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Effects of HRT: Alone, in Combination or Sequencing
Osteoporosis & Bone Health | Last Active: May 14 2:45pm | Replies (94)Comment receiving replies
@dmshope
I’ve been using transdermal estradiol 0.025mg/day patches and oral micronized progesterone 100mg daily at bedtime.
My endocrinologist and a bone specialist originally advised titrating up to the standard 0.05mg/day patch dose (roughly the equivalent of the CEE dose used in the WHI study). However, when they saw my CTX drop to 302 after just 3mo, they had me hold at the lower dose. By 6mo mark, my labs confirmed that the 0.025mg/day was adequate for suppression. Please note that my 1st year BTMs were influenced by coming off Forteo, with a high turnover rate at the time; therefore, part of those initial CTX changes was likely due to that transition.
I’m nearing the end of my second year on HRT, and my CTX has consistently remained below 120 during second year. I won’t have my next DXA results until later this year to see the formal BMD impact.
Have you finished your Evenity course? If so, you may want to keep an eye on your CTX closely as it can take 6-9mos for estrogen to reach its peak anti-resorptive effect, if you choose HRT route.
There is evidence suggesting that low-dose and conventional-dose patches can be equally effective at preventing bone loss across all post-menopausal ages:
https://pubmed.ncbi.nlm.nih.gov/8706298/
I believe @debbie1956 used the same dosing as mine and I’ll tag her here. I’ll also tag @teb who has been on HRT for quite a long time and shared similar experiences in the past, just in case either of them has a moment to chime in with their experiences.
Replies to "@dmshope I’ve been using transdermal estradiol 0.025mg/day patches and oral micronized progesterone 100mg daily at bedtime...."
@mayblin , Yes, I recall you starting the estradiol patch and micronized progesterone around the same time that I did, approaching 2 years ago at age 67, and that we were on the same doses. My response has been very similar to yours. To CTX tests since starting show that the CTX has come down from 688 to close to 100 within a year. This is a phenomenal reduction as I have never taken anti-resorptive nor anabolic osteoporosis medication. My t-score spine bmd went from -.3 to -2.6. I am due for another bone scan soon as well to see if these gains have held or maybe further improved. When I began HRT, my greatest hope was to stop my staggering progression of bone loss, so this gain was an unexpected bonus.
@mayblin I so appreciate all your extensive research and studies that you post for us. I just read your PubMed study on low dose transdermal estrogen for women of all post-menopausal ages. This was such an encouraging study to read and really affirms our experience of Estradiol patch 0.025 with micronized Progesterone 100 mg. There seems to be very few studies on HRT for women over 67.
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@mayblin
Thank you for the detailed and kind response. That gives me guidelines.
I went off Evenity at 11 months due to no reponse ( no dexa improvement) and continued fracture ( lower limb). It may not have been the evenity as much as the sequencing of evenity so close to tymlos and after a course of actonel. Evenity after tymlos has lower effectiveness but still should have some effectiveness.
I am hoping the HRT will improve cortical bone and nourish my body and manage normalizing CTX but as we know CTX increases with a fracture to promote healing; so we will have to moniter this and figure out what is best.
Good health to you.