Hormone Replacement Therapy E4 Women

[KatieS]

Improved cognition in women in 70’s with AD using 0.1 estradiol patch

Slacker, I so appreciate your work for these detailed notes and references. This appears to be 0.1mcg/day patch, which is 10 times my dosage at 0.014mcg/day. Possibly I'm not in the neuroprotective range as noted in this study However, when I used a slightly higher dose, i developed breast tenderness, vaginal discharge and increased chin acne. At the 0.0375 patch, I had these symptoms plus postmenopausal bleeding. My 3/4 mother had a hysterectomy for this estrogen induced dysplastic postmenopausal bleeding. Now, almost a half-century later, is still cognitively intact with the estradiol 0.06 patch.

[Stavia]

Katie do you mean the trial used 100micrograms=0.1milligrams and you are using 14 micrograms = 0.014 milligrams? Or are you really cutting the 25 microgram patch= 0.025 milligrams into that many pieces?
Or am I totally wrong and does the patch come in a 0.1microgram size in the US?
It comes in 25, 50 and 100 micrograms in my country which is 0.025, 0.050 and 0.1 milligrams.

[Nancy]

I just left my yearly ob/gyn appointment and my dr has me on Duavee. Does anyone know if this will be sufficient for helping to prevent AD? I am about to turn 49. I tried to explain to him that I need to keep the estradiol to progesterone ratio in my blood at 1:5. He did not seem to know what I was talking about. He seems quite reasonable, so if I asked him to change my prescription, I think he would.

[KatieS]

My patch contains 0.39 mg of estradiol, delivering a daily amount of the 0.025mg. I cut it into half for the minimal dose of 0.0125mg. The ultra-low dose patch (0.017mg) I cited in the above 2-year study did not benefit cognition. Hence the statement that my dose is unlikely to be neuroprotective, but studies have found this dose to deter osteopenia. I feel good (meaning my typical life-long borderline low estrogen) on this dose, so I should really confirm with a blood estradiol level.

[Stavia]

Oh!! You're talking daily dose, not the patch size! Got it. I was terribly confuzzeled.

So you're using half a 39 microgram patch. Slightly smaller than a 25mcg patch. I personally think that's still within a reasonable range and not that ultralow.

[slacker]

Um....just rethought my question, I wonder if the magic ratio is evidence based or just a guess....

I don't know, but suspect it's experiential and not evidence based.

[slacker]

Improved cognition in women in 70’s with AD using 0.1 estradiol patch

Slacker, I so appreciate your work for these detailed notes and references. This appears to be 0.1mcg/day patch, which is 10 times my dosage at 0.014mcg/day. Possibly I'm not in the neuroprotective range as noted in this study However, when I used a slightly higher dose, i developed breast tenderness, vaginal discharge and increased chin acne. At the 0.0375 patch, I had these symptoms plus postmenopausal bleeding. My 3/4 mother had a hysterectomy for this estrogen induced dysplastic postmenopausal bleeding. Now, almost a half-century later, is still cognitively intact with the estradiol 0.06 patch.

The first link under my short statement as quoted above (pubmed 11524467) is the study supporting the 0.1mg/day 17 beta estradiol dose. Please note that there were only 20 women in the study, half on the 0.1 mg/day dose and the rest on placebo. Seems to me that you have found the right dosing balance for you. I greatly appreciate your trailblazing!

PS. More is coming, just had to take a day off today from the computer

[slacker]

Um....just rethought my question, I wonder if the magic ratio is evidence based or just a guess....

I don't know, but suspect it's experiential and not evidence based.

Sorry to go about this piecemeal, but here is a link from ZHT lab concerning ratio.
http://blog.zrtlab.com/progesterone-est ... g-e2-ratio

The doctor (naturopath) indicates that the ratio is only helpful if both estrogen and progesterone levels are within normal ranges, and woman continues to have symptoms. Still not sure where the ratio is coming from, but the link sheds some light on when the ratio is helpful and when it isn't. I know that there are multiple approaches to menopausal hormone therapy in the US, and they don't agree on approach.

[Stavia]

Hmmm...seems a bit too non-evidence based for my liking.
Thanks for chasing it Slacker

[slacker]

I just left my yearly ob/gyn appointment and my dr has me on Duavee. Does anyone know if this will be sufficient for helping to prevent AD? I am about to turn 49. I tried to explain to him that I need to keep the estradiol to progesterone ratio in my blood at 1:5. He did not seem to know what I was talking about. He seems quite reasonable, so if I asked him to change my prescription, I think he would.

Nancy, Duavee is a new medicine that is FDA indicated for menopausal hot flashes for women with a uterus, and osteoporosis. It is different than any other product on the market in that it combines a conjugated estrogen (formally known as conjugated equine estrogen or CEE) and a SERM, or selective estrogen receptor modulator. There is no progesterone in Duavee. The SERM has been added instead of progesterone to help prevent endometrial cancer from unopposed estrogen. Most other SERMs on the market are for osteoporosis or breast cancer treatment. As far as prevention of cognitive impairment, studies that have used CEE would be the closest to predict benefit and risk. I am not aware of any studies looking at SERMs and cognition. There are none looking at Duavee, it is too new.

I apologize if you have posted elsewhere why you wish to start menopausal hormone replacement, but what is your motivation? Is is purely for cognition or are you having quality of life issues with hot flashes? And why did your doctor select Duavee for you as an individual? Most conventionally trained doctors do not measure estrogen and progesterone levels after starting treatment and would not be familiar with estrogen to progesterone ratio targets. There are a lot of older posts from other E4 women, both in this thread and another under the "Drugs" discussion category, discussing their journeys with menopausal hormone replacement. If you haven't looked at both of these, you might find them illuminating.