to use blood testing, so for her target levels I would go with blood.

I'm still left with some questions:

She recommends cycling progesterone if doing so is tolerated, because during reproductive years it cycles. Estrogen also cycles during reproductive years, so why doesn't it need to be cycled also? If progesterone receptors can lose sensitivity to progesterone, couldn't estrogen receptors do the same?

Then, if sleep is a problem when cycling (the case with me) she okay's not cycling. That leaves me with some concern. If my progesterone receptors become less sensitive, will the progesterone adequately offset the risk of endometrial thickening from the estradiol?

Along those lines, it seems to me it would be important for menopausal women to have their uterine lining thickness checked regularly. I'm not sure if just balancing estrogen with progesterone is good enough to be certain that all is okay there. I think maybe doctors wait for breakthrough bleeding to check that. My progesterone is high relative to my estrogen and my thickness is nevertheless at 5.
If you no longer experience any vaginal bleeding, an endometrial stripe above 4 mm or more is considered to be an indication for endometrial cancer. [That's one perspective: https://www.healthline.com/health/women ... ial-stripe]

I have ruled out cancer, but it's led me to think that a recent increase in estrogen to get my levels higher than 50 may have led to some endometrial thickening, putting me at some risk despite a high progesterone level. Maybe something else is at play. I can't say for sure. I just know it isn't cancer … now. I'm going to dial back the estradiol patch to what I used before, but if I stop responding to progesterone I think that still presents an potential problem when it comes to hormonal balance. I'm also going to try to do something additional for sleep one week a month so I can cycle progesterone.

Still wondering why estrogen doesn't ideally need to be cycled too.
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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby Julie G » Tue Mar 02, 2021 9:46 am

Does anyone know, when Dr. Hathaway refers to "estrogen levels" is she referring to the total estrogen level, or the level of estradiol in the blood? When she first discusses the topic she only refers to "estrogen levels" but later in the talk she mentions the level of estradiol.

Hi Babbl! Estriol(E3) and estradiol (E2) are two different forms of the female hormone known as estrogen. I think Dr. Hathaway was using estradiol and estrogen interchangeably in the discussion. As Dr. Bredesen points out, estradiol is the level we care about and the one related to cognition. However, I did hear Dr. Hathaway says that estriol can be used TV for atrophic vaginitis/urogenital atrophy.
Still wondering why estrogen doesn't ideally need to be cycled too.

Interesting question. Would you consider posing it on FB so I can bring it to Dr. Hathaway's attention? FWIW, I've settled on a strange pattern of progesterone usage, suggested by my gyn. I use 100mg every other night because I have no interest in 2 straight weeks of poorer sleep. I recall reading a study that suggested continuous usage of progesterone worsened cognition, so I think there's something important about cycling it.

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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby circular » Wed Mar 03, 2021 7:41 pm

Julie G wrote:
circular wrote:I use 100mg every other night because I have no interest in 2 straight weeks of poorer sleep. I recall reading a study that suggested continuous usage of progesterone worsened cognition, so I think there's something important about cycling it.

That's an interesting approach! Do you seem to sleep as well all nights this way?
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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby floramaria » Thu Mar 04, 2021 12:24 pm

Julie G wrote:FWIW, I've settled on a strange pattern of progesterone usage, suggested by my gyn. I use 100mg every other night because I have no interest in 2 straight weeks of poorer sleep. I recall reading a study that suggested continuous usage of progesterone worsened cognition, so I think there's something important about cycling it.

Interesting about continuous progesterone having deleterious effect on cognition. I hadn’t run across that connection before and did a search. One study I found, “Progesterone and Cognition “ said this :
....differences in cognitive profiles between women using menopausal hormone therapy with and without a progestogen, and throughIn naturally cycling reproductive-age women and pregnant women, there is no consistent relation between progesterone levels and cognition. In postmenopausal women within 6 years of menopause and not using hormone therapy, progesterone levels are positively associated with verbal memory and global cognition, but reported associations in older postmenopausal women are null. Some observational studies of postmenopausal women using hormone therapy raise concern of a small deleterious cognitive effect of progestogen (medroxyprogesterone acetate was most often reported in these studies), but this association may due to confounding factors. Small, short-term clinical trials of progesterone show no meaningful effect on cognition. The quality of evidence is low, but overall findings do not reveal consistent, clinically important effects of progesterone on cognitive function in women.

So far I have not had time to research this further , but note that the progesterone in the study quoted above “most often” is medroxyprogesterone and wonder if that is true of other studies showing no benefit or even negative impact of progesterone as well. Ann Hathaway has said that in studies on progesterone very few look at bioidentical progesterone. She repeatedly and emphatically points out the dangers of medroxyprogestone .
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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby Julie G » Sun Mar 21, 2021 5:02 am


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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby Quantifier » Sun Mar 21, 2021 10:22 am

Julie G wrote:
circular wrote:Still wondering why estrogen doesn't ideally need to be cycled too.

Interesting question. Would you consider posing it on FB so I can bring it to Dr. Hathaway's attention? FWIW, I've settled on a strange pattern of progesterone usage, suggested by my gyn. I use 100mg every other night because I have no interest in 2 straight weeks of poorer sleep. I recall reading a study that suggested continuous usage of progesterone worsened cognition, so I think there's something important about cycling it.


Is there any news from Dr Hathaway regarding cycling of estrogen?

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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby circular » Sun Mar 21, 2021 11:37 am

Quantifier wrote:
Julie G wrote:
circular wrote:Still wondering why estrogen doesn't ideally need to be cycled too.

Interesting question. Would you consider posing it on FB so I can bring it to Dr. Hathaway's attention? FWIW, I've settled on a strange pattern of progesterone usage, suggested by my gyn. I use 100mg every other night because I have no interest in 2 straight weeks of poorer sleep. I recall reading a study that suggested continuous usage of progesterone worsened cognition, so I think there's something important about cycling it.


Is there any news from Dr Hathaway regarding cycling of estrogen?

I'm wondering this too. I don't see anything on Facebook about i.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: BHRT talk with Bredesen, Hathaway and Julie G

Postby floramaria » Sun Mar 21, 2021 12:07 pm

Julie G wrote:Dr. Hathaway recently shared some of the references that she cited throughout our discussion. Some of these were new to me:

https://heart.bmj.com/content/early/202 ... 019-316323\

https://www.onclive.com/view/estrogen-d ... ite-affect

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776312/

https://pubmed.ncbi.nlm.nih.gov/19299024/


Hi Julie, the second of these studies does say that estrogen effects on cognition are better when taken alone than when taken with progestins. Progestins are the synthetic form of progesterone which Ann Hathaway warns against . But here is a quote directly from a slide in Ann Hathaway’s module in ReCODE 2.0 training regarding bioidentical progesterone:
P4 is often cycled part of month on, part off-mimics premenopausal physiology and increases P4 receptor sensitivity. Can be given continuously. . Also on same slide:
15, 23, or more days per month , depending on patient preference
In my notes from her presentation I have written that she does remark that progesterone can get excessively high for some women if taken continuously because it can build up in the body leading to undesirable side effects of sedation or overstimulation.
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