Hormones, Dee's HRT & more.

[Guest guest]

*Blushing here* thanks Gayla.. ( a really long one coming up *grin*)

You are so right with us having to take our own health into our own hands, I know the screw ups over the years that have happened to just me so imagine that with each of us. It's being able to talk with our doctors as a dialogue not just a monologue and working together. There is NO way any doctor can keep up on a person specifically with all that might be going on with a single individual let alone if it's it's six months between visits. Heck I can't even do that with members here without a refresher and I see posts daily.

I've been researching all of this (not only V pain but hormones especially) for about 15 yrs from when my own pain first began, buying tons of medical books or using medical libraries etc. and intensely on the net once I got my computer *smile* for at least 7 years plus doing the lists that long and I do mean daily. *grin* but I'm just one of those information geeks and of course it expands into all directions.

Since you can't seem to use the reg. estrogen forms here's a thought. Have you considered an estrogen 'gel' that's similiar to the T. gel and applied topically for hormone use (that would be a bit different *I assume* than vulvar use) & using it for whole body benefits. I know Pete can make that up as well.

About my own HRT?

This is really ironic.... (there's that lady 'irony' again LOL) but I just sent a really long post about what I use somewhere eles so I'll just paste it here AND I really went into a lot more about the progestins/progesterone too. It's long ( of course) *grin* but I do hope it helps.

ok, herrrrrre goes. ; )

Grab a cup of coffee first, or whatever, maybe a good drink. LOL

Well, hon you've hit on my favorite soapbox and I love to talk about hormones and they really do tie into so much for us women , sooooo here I go for 'my 'HRT regimen.. *smile* I hope it's not too boring for those not near that age, but some good info too for all of us just as women about hormones, so it's up to you if you want to read it and would like to know how your body works & how hormones tie in, and believe me that time comes a lot faster than you realize. *smile* Some start in their mid to late 30's even. OK, Here's what I use.

I take an estradiol tablet (compounded) that is 2mgs total for the day but I split it in half, am & pm... it's a sublingual form that's orange flavored and melts under the tongue within 20-30 seconds. That way it goes directly into the blood stream and bypasses the liver on first pass. I split them purposely to keep my levels stable since the natural bioidentical hormones leave the system fairly fast.

I also add a natural testosterone tablet the same way, (twice a day) the total for that one is 2.50 mgs that I split in half. (although I'm just trying for the first time this month, using a T cream topically on the arms or legs for the whole body benefits but think I'm going back to the sublingual as it's not working as well)

Anyway I've taken that regimen every day, (E & T) sublingually 365 days a yr, (once in a while I'll forget but not often) and have for quite a few yrs and as I was quoted in one newspaper during that last WHI withdrawal, "You'd have to rip my arm off to take mine away from me'' LOL and it's so true.

Those are both compounded specifically for me by the way by Pete Heuseman at Bellevue pharmacy. I fax the prescription in and get it with 3-5 days via mail. They do take most insurance plans but I use my Cr. Cd. (lousy insurance) I also make sure I ask the doc for refills for a year so that I can just re-order when it's needed.

Then I use a topical E & T cream only for the vulva twice a week, peasize since that's 'not' systemic in most cases but just for the vulvar skin and by the way even though I've used this for years and that's including the T. I've not had any side effects, only benefits. *wink* but I do know my own levels and where I need them to be. An overload and not balanced won't work and why HRT often needs to be 'tweaked' when first starting by getting those blood serum levels tested and not a saliva test by the way.

BUT........here's the kicker...... I 'don't' add any progesterone or a progestin and yes I do have my uterus and all parts are working wonderfully. *smile*

I'm certainly not telling anyone else not to add it since that is the typical standard protocol if one still has their uterus. Although quite a few legitimate studies are showing it's ok to add it every 3rd month or even more. Some studies showed that quite a while ago and is where I first picked it up. So believe me the rest of this is what 'I' do and why.

It's the progesterone/progestins that I am so against (for SO many reasons) *especially* breast cancer much more so than any estrogen, especially a bio-identical estrogen, that doesn't frighten me at all like a progestin or progesterone does and also the progesterone creams, (but that's another story for another time,*smile*)

So that is just what "I" do hon for my HRT.... now comes the ramble. (smile) and you thought I was through. LOL

BUT.... 'I' also know thru much research and studying, (and hey when it's for 'me' you'd better bet I'd research it out in great depth) *smile* that if a menopausal woman keeps her estrogen levels at a certain number or level say between 70-114 pg/ml, and those are the numbers we need to be optimal, functional and healthy, they may not need to add a progestin or progesterone at all and it's not likely they'd have any proliferation of the uterus either. Again NOT telling anyone else to do this but I do and why.

.......Just as a side note...... often that increase in uterine lining can be caused by a thyroid malfunction as well as an estrogen overload......

With someone who is in natural menopause.....(or who's had a hysterectomy), the estradiol is often even LESS than 40 all on its own with dead ovaries (even if left in, it's not long before they stop producing because the blood supply has been cut off with the surgery, but this level has been shown to NOT provide any protection against bones, brain, heart, memory, sleep, skin, mood, etc.etc.etc....but get it up in the 70-114 ranges it DOES benefit those things and is desirable if you want to not only look good but feel good as well.

The only reason nature kicks in progesterone (P) midmonth is to nourish & feed the baby, (PRO = for & GEST = Gestation) so if we're not pregnant it washes out that thick uterine lining (built up by a higher E level) by having a period... for no other reason. It's the same when we add the P with HRT, usually 10 to 12 days later a period will start. although it's technically a false period it's the same process of flushing out the uterus, 'in case'.

It flushes out the uterus so to speak and the whole cycle continues again the next month. But if we keep that estrogen level low enough as they are in the early Follicular stages, (when one was Pre-menopausal) there isn't that increase of uterine lining because the P hasn't kicked in yet and the E levels haven't reached a high enough stage yet, so no Progesterone/progestins are needed to do that.

With the E at that level the P doesn't kick in naturally either when we're younger and not menopausal in the normal healthy individual I mean in those early weeks (the Follicular stage) *the first two weeks.

So by keeping those levels of estrogen at that lower range, (as they'd be for a non menopausal woman) there is no increase in the uterine lining. But NOT if the E levels were up to the 200 range then a progestin or progesterone would be needed of course. So no matter how much we might slap on, suck up or take orally or use creams or patches.. as long as those E blood serum levels don't go beyond that it's not likely do to the uterus any harm.

My own physician agreed with me privately & 'off the record' when I finally told him I don't add it (as I did that on my own) and I thought he'd chew my head off, because of how horrible the P. makes me feel even with a natural one like Prometrium. (PMS'y, grumpy, sleepy, bloated, wt.gain, tender breasts, just plain ol' *ouchy*)

And he agreed P affects many women like that and is well known in most of the scientific literature (not laymens sites) BUT..... he did say he can't tell me that openly and would deny it since it's against the rules & regs and standard protocol that's he and other physicians are forced to observe. Talk about a lawsuit, and I can see why. I even told him I'd write a disclaimer and doing this on my own, he just laughed and didn't do it.

I've not added a progestin myself for over 3 yrs (might even be 4) and am still fine, (good idea tho to do an ultrasound at least once a year to double check) PLUS I even have a fibroid that's diminishing to almost nothing so the estrogen I take, and that 2 mgs a day 'every' day is a lg. amt. for most people & they wouldn't need nearly that, but it's what "I" need to keep me at 'my' own normal levels and it still doesn't do anything or feed the fibroid and there is no proliferation of the uterus.

That's also why most fibroids don't need to be removed (unless a serious problem or extremely large) as they do diminish with menopause in most cases just naturally.

Here's a quote from a paper about the uses of E-string & Vagifem, which are two other HRT options and are 'considerably' lower, potency wise, than what I take. And those too are estradiol by the way but inserted into the vagina.

"In regards to the risk of unopposed estrogen and risk of endometrial proliferation and possible subsequent endometrial carcinoma, studies, although short-term, have 'not' demonstrated a risk." (in regards to using both the Vagifem & Estring)

"Estradiol levels in the range of less than 70 pmol/L have been shown to be associated with 'atrophy' of the endometrium."

(Note that)

"These forms (Vagifem & E-String) of estrogen all maintain plasma levels well below 30 pmol/L during steady state. Thus, the risk of endometrial carcinoma is considered minimal."

Me again.....

That 70 E range is obviously lower than what I've read of where to keep it at (70-114) and even shows 'atrophy' of the endometrium (that's the lining of the uterus) keeping it at 70. But the point is they also know that keeping those levels low, a progestin or progesterone isn't needed with any of those products either.

But here's why "I" can't use those products, first of all they're not potent enough for 'me' and I definitely want 'my own' Estrogen levels to be much higher than that 30 pmol/L to be optimal not barely functional. (I try to stay around 100). As I mentioned above, the 40 or usually less range of E is the average menopausal woman on nothing and that's 'not' what 'I' want. It's much too low to have 'any' whole body benefits.

But if it's used for 'topically' for vulvar health? Then yes it is effective for that 'locally' since it's not very systemic at all (as above mentions) and that's even tho the Estring & the Vagifem are inserted into the vagina. AND also why all ages can use it topically. In a way the E string or Vagifem are similiar to using the Estrace topically (and would help the vulva) except topical E. would be even far less systemic and again why all ages can use it, in 'my' opinion.

Not overboard tho. *smile*

Gosh I could go into so much more... like how women NOT on HRT have a higher breast cancer risk statistically than those on estrogen just by virtue of getting older and so they produce more Estrone naturally which stores in fat (aka breasts) and especially in those who may be heavier, they are at a much higher risk automatically even NOT being on HRT. Where going on the natural bioidentical could help balance that out. (plus adding the T).

......Or I could talk about how it was the progestin NOT the estrogen as to why that last WHI study was withdrawn. Here's one quote from the yr 2000 withdrawal by the Nat'l Cancer Institue which did a huge one in 2000 let alone the last huge one a few yrs ago by the WHI using PremPro. Same results of course and WOW did that make me furious as if they hadn't learned when quite a few earlier studies showed the same thing about the addition of P. (tho not as large nor publicized) but they were there and to see them do that WHI study just infuriated me to no end. *sigh*

CONCLUSIONS: "This study provides strong evidence that the addition of a progestin to HRT enhances 'markedly' the risk of breast cancer relative to estrogen use alone. These findings have important implications for the risk-benefit equation for HRT in women using CHRT (continuous HRT)"

Comment in J Natl Cancer Inst. 2000 Jul 5;

(so this is from the earlier one and they knew that. )

And here's a report from The Fred Hutchinson Cancer Research Center, home of two Nobel Prize laureates, and is an independent, nonprofit research institution dedicated to the development and advancement of biomedical technology to eliminate cancer and other potentially fatal diseases.

Here's what they had to say about HRT (clips only) with the 'last' WHI study withdrawal, (around July of '02) and please please keep in mind that word "COMBINED' meaning with a progestin like PROVERA (the drug was called PREM-PRO Premarin 'and' Provera.) and that's what so many reporters overlooked and just kept saying estrogen or hormones do this or that, no wonder women were frightened. ARGHhhhhhhhhhh

"Women who take 'combined' HRT for five to 15 years or for 15 or more years - whether they take progestin sequentially (estrogen daily plus progestin about 10 days a month to mimic natural hormonal fluctuations) OR continuously (estrogen 'and' progestin daily) - face a 100 percent increase in breast-cancer risk, report I. Li, M.D., Ph.D., and colleagues in the June 25,03 issue of the Journal of the American Medical Association."

Among their most significant findings of women who took the 'combined' hormones:

"Lobular breast cancer - the researchers found a 2.7-fold (170 percent) increased risk of invasive lobular breast cancer. Lobular carcinoma, the second most common histologic type of breast cancer, involves the lobules, or chambers in the breast that contain the milk-producing glands." "Ductal breast cancer - the researchers found a 1.5-fold (50 percent) increased risk of invasive ductal carcinoma, which accounts for about 80 percent of all breast-cancer cases. This type of breast cancer involves the milk ducts that carry milk from the lobules and out the nipple." "Hormone-receptor-positive breast cancer - women who took combined HRT had double the risk (100 percent) of hormone-receptor-positive breast cancer (tumors that need estrogen or progesterone to grow)." "It appears that HRT 'MUST' contain progesterone to promote breast-cancer growth, and that it may act through stimulation of both estrogen and progesterone receptors, not just one or the other."

"Li and colleagues found that older women who took ''unopposed'' estrogen exclusively, even for 25 or more years, were at NO greater risk of breast cancer than those who had ''never'' taken any form of hormone-replacement therapy."

*SMILE* *NOTE that means No P. at all (unopposed) and had no greater risk than a woman who had 'never' taken HRT... estrogen alone is all they took. In fact the arm of the WHI study with estrogen alone was continued after the combination one was halted.

But that doesn't mean being ON OR OFF HRT either way is going to prevent a breast cancer if it's going to happen but in my opinion certainly doesn't increase the risk as long as no progestin or progesterone is added.

Well hon I sure went on a roll but I have at least 2,000 studies articles, journal pieces and prob. thousands more that I've read that all talk about progesterone or progestins and I've sent quite a few posts on to the group about it especially about breast cancer so if someone wanted to search those out in the archives they're there, (but YAHOO really sucks with their search area in the groups files) *sigh*

And I know how scary it's got to be to have breast cancer and my heart goes out to anyone who's gone through that, so I don't mean to diminish that or make light of it, it's got to be a horrible experience no doubt about it and can't blame anyone for being fearful of estrogen but so much of the information was just so erroneous to me as far as it being the 'trigger' it's a shame. In fact 'I've' never seen one study that ever stated that, but have that it can feed an already 'existing' cancer and why then it would be necessary to halt it of course. But that's 'after' the fact.

I just think all along the poor estrogen has gotten the bad rap when it was more so the progestins or the progesterone that is at fault,(yes several studies said the same about 'progesterone' as they did about 'progestins') and it has been all along from smaller studies I'd seen that all said the same thing even years back, but was ignored and the focus was on estrogen alone. *sigh*

And another thing........

.....is that in almost all of those studies, (prob. 99.9%) the Pepi trial, the Nurses Study, Framingham etc.etc.etc.. guess what product they used for the estrogen? Yes it was Premarin...donated freely of course. (sarcastically said)

One that just isn't like our own estrogen at all as the Estradiol is bio-identical in Estrace or other estradiol products but unfortunately ALL Estrogens got the same sticky wicket and were all labeled that way, word for word, for word, sad to say. When Premarin takes about 3 months or more to be eliminated from our systems even when we stop it, vs. Estradiol which is out of the system within 48 hrs it's so natural.

Most likely someone just starting out on HRT would NOT need anywhere near what I use as far as dosage amts. but now is the best time to start, she might even consider an estradiol Patch form or even the Estradiol gels. For instance osteoporosis cannot be reversed but only halted in its present stage...and it 'starts' slowly but surely while in peri menopause, from what I've read that can start 5 yrs 'before' actual menopause... but it can be halted by the sooner one starts their HRT when it's needed (and immediately after a hysterectomy) than wait till it's too late where it can't be reversed but stopped hopefully where it's at and that's only ONE of it's benefits.

Just imagine if I went into rambling about the Testosterone (T) ... LOL and believe me that one is as important as the other, because if a person only takes E in their hormone replacement....... that diminishes the T even more and there goes libido too. *grin*...In fact T. may be even better for bones than E. they're finding out and may even be beneficial for breast protection (See how easy I could go off again, haha) Sorry.

Take care hon & Big HUGS and forgive me for straying off topic, I don't like to do that but you asked but once in a while it just seems to fit. And needless to say once again, that's 'my' opinion and what 'I' do and know. *smile*

Dee~