HRT Safety

@mayblin that doesn't make sense to me. The part where you say:
"The cardiologist I consulted said if ldl-c can be controlled under 55, there will be little chance for more plaque to build up. Also, both cardiologists like statin therapy to be in place (to stabilize any existing plaques)." I might disagree. If one has CAD Coronary Artery Disease, that may not be true. I am now on LEVEQIO, which is a notch up, which did lower cholesterol and stopping plaque deposits. Plaque deposits with artery diseases are not entirely controllable, is my understanding without added measures. Keeping cholesterol in line is part of it. Statins are part (I can't take them), drugs like LEVEQIO, exercise and low fat diets.
Happy Valentine's Day! No fatty steaks for this girl! I love restarting the BHRT since last fall! I'm sure the hormones will help with the accelerated bone deterioration experienced after stopping the HRT, at 58, when the old info said we should after being on it for 8 - 10 years. Now we can restart at any age, too!

Dear @debbie1956, @mayblin , and @newenglandtransplant. Thank you so very much for your kind, thorough, and thoughtful responses!

Debbie1956,
Great idea to consider working with a naturopath and especially certified by NA Menopause Society - I had not thought of that and will look into it.
Indeed, I have learned how BHRT transdermal and micronized progesterone can be safe tho have risk of blood clots.
Also helpful to be reminded to ensure I include a plan for the appropriate frequency and type of testing such as lipid panel, CTX - turnover/resorption, coronary artery, vitamin d, ++.
Sorry to hear you had a vasculitis autoimmune condition and needed Prednisone - can only imagine the side effects and impact on bone integrity.
I also have only been learning about the REMS Echolight test so need to ask about that.
So incredibly frustrating to think that you could have avoided so much trauma and the same for me if the WHI study had not mislead a whole generation.

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Newenglandtransplant, just a quick note - my mom had invasive lobular breast cancer. I am very glad your regimen includes bi-annual MRI and Mammogram screenings. please consider adding, if you don't already, always telling the technicians about your LCIS. My mom's gyn detected the tumor during a routine annual breast exam. It turned out this had been evident on mammograms in at least one prior year, but had been overlooked. By then, the tumor was stage 4. I recently read an article reminding that technicians and radiologists have varying skill levels and and moments of attentiveness (like anyone) and supervising radiologists can sometimes sign off without checking the scans. I know this sounds paranoid, but we were told later that "lobular masses are difficult to see on scans." Maybe the doctors were just trying to protect the radiologist from litigation (which we did not pursue for many reasons). Just please be extra vigilant.

I am now seeking new providers, will look for a breast clinic, and will ask about anabolic/bone forming medications. My lowest dexa score is -3.3 so I don't see why my endocrinologist was so ready to just have me wait and see, only ensuring osteo-specific exercise and vitamins.

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Mayblin, thank you for sharing the study - extremely helpful. Such a reassuring statement: "A thorough literature review affirms that, in postmenopausal women, estradiol (E2) effectively relieves vasomotor symptoms and symptoms associated with the genitourinary syndrome of menopause, that is, vulvovaginal atrophy symptoms, while maintaining bone mineral density. The evidence also supports that estrogen–E2 is associated with decreased breast cancer and cardiovascular mortality."

I will definitely look into and ask about Evista (raloxifene).

I keep seeing references to "prior history of cancer and/or breast cancer or family history of either" often negates candidacy for HRT, and I know there a studies showing increased likelihood of recurrence, but I have not yet come across a study showing use of the newer forms of HRT and increased incidence of breast cancer. It certainly makes sense to consider this, I just would like to see more data so will keep looking.

I do understand that my primary focus of treating Osteoporosis is not aligned with the current prescriptions of HRT. I just want to try to avoid missing out on something that could at least maintain my bone density/integrity while also boosting the many other organs and systems that so heavily relied on hormones pre-menopause.

Thank you again to all three of you and I will stay involved here to share updates and see if I can help support in any way.

All the best for now!

I agree with @newenglandtransplant regarding consideration of an anabolic, especially if your DXA/TBS or frax score indicate the need for bone building. Either HRT or raloxifene are mainly for bone preservation- they might increase bmd somewhat in the first few years but they are not going to build meaningful new bones. Check with your endos.

@loriesco thanks for your inquiry and comments. Hope bHRT works wonders for you as it has for me so far!

At the beginning I thought I had little chance of being a candidate for HRT due to my existing mild cad. My regular cardiologist approved on the same day after I visited my obgyn inquiring about HRT, but he is a man of few words... At the recommendations of several physicians, I consulted another cardiologist who specializes in women's heart. After reviewing many years' worth of tests and labs, my medical history and family history, she explained to me - I don't have a genetic backgroud for cvd (my LPa is 10 and no family history of cvd from either family tree), my cac score is 38 which indicated late stage of atherosclerosis but she was not alarmed by the number (the score might have also been increased a little since it was done 1 yr after I took resuvastatin), my LDL-c is well controlled at around mid-30s and APO-B at 50 (i do take rosuvastatin 5mg + ezetimibe 10mg). So the plaques will be there forever (!), however, with well controlled LDL-c, HbA1c and low genetic risk, she felt confident that future plaque accumulation will be kept to a minimum and that adding HRT won't emerge as a threat to worsen my existing cad. I had read also that people who kept their LDLc in the 30s/40s throughout life had very little plaques accumulation overall (well, their LPa and APO-B had to be low also as these two are more atherogenic). Statins are said to stabalize soft plaques which is important especially for the first year use of HRT. I had that in place so she was glad about it.

The past few years had been a challenge to modify diet, life style and exercise regimen to get my metabolic health in order, and to top it off, wrestle with osteoporosis. Yes, no more fatty steaks, in my case no more truffles or pastries! I've learned to enjoy sweet moments in life other than sweets. HAPPY ♥ Valentines!

@kper , My situation is very similar to yours. I am 68 now and began BHRT low dose estradiol patch with 100 mg micronized progesterone at 14 years past menopause 7 months ago (age 67). Like your doctor, my NA menopause certified naturopath said she would not be increasing the dose. Like you, I notice improvements in my sleep and thinking. My main reason also for using BHRT is to preserve my bones and hopefully avoid medication. My REMS Echolight showed good bone quality still with borderline low fracture risk in April of 2024 despite my -3 spine T score and -3.5 DEXA score. I am scheduled for another Echolight and will request another DEXA with TBS to check my scores now. I will have another CTX bone turnover marker done as well. If I am preserving bone, I hope to remain on BHRT for the longterm. I also take supplements, greatly increased my daily protein, greens etc. walk daily and do some weight resistance. The naturopath provides guidance with this and I also follow Keith McCormick's "Great Bones" book.

You got it going on @mayblin! Yes, with your LPa being 10 you "don't got it." (CAD/CVD) but I do. And my test score from last night went in the wrong direction! (was stable at 66 to 88!) One test of what is in your bloodstream isn't predictive and it can also be the LEVEQIO LOOSENING the plaque and dumping it into my bloodstream, so you bet I'll keep an eye on it. Also the BHRT could be a factor and I will inquire about that. However, I interpreted this to not worry about it too much at the moment. You might appreciate this article. https://www.acc.org/Latest-in-Cardiology/Articles/2019/07/17/11/56/Menopause-Hormone-Therapy
I've been sitting at my desk too much lately with work. Weather has been bad, too (I hate cold) and so I figure if I exercise outdoors a bit more I will get things better under control on all fronts. Yeah... a little dark chocolate was on my Valentine's Day list. Quality of Life, you know! I have to keep a low-fat diet on a regular basis. Gallbladder issues run in the family. My terrier has pancreatitis so we eat the same diet.

I'm 63 and 12 years post menopausal. No hormone therapy the last 12 years. I finally found a doctor who would prescribe a low dose (0.025) estradiol patch and 100 mg micronized progesterone. She said she would not be willing to increase the dose. I've been on this for about 5 weeks and have some very minor improvements in my sleep, thinking, vaginal comfort - minor. My question is if there is anyone out there who started MHT past the 10 year traditional recommendation, at what dose did you start, how long did you stay on it, did you increase at any point? My main reason for using this is to preserve my bones. What dose is recommended?

Hi @kper I started HRT at 61 and was 11 years post menopausal at the time. My hrt dosage and forms are exactly like yours. My bone markers and dexa so far have shown that the dosage is working for me as a follow-up for Forteo. As of now, i won't be adjusting doses unless otherwise indicated. Since everyone responds to medications differently, maybe you could use periodic bone marker testings and yearly dexa as monitoring tools?