Transdermal HRT

Posted by vkmov @vkmov, Oct 19, 2023

Many studies have found that transdermal HRT protects and builds bone without all the horrific side effects of many first-line osteoporosis treatments. The patch bypasses the liver and thereby avoids the risks of breast cancer, strokes, etc. Has anyone explored this or discussed it with their doctors?

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

mayblin | @mayblin | 1 day ago

In reply to @gravity3 "Any testosterone and vaginal estradiol?" + (show)

No, not testosterone or vaginal estrogen. Patches and oral micronized progesterone only.

mayblin | @mayblin | 1 day ago

In reply to @drsuefowler "Thanks @mayblin. Those dosages are very helpful. My CTX was 1400 twice on Tymlos, at 3months..." + (show)

I wish you luck in finding a physician who is informed with current info and who can give you an individualized evaluation.

My endo wasn't sure at first. After I got cleared by 2 cardiologists, she gave me an obgyn name at a different organization and send me for a second opinion. When all lights came back green, she is okay with it and even okay with writing a script when I need one. My thinking is the risks of cvd and breast cancer while using HRT need to be thoroughly evaluated by pertinent physicians, not endocrinologists. However, endo is the one to judge what role HRT is playing in the management of your osteoporosis - whether or not it can be used alone or as an adjuvant (add-on) therapy; and how to monitor progress etc.

drsuefowler | @drsuefowler | 1 day ago

In reply to @mayblin "I wish you luck in finding a physician who is informed with current info and who..." + (show)

@mayblin,

I'm glad you were able to get the evaluations you needed to safely take
estrogen. I currently have 3 endocrinologists, the only 3 in this area. One
actually gave me a 1mg estradiol tablet prescription, but that is not what
I wanted. He didn't even ask about the uterus. He didn't even listen to me
when I asked about bioidentical estrogen. I still have a cervix so I think
I am supposed to take progesterone with estrogen. The other two (who are
more competent) are firmly against it. I think I would be more comfortable
with evaluations by other specialists. Unfortunately, the cardiologists
here are so busy that so far I haven't been able to see one. So far, every
time I ask for a referral, I don't get one. I can see a gynecologist. My
PCP asked me to sign a release to one of my endos in response to my
estrogen request. I will see him in 2 weeks to find out what he thinks.

Thanks so much @mayblin for your input. I always appreciate what you write
on the Mayo thread.
Sue

mayblin | @mayblin | 1 day ago

In reply to @drsuefowler "@mayblin, I'm glad you were able to get the evaluations you needed to safely take estrogen...." + (show)

Transdermal E2 patches are definitely more advantageous than oral E2 in terms of minimizing side effects. Ugh you are so close getting the right script. Seeing doctors nowadays is such a challenge that the wait is long and the actual appointments often were so short. We almost need to be 200% prepared to get all our questions answered or issues resolved at one single meeting. Hope you get everything resolved soon.

drsuefowler | @drsuefowler | 1 day ago

In reply to @mayblin "Transdermal E2 patches are definitely more advantageous than oral E2 in terms of minimizing side effects...." + (show)

You are so right @mayblin! Each appointment is like defending a
dissertation. Now I should probably start bringing copies of studies to
support my requests! Unfortunately, my docs often are not up to date on
recent studies. Yes 200% prepared, but then the Dr gets off on a tangent
and leaves the room. Exhausting! Thanks Mayblin for all of your help.

mayblin | @mayblin | 1 day ago

In reply to @drsuefowler "@mayblin, I'm glad you were able to get the evaluations you needed to safely take estrogen...." + (show)

I just realized and wanted to add some more info. You probably know that micronized progesterone is added to the mix of E2 for those who still have a uterus to minimized the risk of uterine lining hyperplasia. Your obgyn would know if you need progeterone in your case.

This link which @gently provided is very useful in that it's a compilation of users' data for women older than 65:
https://journals.lww.com/menopausejournal/fulltext/2024/05000/use_of_menopausal_hormone_therapy_beyond_age_65.3.aspx
Table 3 and 4 summarized risk reduction or increase based on:
Estrogen alone
Estrogen + progestin
Estrogen + progesterone
Then by type of Estrogen, route and dose.

If one uses E2 alone, the adjusted hazard ratio looks very favorable in many risk categories. Hope these info are somewhat useful to you also if you haven't read them.

kper | @kper | 1 day ago

My gyn reluctantly agreed to prescribe transdermal estrogen (.025) and micronized progesterone (100). I'm 63, menopause at 51, so I'm out of the traditional "window". She said she would NOT agree to increase the dose because there is not enough evidence to support any bone health evidence (yet) on people my age.

For those of you who have started HRT out of the standard window (like I am), did you find physical benefits from this low dose (less brain fog, less musculoskeletal pain, better sleep, increased libido, etc)? And how long did it take to notice these benefits? Any negative side effects?

Are there any tests that should be done while on HRT to check for possible negative side effects, such as increased risk of stroke, blood clot, etc?

gravity3 | @gravity3 | 1 day ago

I have had a hysterectomy.
My cocktail includes estradiol patch currently .0375 but will go up a bit more, progesterone, testosterone pellet and estradiol cream to be used vaginally.
Yes, less brain fog, more grounded, terrific increase in libido.