Can I take BHRT with my coronary artery disease?

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TheBrain
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Can I take BHRT with my coronary artery disease?

Postby TheBrain » Tue Dec 13, 2016 1:13 pm

I just had a disappointing appointment with a GYN. Our purpose was to discuss hormone replacement therapy. I told her about:

    * My ApoE4 status
    * Dr. Bredesen's recommendations that I take progesterone and estradiol (for the latter, ideally around 80 pg/mL)
    * My coronary calcium score, which was determined to be 365 in August of this year through an EBT scan. This is in the 99 percentile for my age and gender. I'm 56. So not good..
    * Recent blood work showing my hormone levels

I was officially in menopause in April of this year. I'm currently taking 100 mg natural progesterone at bedtime. I've not started taking any estradiol, but I want to. Of course, I don't want to be stupid about it.

On 11/15/16, my progesterone was at 5.1 ng/mL. My estradiol was at 15.7 pg/mL.

I'm pretty sure this GYN only deals with the non-bioidential hormone replacement, but I should have asked. (I'm sleep deprived and should have written down my questions beforehand.) She said that I can continue with the progesterone. However, with my coronary calcium score, she could not prescribe estrogen for me. She said I'm in a tricky situation with being at high risk for both Alzheimer's and CVD. She said I could have a heart attack or a stroke while on estrogen because it helps to clot the blood. In fact, she said, when people have a nosebleed, a common treatment is to squirt estrogen into the nose to stop the bleeding.

Is this risk of heart attack and stroke the same with bioidentical estradiol? Has anyone else been in this dilemma? If so, what did you decide to do?

Why can't any of this be easy? :(
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!

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Julie G
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Re: Can I take BHRT with my coronary artery disease?

Postby Julie G » Tue Dec 13, 2016 1:47 pm

(((Alysson))) You know I'm not a doctor, but I strongly suspect her fears are not based upon relevant information. There is no evidence that transdermal bio-identical E2 increases risk for CVD via clotting. To my knowledge that correlation has only been found with equine synthetic oral E2; the WHI studies. In fact, estrogen is strongly associated with CVD protection. Given your 4/4 status, cognitive history and documented mitochondrial dysfunction, I would print a copy of Dr. Brinton's recent paper and run to a new practitioner.

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Re: Can I take BHRT with my coronary artery disease?

Postby TheBrain » Tue Dec 13, 2016 2:28 pm

Oh, Julie. Thank you. You are giving me hope that I can, indeed, take bioidentical estradiol. I will read that paper (carefully this time) while I search for a new practitioner to share it with.

I know of two local practitioners who are experts with bioidentical pellet therapy, in which the hormones needed (progesterone, estradiol, and/or testosterone, not sure what else) are compounded into a pellet. Then, the pellet is injected into the butt. The pellet slowly releases the hormones and lasts something like three months.

However, two practitioners have told me to be very careful with the pellet method because if the doses aren't right, one can be miserable until the pellet finally is done releasing hormones. You can't remove it.

I really want to use an estradiol patch and keep taking the oral progesterone.
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!

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Re: Can I take BHRT with my coronary artery disease?

Postby KatieS » Tue Dec 13, 2016 2:29 pm

Allysson, I run a dangerous high lp(a) and have equivocal carotid plaque, so I'm limited to the ultralow dose estradiol patch. My doctor will not prescribe progesterone to me which would be required with higher prescribed estrogen doses, due to the breast cancer risks associated with progesterone. (Never mind that the studies were muddled with synthetic progestins). Perhaps, even a low-dose patch can add some CV protection. Estrogen seems to be more cardioprotective, but study results are mixed results so far.

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Re: Can I take BHRT with my coronary artery disease?

Postby TheBrain » Tue Dec 13, 2016 2:42 pm

Katie, thanks for sharing your experience. It's good that even though you have those issues, you can still use an estradiol patch. What is the dose of your patch? And what blood level of estradiol do you end up with?

That's interesting about the progesterone. Here my estradiol is quite low, and my progesterone is high compared to it. And the GYN I saw today said to go ahead and keep taking it!

I really do need to run away from her and find a practitioner who can meet my needs.

Thanks for those links. I'll check them out.
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!

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Re: Can I take BHRT with my coronary artery disease?

Postby KatieS » Tue Dec 13, 2016 3:03 pm

My dose of estradiol patch is half of the delivery of 0.025mg/day (a minimal 0.0125). Also, I supplement with VagiFem 10mg/twice a week. My doctor does not order estradiol levels, but even when I was younger my levels were low normal. My uterine ultrasound did not reveal an increase in the endometrial lining, otherwise I think the doctor would refuse to prescribe unopposed estrogens. Since even slightly higher doses of estrogen seem to create breast tenderness, etc..., I think my levels are typical to my low premenopausal levels. Still I agree, the labs might be surprisingly low. This ultralow-dose estrogen supplementation has only been linked to bone protection.

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Re: Can I take BHRT with my coronary artery disease?

Postby TheBrain » Tue Dec 13, 2016 3:43 pm

Thanks, Katie. Well, there's a lot to be said for bone protection. I need that too (I already have osteoporosis).

Does insurance cover your BHRT? I understand that the pellet therapy I mentioned previously isn't covered, but I see in my insurance company's formulary for 2017 that "estradiol patch" is in there. (My hair stylist pays about $100 per month out of pocket for her pellet therapy, which only contains testosterone.)

Do you know if an estradiol patch is always BHRT?
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!

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Re: Can I take BHRT with my coronary artery disease?

Postby Julie G » Tue Dec 13, 2016 3:52 pm

I think many/most estrodial patches are bio-identical. I use Minivelle. Many here use Vivelle or Vivelle Dot. I believe that there's even a generic version of these. All are covered by standard medical insurance.

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Re: Can I take BHRT with my coronary artery disease?

Postby TheBrain » Tue Dec 13, 2016 5:00 pm

Thanks, Julie. This is excellent news. I'm fine with using a generic version, if that's what I need to do.

I really appreciate you gals being so responsive and answering my questions. And giving me hope. :)
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!

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Re: Can I take BHRT with my coronary artery disease?

Postby KatieS » Tue Dec 13, 2016 5:23 pm

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.


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