Transdermal HRT

@rjd
Actually, I take BHRT topical and vaginally. HRT is a term for all hormone plans with BHRT being one of them; HRT is more commonly associated with synthetic hormones, but like the terms progesterone and progestin the terms get muddled.
If I am a "cheer leader" as you name call me, then I am a cheer leader for bone health and hormonal health in the safest most conservative way possible. I have nothing to gain from people using BHRT or strontium, I post hoping that my story will help others.
You ask: "So how do you know that you won the 'bone lottery' with strontium if you are being treated with both HRT and strontium"
Answer: because I seem to be the only one on Inspire who is taking HRT or BHRT while on strontium and all of them have had similar results. Plus, all the research on strontium shows similar results to what I have had.
So you don't like research, or you have a prejudice against AI giving research? Plus, you are asking personal questions; AI does not research me personally so your statement against AI is moot and serves no logical purpose in this context.
I do not find research overwhelming, and AI with all its potential faults is an amazing tool to locate research at a moments notice. I am sorry that the brief post listing of research and information which AI provided overwhelmed you. I suggest you just skip what you find overwhelming, that is what I do in long reseach articles. Ha, or I ask AI to give me the conclusions thru the window which I am researching. Now that is a thought you might post the reply which you find overwhelming into copilot and ask for it to condense it down for you. 🙂
Here are some posts which you may find more readable:
Inspire stories of strontium users:
https://www.inspire.com/m/Kathleen1314/journal/d69831-strontium-users-stories-3-alternative-to-pharma-meds/
Compilation of strontium research and posts:
https://www.inspire.com/m/Kathleen1314/journal/8af3d2-what-s-actually-working-for-your-interstitial-cystitis/

@wondering1
In some cases of extremely high progesterone may cause breast tenderness due to fluid retention, but usually this is a side effect of estradiol which produces a sharper tenderness contrasting with the heavy swollen feeling of progesterone overstimulaton.
But....
Since you began to bleed after you changed your progesterone to a cyclical schedule that leans towards the idea that your estradiol is too high or you are sensitive to estradiol.
Estriol might be a better match for you with the progesterone reinstated at a lower level if the hormone tests indicate a need to actually lower progesterone.

How is your doctor checking your hormone levels? I ask because topical hormones will not show in serum testing accurately. For topical hormones you will need a saliva test.
AI Overview, based on the current practices and research which it analyzed:
Saliva testing is considered superior to serum (blood) testing for monitoring topically applied (transdermal) bioidentical hormones because it measures the bioavailable, free hormones that have entered tissues, whereas topical hormones often do not show up accurately in blood serum. Topical hormones, particularly progesterone, tend to accumulate in subcutaneous fat, making saliva a more direct reflection of tissue absorption and reducing the risk of over-dosing.
\https://coyleinstitute.com/saliva-testing-vs-blood-testing-for-hormone-levels/#:~:text=In%20the%20body%2C%20almost%20all,use%20by%20tissues%20and%20organs.

Yes, I think I will ask about the cream. Unfortunately, although the clinic gets good reviews from those I have contacted, the doctor there is really pushing the pellets. I suggested the creams and she shot the idea down as a bad idea. However after talking to my PCP, he suggested that the creams can be adjusted, but the pellets are in there for 3 months. The clinic has a monopoly on BHRT in my area. And they have no shortage of clients. I believe I will stand my ground about the creams vs pellets, even at the risk of the doctor not helping me.

@kathleen1314 , thanks for your thoughts on this! All my levels are being checked via blood tests. I'm taking estradiol via the patch...does that count as topical? My progesterone is oral.

The breast tenderness really seems to be linked to progesterone. When I lower progesterone dose, the breast tenderness gets better. My provider says based on my blood levels, I seem to take up progesterone at a higher rate than she sees in most of her patients.

My provider has been looking at the ratio of progesterone to estradiol and wants my progesterone lower compared to estradiol. In researching this ratio, I've been unable to find anything much on an ideal ratio. Dr Doug Lucas does mention it, but I haven't seen it anywhere else. Do you know of any research related to this?

@wondering1
Yes, the patch is considered a topical transdermal application.

Some sources say Progesterone to Estradiol ratio should be:
In saliva testing, the optimal ratio of progesterone (Pg) to estradiol (E2) in healthy, cycling women during the mid-luteal phase is generally considered to be in the range of 100:1 to 300:1, or up to 300 times more progesterone than estrogen. This high ratio reflects the crucial need for progesterone to balance the effects of estrogen. I also found this in research to be an optimum level.
According to ZRT Laboratory (Salivary Steroids) and related clinical guidelines, the optimal salivary ratio of Progesterone (Pg) to Estradiol (E2) during the mid-luteal phase is generally considered to be 100 to 500. This ratio helps balance the effects of progesterone against estrogen, with a ratio below 100 often indicating estrogen dominance.
The saliva test will spell out the ratio with the results from the saliva test.

Hormones testing is one of those changing, evolving tests. In the past, all hormone tests have been so iffy in all venues, saliva, serum etc that doctors went mainly by symptoms. The problem is many of the symptoms like breast tenderness can apply to more than one hormone although estradiol is usually the culprit. Saliva testing in particular is evolving, probably lead by saliva testing being used for some many other things like cancer tests,measure biomarkers for inflammation, cardiovascular risk, and diabetes etc. etc But...many doctors were trained the old way to only use serum....this is before topical HRT began to be used so frequently....and now the research is saying that the serum will not pick up the transdermal topical accurately. Doctors are still catching up and hopefully the tests will be transformative for all of us sooner than later.

The below might be very helpful for you.
Here is some research with amounts of estradiol and an oral progesterone.
https://www.ncbi.nlm.nih.gov/books/NBK493191/.
copied from the above research "Micronized progesterone 100 mg to 200 mg orally nightly is an excellent starting point. With a standard dose of 0.05 mg estradiol daily in patch form, 200 mg of daily micronized progesterone protects the endometrium. With lower doses of estrogen, lower doses of progesterone may be adequate"

Also, great news in one of largest population studies of hormones ever done the progesterone group was the only one that showed a 0%increase in breast cancers.
https://cemcor.ubc.ca/resources/does-taking-progesterone-alone-or-estrogen-increase-womens-risk-breast-cancer/

@kathleen1314 , thank you for this very helpful info!

@smodesitt
Yes, hormone replacement therapy (HRT) can be taken with Forteo (teriparatide). Indeed, studies indicate that combining them may lead to greater increases in bone mineral density (BMD) compared to using either treatment alone. Combining these treatments acts on bone formation (Forteo) and resorption (HRT), showing significant improvements in spinal and hip bone density.
https://pubmed.ncbi.nlm.nih.gov/16418784/.
"Conclusions: Adding teriparatide, a bone formation agent, to HRT, an antiresorptive agent, provides additional increases in BMD beyond that provided by HRT alone. The adverse effects of teriparatide when added to HRT were similar to the adverse effects described for teriparatide administered alone. Whether teriparatide was initiated at the same time as HRT or after at least 1 year on HRT, the incremental increases over HRT alone were similar."
Let me suggest that you do some research about the safest way to use HRT. The research will show over and over that BHRT topical, vaginal, non oral are the safest ways to use hormones.

@seapen Me too! I might ask about a tiny dose of testosterone to go along with Menostar.