Ideal post-menopausal estrogen level?

[SusanJ]

If you're having trouble raising your estrogen levels and you exercise a lot, here's a paper for you.

Effect of physical activity on sex hormones in women: a systematic review and meta-analysis of randomized controlled trials

The overall effect of physical activity was a statistically significant decrease of both total estradiol (standardized mean difference [SMD] -0.12; 95 % confidence interval [CI] -0.20 to −0.03; P = 0.01; I2 = 0 %) and free estradiol (SMD −0.20; 95 % CI −0.31 to −0.09; P = 0.0005; I2 = 0 %). Subgroup analyses suggest that this effect is independent of menopausal status and is more noticeable for non-obese women and for high intensity exercise. Meta-analysis for secondary outcomes found that physical activity induces a statistically significant decline of free testosterone, androstenedione, dehydroepiandrosterone–sulfate and adiposity markers, while a significant increase of SHBG was observed.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635995/


And with regards to compounded cream versus a patch, check this one out.

Bioidentical compounded hormones: a pharmacokinetic evaluation in a randomized clinical trial. (2013)

Results were analyzable for 37/40 women. Study medications were well tolerated. The AUC at 24h and at steady-state for estrogens remained consistently lower for all doses of Bi-est tested relative to the patch. The difference was statistically significant for Bi-est 2.0mg (AUC-estradiol=181 vs. 956; p<0.001) and 2.5mg (AUC-estradiol=286 vs. 917; p<0.001). Estriol levels remained low in all study arms. Serum progesterone levels were comparable in conventional vs. compounded groups.

http://www.ncbi.nlm.nih.gov/pubmed/23384975

I have an appt with my doc tomorrow, and plan to ask to move to the patch. We upped my Biest a couple months ago, and my levels went down. Just not working for me anymore.

[Stavia]

I love the patch. I cut a 100mcg in half, it's cheaper that way. Change it every 3 1/2 days. Run around 200ish of my units, 60ish of yours

[SusanJ]

Good to know Stavia. I was on Vivelle Dots during the first signs of menopause for hot flashes, etc, and found even cutting the lowest dose patches, I was getting too much, so switched to cream. But now I'm 6+ years from menopause, so I think it will work just fine for me given my past history and I'm guessing I will absorb this stuff better.

[Silverlining]

I began using Biest compounding cream September of last year. Here are the results and my estradiol levels:

9/11/15: Estradiol serum level: 18.9 pg/ml (before beginning any HRT)

September 2015: Began Biest 80/20 (estriol/estradiol) 2ml
October 2015: increased Biest 80/20 to 4ml
November 2015: adjusted Biest 70/30 to increase estradiol to estriol ratio, still at 4 ml strength

11/27/2015: Estradiol serum level 14.5 pg/ml

December 2015: adjusted Biest 50/50 to increase estradiol to estriol ratio, still at 4ml strength
January 2016, continue same rx as December

2/5/2016: Estradiol serum <5pg/ml, basically undetectable!

February 7 2016, started Vivelle dot patch .1mg twice a week and oral micronized Prometrium 100mg nightly.

So, it's apparent, I think, the Biest cream was about as effective as rubbing water on my arms! I've been on the patch now for a few days and I'm seeing a relief from hot flashes. I'm also LOVING the oral progesterone for sleep at night. It's amazing! I still wake up, but go back to sleep, super nice and WAY better than waking at 1 or 2 and staying awake, something I did routinely. I suppose until I pull another blood draw, I won't know for sure if this is raising my estradiol levels, but as far as I'm feeling, I'm much happier with this new routine.

[Julie G]

(((Silver))) I'm guessing you've been feeling awful? I've had similar problems getting my levels up. Even using your same patch dosage (and TV Esterase cream,) I was only yielding 25-30 pg/ml. Bt experimenting, I learned that I had to put my patch directly on body fat to get a decent bump in my levels. My last test was over 100 pg/ml and I'm stunned by the positive effect on my overall health and cognition. Congrats on figuring it out. I'm sending good energy that you continue to feel positive effects.

[Stavia]

Yay Silverhoney. What a waste of time mucking about with the topical creams. Well done on insisting on the patch and enjoy the better sleep!

[Silverlining]

Yes Julie, I put it on "da booty", only fat I could find . We'll see, but so far so good

[Silverlining]

Updating my lab results (see above post for history)....After approximately 6 weeks on .1mg estradiol patch (generic), my Estradiol level went from undetectable (after five months on Biest) to drumroll please.....36.2! Yay. But most importantly, I have ZERO hot flashes, thank goodness! They were so very horrible. Interestingly, my testosterone also went up...before patch, T was 7ng/dl, now T is 15ng/dl. My progesterone is 2.2ng/ml. This is out of range for post menopausal women (range: .1-.8). I did a little research on micronized progesterone to see if it raises breast cancer risk and found this study...

{Risk of Breast Cancer by Type of Menopausal Hormone Therapy: a Case-Control Study among Post-Menopausal Women in France
http://journals.plos.org/plosone/articl ... ne.0078016

"This study confirms differential effects on breast cancer risk of progestagens and regimens specifically used in France. Formulation of EP therapies containing natural progesterone, frequently prescribed in France, was not associated with increased risk of breast cancer but may poorly protect against endometrial cancer."}

I did want to mention that while on the high dose Biest cream 4ml at 50% estradiol and 50% estriol, I developed a very large, golf ball size lump. I have extensive history of fibrocystic breasts with many lumps (from the age of 16) resulting in aspirations, biopsies, etc.; also have highest grade density breasts. Annually, or more often, I get ultrasounds, regular mammos and the upgraded mammos (can't remember name now). Anywhoo, after just a few days on the patch, the large lump began to diminish and completely went away within a couple of weeks. All kinda scary stuff, but I feel SO much better on this HRT. I was definitely experiencing some new brain fog before starting the patch and now I feel positive that my brain operates much cleaner, clearer and faster.

EDITS: (1) I went to the lab 48 hours after patch placement. I change the patch every 84 hours (3.5 days).

(2) NOBODY may be interested in this, but I'm sharing anyway. I take daily baths, not showers; I LOVE my baths and it was almost a deal breaker when I read on hystersisters that taking baths (or hot tubs) increased the release of estradiol from the patch. Studies have not been conducted on HRT patches, however, the women on hystersisters swear it is true. However, there ARE studies on fentanyl patches and yes, the meds are increased when exposed to heat (baths, heating pads, etc). SO, I had to find a solution. First, I decided to 100% waterproof the patch. I found tegaderm patches and they work perfectly. This can be a bit tricky so as not to adhere to your patch , so please pm me, if you want to know. Secondly, after trial and error (don't laugh!), I discovered that I can use a small lunchbox type refreezeable ice pack wrapped in a stretchy piece of material, tied around my hips. I know, I know, it's a little funny, BUT IT WORKS. After baths, my patch is 100% dry and cool and my skin is clear. I got a little "patch rash" at first before I implemented all these things and I believe it was from the water soaking the patch every day. Showers also soak the patch, so if you find a rash beginning, try my suggestions!

[Stavia]

Silverhoney - happy dance for you!!
Sister Stavia wanted a patch for you from the beginning. I am delighted.
A few comments here:
I use tegaderm to anchor mine too. It also stops the icky glue edge leak thing picking up debris and leaving sticky black marks after removal. Tegaderm cost adds up so I cut it lengthwise. Dont try cut it sideways it'll be impossible to place.

Didn't know about the hot bath - I spend ages in the shower and more importantly in a very hot spa (hot tub) in winter. I will do your ingenious trick. You are a clever clever girl. I get the rash randomly too.

Someone please correct me if I'm wrong but doesnt oestrogen raise sex hormone binding globulin so the bound testosterone will be higher but its the free testosterone that is biologically active?

I also change every 3 1/2 days. Thurs am and Sunday nite.
So happy for you honey! !!!

[Tincup]

Someone please correct me if I'm wrong but doesnt oestrogen raise sex hormone binding globulin so the bound testosterone will be higher but its the free testosterone that is biologically active?

Yes. As Peter Attia noted, low carbs and low animal protein will also increase SHBG: https://www.apoe4.info/forums/viewtopic ... nda#p23758

I noticed this when I went from a high animal protein LCHF diet to a modest animal protein (20g/day) LCHF diet. SHBG was high and free testosterone was out of range low. Dr. Gundry prescribed 25 g/day of DHEA to increase testosterone and 30x2mg/day of ginko biloba to keep it from converting to estradiol. Six months later, he upped the dose to 50 g/day DHEA (noting I still had "plenty of room to play with" in my DHEA measurement).

In males, anyway:
boron decreases SHBG as does vitamin D, fish oil, magnesium, zinc and testosterone (T)
high-carb diets significantly increase T while they simultaneously decrease (o)estrogen, cortisol, and SHBG
fiber (fibre) increases SHBG as do statins, beta blockers, antifungals, antidepressants, and hair loss drugs