Hormone Replacement Therapy E4 Women

[Lindajane]

KatieS, I am on biest 2 (50/50) prog 80mg topical cream. My mood is okay, my energy level is not as high as before. I sleep fine but my libido is not as good as before hormones.

I would like to see some information for HRT replacement for women my age. I want to do everything I can, but I'm just not sure hormone are for me.

[Julie G]

I managed to be a guest at the AAIC2018 conference in Chicago on July 23 and heard a fascinating presentation by Dr. Walter Rocca and others about HRT and AD. This is the elevator version: Since women are 2/3 of the AD patients, the disparity may be explained in part by the sudden decline in estrogen at menopause. Estrogen is necessary to metabolize lipids. If there isn't enough estrogen, the brain goes into starvation mode and starts to metabolize myelin for fuel. The WHI study that found HRT increased AD risk randomized women who were 10 years past menopause into HRT/non-HRT. But APoE4 women who start HRT at 50 and continue past the age of natural menopause may be protected. I haven't seen anything online or in media about this idea, but I keep looking. Anyone else know anything about this theory?

Fascinating, WillsMeme. So glad you got to attend. I'd like to learn more. Do you remember who presented this? It kinda reminds me of Roberta Brinton's work suggesting that E4 women are at a greater disadvantage during the perimenopausal transition period as we begin the process with a neurological fuel deficit. My understanding is that estrogen helps with glucose metabolism which is already disadvantaged in our genetic subset. If ketones aren't present to make up the neuronal fuel shortfall, that's when the cannibalization of the myelin would occur.

[Julie G]

Waves and smiles to all my APOE sisters and brothers. I'm trying to get to that magic level of 40-60pg/ml of estradiol that Ann Hathaway recommended at the Lo Carb convention last year. I've been using transdermal for most of the >10 years of menopause. But my levels kept coming back <25 so switched to patch and have titrated up to .05mg but my levels are still <25pg/ml (checked 2x vis blood).

Waves back, sister Betty I had this same problem. My gyn hypothesized that it was because I was thin and wasn't putting the patch on a spot with enough belly fat. This may be your problem as well. I moved it from my lower abdomen up closer to my belly button. It really helped boost my levels. FWIW, I had to increase my patch dose to 0.1mg and include Estrace cream. Miss you!

[Plumster]

Hi all,
I apologize if this has been touched on in this thread already (it's a long thread and my question isn't easy to use the search box for). I am 48 and started progesterone as my levels were low, I'm still menstruating (not always ovulating). I want to start BHRT soon to reap the benefits. I just got my estradiol tested and it was at a good level for my cycle--i.e. not low nor too high--despite having frequent hot flashes (and significant insomnia as well as hair loss, which may be due to former low progesterone?). My question is this: When exactly is a good time to start estradiol patches/creams? Does my estradiol have to be below a certain number at a particular point of my cycle? I don't want too much estradiol, of course, but I am unclear how it is determined when to begin the therapy. I looked for the Wiki info, but it's not there yet. THANKS!

[slacker]

Hi all,
I am 48 and started progesterone as my levels were low, I'm still menstruating (not always ovulating). I want to start BHRT soon to reap the benefits. I just got my estradiol tested and it was at a good level for my cycle--i.e. not low nor too high--despite having frequent hot flashes (and significant insomnia as well as hair loss, which may be due to former low progesterone?). My question is this: When exactly is a good time to start estradiol patches/creams? Does my estradiol have to be below a certain number at a particular point of my cycle? I don't want too much estradiol, of course, but I am unclear how it is determined when to begin the therapy.

There isn't one approach for peri-menopausal treatment. A conventional provider typically doesn't check estradiol or progesterone levels, just goes based on symptoms. A functional medicine doctor I worked with briefly did saliva testing over a 24 hour period (probably mid cycle) to get a sense of the estradiol/progesterone balance before starting treatment; it sounds like you may have had this done. And this FM doctor often started peri-menopausal women on progesterone only, if the woman was "estrogen dominant." You have good questions, and they are best addressed by your provider.

[Victronix]

So glad to see this thread here! I also started on HRT because of being almost totally non-functional when my estrogen tanked (1xE4). Seems like a lifetime since then, but it was only a few years ago (I was around 52 at that point) . . . I had seen the research about women take HRT who were APOE4 having a benefit over 2 years, so that was very helpful to know.

[catalinda8]

At 55, I'm just starting menopause -- I'd like to look into bioidentical hormones, although I'm not having hot flashes or any of the other nastier symptoms. In fact, I feel great as usual. I don't think insurance will cover bioidenticals. Is there anything I can do on my own with supplements?

[jkramer65]

Hi. I'm just entering this e4 world and my mind is about to explode! I am curious about HRT. I'm just 53, fine mentally and still menstruating regularly. I'm one of 3 girls. Our mother had a very late menopause (57 or 58) -- she is now 91 and fine mentally; my oldest sister who is now 68 had a hysterectomy at 33 but had ovaries and thinks she was mid 50s when she went through it. She is, so far, fine mentally; My middle sister who is 64 was recently diagnosed with AD and also had menopause around 56-57. Our father died of AD at 87. 23 and me says I'm e4/e4. That means my mom has at least one copy of 34 right? I'm the only one who has tested but working on others to do the same. Is late menopause a benefit? NOW. my mother was on HRT for years! back when it was the normal thing to do. I"m not sure when she started but I bet was on it for at least 10 years. At least until late 60s or 70.
Anyway, what is the latest on hormones? And is what ever the "latest" is different if you are e4/e4? I'm so confused by it all. I just know that right now I'm in such a tizzy about all of this -- as it is only a few months old for me -- that i'm not sure where to begin. I'm so obsessed with trying to prevent this I'm probably going to cause it! I brought it up to my gyno and she brought up the party line of risk/benefit ration blah blah blah breast cancer etc. didn't seem too open to it. Any advice would be appreciated. Thanks!

[slacker]

At 55, I'm just starting menopause -- I'd like to look into bioidentical hormones, although I'm not having hot flashes or any of the other nastier symptoms. In fact, I feel great as usual. I don't think insurance will cover bioidenticals. Is there anything I can do on my own with supplements?

Welcome catalinda8;

Deciding if and when to start hormone replacement is an individual decision. The definition of "menopause" is one year with no period (with intact uterus). "Perimenopausal" is the time when periods start to get irregular, or onset of side effects like hot flashes prior to one year without a period.

There are some regular prescription "bioidenticals" which are covered by many insurances. Estradiol patches are bioidentical, as well as oral prometrium (progesterone). There is a chapter in our Primer on hormone replacement; you might find this helpful. This thread (Hormone Replacement Therapy E4 Women) is also very helpful, and does require some patience to slowly read and digest its contents.

corrected spelling of prometrium (had used radioactive element 61 instead by mistake!)

[slacker]

Hi. I'm just entering this e4 world and my mind is about to explode! I am curious about HRT. I'm just 53, fine mentally and still menstruating regularly. I'm one of 3 girls. Our mother had a very late menopause (57 or 58) -- she is now 91 and fine mentally; my oldest sister who is now 68 had a hysterectomy at 33 but had ovaries and thinks she was mid 50s when she went through it. She is, so far, fine mentally; My middle sister who is 64 was recently diagnosed with AD and also had menopause around 56-57. Our father died of AD at 87. 23 and me says I'm e4/e4. That means my mom has at least one copy of 34 right? I'm the only one who has tested but working on others to do the same. Is late menopause a benefit? NOW. my mother was on HRT for years! back when it was the normal thing to do. I"m not sure when she started but I bet was on it for at least 10 years. At least until late 60s or 70.
Anyway, what is the latest on hormones? And is what ever the "latest" is different if you are e4/e4? I'm so confused by it all. I just know that right now I'm in such a tizzy about all of this -- as it is only a few months old for me -- that i'm not sure where to begin. I'm so obsessed with trying to prevent this I'm probably going to cause it! I brought it up to my gyno and she brought up the party line of risk/benefit ration blah blah blah breast cancer etc. didn't seem too open to it.

Hi jkramer65;
Many of us are overwhelmed by the amount of information, and the uncertainty. If you are menstruating regularly, it is too soon to think about starting HRT. Relax on this one! Focus on the basics - nutrition, exercise, sleep, and stress management. Start with small steps.

As far as the latest on hormones and unique factors for ApoE4s? You can probably find it here in this topic. Bear in mind that US studies typically look at synthetic estrogen and progesterone, where as European studies look at bioidentical estradiol and progesterone. The risks look far less on bioidenticals versus synthetic hormones. However, everything in life has some risk.

There is a summary in the Primer which I linked earlier today in this topic for another E4 concerned about hormone replacement; you might find this helpful. Here is another entry about possible reasons why hormone replacement is more important for E4 women. It is sort of technical; most studies are.

If you are a 4/4, you got one copy from your mother and one from your father. As far as suggesting other family members get tested, consider reading this discussion of pros and cons of testing for ApoE status.