Wrong about HRT

[sengsational]

I listened to a podcast on hormone replacement therapy for women and found out I was mostly wrong in my thinking. I thought it had been proven that it increased breast cancer risk, universally. Wrong. I thought it's only plus was to reduce menopausal symptoms. Wrong.

https://peterattiamd.com/caroltavris-avrumbluming/

The above is two+ hour interview of a pair of people who wrote a book called "Estrogen Matters". The interviewer is Peter Attia (a "longevity focused" MD clinician and podcaster).

In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC, and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause.

What surprised me the most is the apparent protective effect hormone replacement seems to have on so many "really bad" and feared diseases such as Alzheimers, diabetes, colon cancer and more. There are contraindications, like if you have existing high risk of CVD, your chances of an event go up slightly in the first year, but then down later. But HRT even helps protect against atherosclerosis as long as you're not in the throws of it already. And, unlike what was in the headlines, HRT probably isn't going to increase the likelihood of breast cancer. They talk quite a bit about why many of us came away with that wrong idea (but no true smoking gun).

Anyway, I thought if this post led some people to learn more about this topic and then ask their doctor about it, it might make for a few longer, healthier retirements.

 

[rodi]

Haven't heard the podcast... will give it a listen... But it is a topic I have followed. My mom was on HRT. She also developed ovarian cancer (and died of it.) She was well past menopause and still on HRT when she was dx'd with cancer.

I recognize this is anecdotal.

I chose to not do any hormonal therapy when I was perimenopausal and now that I'm menopausal. My sister chose to do some therapy during the perimenopause period to help with hot flashes and other symptoms. She weaned herself off over time.

I will listen to the podcast.

 

[audreyh1]

I think some of the testing was done on women very old for HRT, so I always wondered how that skewed the results.

I had too much estrogen even after menopause, so I’m still on progesterone cream to combat it.

 

[athena53]

Thanks for this reference- I've been looking for a good medical podcast and will check it out.

I use only an estrogen cream for menopausal symptoms- never liked the idea of taking them orally and having them coursing through my system.

 

[davebarnes]

Thanks for this.
My wife's estrogen disappeared from her body at age 39 and she has been on HRT for 24 years.

 

[Amethyst]

About three years ago, I was informed that after age 60, a woman's dementia risk increases on HRT.

My mother was on it for 40 years and she did develop dementia in her 80's. Then again, so did her brothers, who obviously hadn't been taking female hormones.

 

[tmm99]

At my doc's request (and I agreed to his request), I weaned myself off of NHRT (Estradiol patch and oral progesterone) at the beginning of this year. (I'm 61.) I cut my patch by 25% over a few months. It was good for a few months and then, boom! Hot flashes started. I have a fan all over my living room so I can turn one on closest to me when they hit. I also started taking a few capsules of soy isoflavone which seems to help with the frequencies of the hot flashes A LITTLE. I've also noticed that I am much more forgetful and sadly, I feel kind of dry... I may go back to my doc and see if he can do something about that... (Estriol cream??) Another thing I've noticed is that I'm less bloated (my rings are looser).

 

[Aerides]

What infuriates me is the lack of scientific research and understanding on menopause vs. say pregnancy.

You go to your doc with peri/menopause symptoms (even your older female gynos who have been thru it) and it's basically a shrug and a mystery and knowing chuckle that every woman is different, la la la. Hot flashes, crazy hormonal stuff worse then when you were a teenager? ok they say things like try yoga and tea and herbal stuff.

Compare that to pregnancy... I recently searched on books on amazon on pregnancy - over 50,000. On peri-menopause? - 2,000.

 

[Amethyst]

Well, up until a few years ago, menopause wasn't even mentioned in polite company - unlike pregnancy. Shhh, you'll embarrass the men! All I knew about it, I heard from my mom. And mine really was different from hers, and from my sister's too.

What infuriates me is the lack of scientific research and understanding on menopause vs. say pregnancy.

Compare that to pregnancy... I recently searched on books on amazon on pregnancy - over 50,000. On peri-menopause? - 2,000.

 

[MrsHaloFIRE]

This is valuable discussion and I appreciate you bringing it up. Perimenopause and menopause do feel like the final taboo.

 

[2017ish]

DW, who was an obg, is completely comfy with hrt for herself--familial breast ca history notwithstanding. (And when practicing generally informed her patients that studies were more pro than con.)

Surprised that menopause (and peri) are considered taboo by some. Weird.

 

[Vacation4us]

No HRT for me. Mother has had 2 strokes on hormones. Once in her 20’s on birth control and once at 60 with HRT. Not to mention other relatives who have had or passed from Strokes.

The dryness stinks but after 2 years the hot flashes are gone. Sex ain’t what it used to be, which so far is the biggest disappointment. It’s amazing how much my skin has changed in the last 3 years.

Getting old stinks but it beats the alternative.

 

[becca]

My mother was on HRT after having a hysterectomy (which was probably not necessary) in her 40s. She developed dementia in her early 70s and died of a stroke at 79. She did not smoke, was not obese, nor had any family history. I always thought the HRT might have caused her issues and never chose that option for myself.

 

[Amethyst]

I suspect this is the real reason that menopause is not openly discussed. "Dryness," cough cough, is easily treated; but some women simply lose desire for sex.

Sex ain’t what it used to be.

 

[athena53]

The dryness stinks but after 2 years the hot flashes are gone. Sex ain’t what it used to be, which so far is the biggest disappointment.

The Premarin cream works for the dryness. Not cheap and I use it only twice a week- less often than recommended but that dose works for me. Like you, I have few other symptoms. If I'm in an overheated room with no ventilation it will trigger a hot flash but that's about it.

 

[tmm99]

I believe there is a difference between synthetic HRT and bio-identical HRT. Bio-identical kind fits perfectly to our body while the synthetic kind (premarin provera) do not and they tend to give side effects

 

[Born2BRetd]

At my doc's request (and I agreed to his request), I weaned myself off of NHRT (Estradiol patch and oral progesterone) at the beginning of this year. (I'm 61.) I cut my patch by 25% over a few months. It was good for a few months and then, boom! Hot flashes started. I have a fan all over my living room so I can turn one on closest to me when they hit. I also started taking a few capsules of soy isoflavone which seems to help with the frequencies of the hot flashes A LITTLE. I've also noticed that I am much more forgetful and sadly, I feel kind of dry... I may go back to my doc and see if he can do something about that... (Estriol cream??) Another thing I've noticed is that I'm less bloated (my rings are looser).

I had an OBGYN that had me go cold turkey on progesterone due to spotting. In a few months, I was in hot flash hell and had non stop hot flashes that took me years to get under control.

There are estrogen vaginal suppositories you can use that just treat the local area and are not systemic. You don't want so get to dry that you feel like you are cracking in two just from moving around (don't ask how I know!). If doctor won't prescribe, you can order Bezwecken Hydration Ovals.

 

[tb001]

I believe there is a difference between synthetic HRT and bio-identical HRT. Bio-identical kind fits perfectly to our body while the synthetic kind (premarin provera) do not and they tend to give side effects

Have you tried them both? My dr put me on bio identical hrt first and the difference between that and nothing is amazing. I feel like I have my brain back. I’d like to get on a more standard hrt because the bio identical is all out of pocket and $$$. And the studies have all been done on the other, so I feel it’s better known. But I don’t want to go backwards.

 

[audreyh1]

I believe there is a difference between synthetic HRT and bio-identical HRT. Bio-identical kind fits perfectly to our body while the synthetic kind (premarin provera) do not and they tend to give side effects

Yes, I that is definitely part of the problem.

 

[audreyh1]

I had an OBGYN that had me go cold turkey on progesterone due to spotting. In a few months, I was in hot flash hell and had non stop hot flashes that took me years to get under control.

I had some problems with oral progesterone and spotting (in perimenopause), but none whatsoever with progesterone cream.

 

[Freedom56]

My wife has been on bio-identical hormone replacement therapy for about five years. She sees an OBGYN who specializes in this therapy at UCLA. They run blood tests for estrogen, testosterone, progesterone, and DHEA levels and many other markers. She is then prescribed estrogen, testosterone, progesterone, and DHEA in accordance with her blood test to balance her system. So far it seems to be working. The key is finding a doctor who specializes in this therapy and adhering to the protocol.

 

[sengsational]

The key is finding a doctor who specializes in this therapy and adhering to the protocol.

Yes, either specializes or is ready to test and react using the latest science, as opposed to "do what they've always done". I have a feeling many people are being treated (or probably not being treated) in the latter category. That's why I thought that getting up to speed on the latest science using the book or podcast was important.

 

[tmm99]

Have you tried them both? My dr put me on bio identical hrt first and the difference between that and nothing is amazing. I feel like I have my brain back. I’d like to get on a more standard hrt because the bio identical is all out of pocket and $$$. And the studies have all been done on the other, so I feel it’s better known. But I don’t want to go backwards.

I had been on a bio-identical estradiol patch and bio-identical oral progesterone for several years. I tried different types/delivery methods available before setting down with them, including a combo patch (progestin), suppository bio-progesterone, some kind of progesterone device that's inserted in your uterus and stay there for 6 months (I can't remember what is called). I loved my bio-identical estradiol patch from the beginning, but I had a difficult time finding the right progesterone (stomach cramps, sleepiness, strange space-out feeling in the head, etc). But anyway, I wasn't sure if it's OK to be on HRT (even if it's NHRT) at an older age (I'm 61) so that's why I got off mine at the request of my Dr.

I've been off both estradiol and progesterone for about 3 months and I have become very forgetful. It's palpable.

 

[tmm99]

I had an OBGYN that had me go cold turkey on progesterone due to spotting. In a few months, I was in hot flash hell and had non stop hot flashes that took me years to get under control.

There are estrogen vaginal suppositories you can use that just treat the local area and are not systemic. You don't want to get to dry that you feel like you are cracking in two just from moving around (don't ask how I know!). If doctor won't prescribe, you can order Bezwecken Hydration Ovals.

Thanks. I am thinking of going back to my doc and tell him that I'm too miserable without something. It looks like Bezwecken Hydration Ovals is estriol-based, which is a much more benign form of estrogen (less strong compared to estradiol and usually produced by pregnant women). I could mention to him about estriol cream, but overall I just don't feel very good without some estradiol for my brain and I'm definitely losing my pep, but maybe I'm supposed to feel old like that as we age...

 

[tmm99]

I think some of the testing was done on women very old for HRT, so I always wondered how that skewed the results.

I had too much estrogen even after menopause, so I’m still on progesterone cream to combat it.

I read that the estrogen created past menopause is mostly estrone, which is considered a bad estrogen (causing breast cancer) and overweight women have more circulating estrone in their bodies. (Incidentally, synthetic estrogen has a very high concentration of estrone in it.) My obgyn back in California said she prescribes progesterone (without estrogen) to some patients routinely, just for that reason. She might have told me how often (I feel like she might have said once a year for one month), but I can't remember for sure.

Disclaimer: I'm not a doctor but I read "Screaming to be Heard" by Elizabeth Vliet MD years ago. She mentioned that some of the progesterone creams over the counter can be too strong and it could cause some side effects. (I think she mentioned worsening of diabetes and loose joints (more injuries?)) but again, I am not sure. I read the book about 10 years ago.