Hormone Replacement Therapy E4 Women

[Julie G]

krientz, you need to talk to Lilly; hope she weighs in for you. I'm pretty sure she shares that SAME mutation- hence her trip to an NYC optimal-aging specialist to get his medical opinion. AND, I'm pretty sure she's had experience with creams vs. patches. Surprisingly, the prescription- strength creams might even be more potent. You are most definitely NOT alone in trying to figure this out.

Hormonal replacement for E4s is tricky. We are left weighing risks vs benefit. And, finding a physician who will take the time to learn & take all of your risk factors into account is difficult

[circular]

I just got bumped up to 1 mg per day estriol, .5 mg estradiol per day and .5 testosterone per day based on blood levels. I can't take progesterone. The question would be what blood or saliva levels (leaving out the issues there!) are protective, assuming either measurement reflects what's happening with brain receptors. I think the best we can say is that indications are that some is good for us?

[Gina99]

I think you need to see how you feel. It should be dramatic enough to make a change to your daily life. If the creams dont make a difference then. it isnt enough. I still see aging in my face, etc. hopefully not related to AD. If you have the ability to go to a specialist then do it.


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[Sherry]

I am 70 years old and have taken hormone replacement therapy since in was in my 50's. I have had to fight my doctor and insurance company for years to stay on my hormones. I still take low dose estradiol.

I was thrilled to see this study.....maybe now they will stop harassing me. I have no other health problems except slightly elevated blood pressure. I am thin, active and overall very healthy.

I would rather die of a stroke or heart attack than have Alzheimer's.

[LillyBritches]

If this has been addressed in an earlier post, I apologize -

I have the Factor V blood clot risk. I have the heterozygous mutation. No one in my extended family has ever had a blood clot. Nevertheless, my doctor will not renew my bio hrt and I doubt I could fine anyone who would. Taking matters into my own hand, I ordered some cream type products. The one I use contains .25 mg estradiol and 1 mg estriol. I use 2x - so I get .5 mg estradiol and 2 mg estriol daily. I also use a progesterone product from the same source.

Does anyone have any information (or an opinion) as to whether this dosage and the delivery method is enough to make a difference? I'm sure it's not "sufficient" to bring my levels back premenopausal levels.

Dear krlentz - mea maxima culpa for not responding before now! And I'm getting sleepy and going to bed soon, so I'll expand my post in detail later today - but I just wanted to tell you that you absolutely CAN, without a doubt, take HRT if you're a heterozygous Factor V female! I ought to know. I am...and I do. I'll relate my sojourn at some point today wherein I researched studies and then searched high and low for a physician who would give me my her moans. I was bound and determined not to play around with this estrogen thing; hell, no. Not as an 4/4 female.

Bottom line: each and every study re asymptomatic heterozygous Factor Vs (read: no prior DVT) have shown that we have NO increased risk for a DVT when we're on bioidentical HRT. I presented my evidence and plead my 4/4 case to a very medically conservative local and highly-touted hematologist...even argued with him...and he STILL wouldn't give me HRT.

Um, no.

That's when I found, and called, Dr. Trutt at PhysioAge who knew all about ApoE4 and how very important it is that we ApoE4 females are on estradiol (bioidential estrogen). And he knew of all the aforementioned studies I had found. He chuckled and told me that, as I had found, there was no reason on Earth I couldn't take bioidentical HRT and that, as a 4/4, it was crucial that I did just that. He then said that I needed to find someone in the DC metro area (my locale) who was savvy enough to be current on this topic, and I said, hey. I need an excuse to make trips to my beloved NYC. Will you be my HRT doctor?

*bats eyelashes furiously*

He laughed some more and said, "Sure!" He's very personable.

I've been on HRT for almost a year now. And will probably never, ever stop.

So yes, Virigina, there is an Estrogen Santa Claus. I will detail everything later today. Keep hope alive, my 4 sista. You can do this. Just not via ill-informed, haven't-kept-current-with-research-and-classes physicians.

xoxoxo

P.S. I'm not sure if those doses are doing diddly-squat for you, kr. I'll outline my meds and doses in a subsequent post today.

P.P.S. Shout-out to my friend, the perpetually caring and lovely Julie, for bringing this to my sometimes-addled attention. Thanks, girl.

[Sandraz]

I am very interested in what you have to tell!!i have to tell you I was totally against HRT. But now I see bio identical is most certainly different. Any info you can pass along esp about apoe4 would be great. I will be talking to doc about it end of July. It's going to be a half day appt.. Not really just have so much stuff to go over. My doctor is already outside the box, so I bet she knows about this stuff, but maybe not from an APOE4 perspective.

Does your NY doctor have you come back yearly for check ups or treat you from afar after initial visit? Always nice to know there are other options.

Thanks,
Sandra Z.
I don't have the factor v clotting gene. Do doctors have you taking baby aspirin preventatively? Or maybe good to take if long sitting trips in plane or car etc. just curious.

[KatieS]

I was on Menostar 0.14 ultra-low dose patch for six weeks until I had a very scary 20 minutes of jumbled vision (migraine equivalent). Although I was on HRT ages 50-59, weaning off about 4 years ago when I had my first migraine equivalent. So I've been off the estrogen for the past 3 months, feeling the same without further scary visual episodes. While my 96 y/o mom continues on estrogen 0.6 patch, she has the estrogen use protective (0.4) mortality gene, according to the PLOS Estrogen Polymorphism and Morality Study (referenced here). I have the gene that triples my cancer risks, so together with the possible migraine side effect, I am concerned about trying the patch again.

[KatieS]

Well, I had another visual migraine while months off the ERT, so now I'm debating restarting the ultra-low dose estradiol. I have continued the vaginal estrogen cream. If not, for the rs2234693 TT 3-fold cancer risk, but decreased overall mortality risk (mom was CT which only had the decreased all-cause mortality associated with the C).This French study was not limited to the bioidentical hormones and has few on estrogen-only.

Since last year's headline, "Estrogen Puts the Brakes on AD" for E4 carriers, are there further updates? The doctor associated with that headline, was very non-committal to me, "You can use until you're 65, best to be non-systemic ". Now that I know my mom (age 96, on ERTx 50 years) is 3/4, and still living independently, eccentric as ever, I'm thinking estrogen was protective for her.

I'm interested in what Sandra Z's doctor recommends related to ERT in her apt later this month.

[Sandraz]

Hi Kitano,
I will let you know what she says (end of July) Do you know of other articles in particular about BHRT and E4, otherwise I will peruse the links here. I have not done the 23&me testing. Will that show the gene you just mentioned? And are there others genes, SNP's to look for when deciding? My other issue is that even though I am only 51, I have been in menopause since age 45. Already have osteopenia, and I know bone loss happens in first years after menopause so I missed that boat. I toughed it out, now I find that may not have been such a great idea.

Sandra z

[KatieS]

The SNPs were done on 23andme six months ago, but my mother's data from two months ago, did not include one of the SNPs. The elevated cancer risks were associated with certain SNPs:
http://www.plosone.org/article/info%3Ad ... 34112-t005
However, note that transdermal therapy seemed to be associated with lower mortalities and I did not see ultra-low dose transdermal Estradial included.
I was trying to find a reference related to bone preservation, SNPs and ERT, which would be important for you. From age 49-59, I was on a a half, then a third of a Combipatch. Perhaps, I should take PhillyFree's suggestion and have estrogen levels drawn, since I know that my baseline levels have been persistently low (30). Maybe menopause is no different for me, as I never had hot flashes or complaints.
The neuroprotectivenes of estrogen seems so important, hence my dilemma.