HRT Safety

Mayblin, thank you for all your contributions and hard work.
Unfortunately, I have no helpful information. My last dexa was on 6/2024. I had been on a .025 patch for only 2 months. There wasn't a change from the dexa two years previously, 6/2022. I expect the same numbers in 6/2026, after the patch increases to .05 and the added testosterone. The two endocrinologists I went to don't do CTX or P1NP.

I started slowly with a .025 transdermal estradiol patch for 3 months, then .375 for 3 months, and then .05 which I'll stay on. With each new dose, I had breast tenderness. It wasn't bothersome and went away in a short amount of time. I tried 100 mg of oral Progesterone for sleep improvement but alas it didn't happen. I would say my mood was more mellow. I stopped taking it since I don't have a uterus. You can get DHEA with a prescription or over the counter. My systemic DHEA cream is a compounded prescription. There is an excellent local Rx vaginal DHEA but it's expensive, "Intrarosa". Amazon sells a vaginal DHEA "Bezwecken" that doesn't need a prescription. My next Dexa won't be until 2026 so I won't know for sure about my bone health but I'm confident that my numbers will stay in osteopenia (or better?). Try to be knowledgeable about HRT before you see your endocrinologist so you can advocate for yourself.

CTX right before HRT was 793, bearing in mind that I was treated with Forteo and had a high turnover rate because of the treatment. With CTX at a low of 163 currently, I definitely will stick with the current dose. After 6mo HRT, Lspine bmd had a further 8.7% increase, right hip +4%, left hip stable, femur necks 5-6% increase. Prior treatment with Forteo probably was a big factor in the continued bmd improvements. I had an early DXA done for a confirmation that the low dose is adequate.

I'm sure you will see a good downturn in CTX, which is what estrogen is supposed to do. It will be interesting to see how yours results turn out.

CTX right before HRT was 793, bearing in mind that I was treated with Forteo and had a high turnover rate because of the treatment. With CTX at a low of 163 currently, I definitely will stick with the current dose. After 6mo HRT, Lspine bmd had a further 8.7% increase, right hip +4%, left hip stable, femur necks 5-6% increase. Prior treatment with Forteo probably was a big factor in the continued bmd improvements. I had an early DXA done for a confirmation that the low dose is adequate.

I'm sure you will see a good downturn in CTX, which is what estrogen is supposed to do. It will be interesting to see how yours results turn out.

I mistakenly wrote total hip instead of right femur neck on the REMS Echolight increase from T score -2.6 to -2.3 on second Echolight after 10 months. The total hip went from -2.1 to -1.6 on the Echolights. As mentioned I started HRT 6 months before the second Echolight.

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.

***
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.

***

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!

Hi, @alyssa5455 I hope you are having success with your decision making . During a recent regular checkin with my onc, she mentioned a new(ish) type of HRT and it occurred to me this may be of interest to you as well. Duavee contains both estrogen and a SERM, with the SERM eliminating the need for progesterone to protect the uterus. Like raloxifene, the SERM (bazedoxifene) has a positive effect on bone. There is a current study (PROMISE) investigating if Duavee can reduce the risk of developing invasive breast cancer after DCIS. I still have some homework to do regarding Duavee, but thought I would put it on your radar as well.

Has anyone tried bio-identical transdermal estrogen/progesterone therapy and started it at over 70 years old? (Or even started the patch after age 70) I feel like the lack of hormones are wreaking havoc on my body-sleep, mood, energy, vaginal dryness and atrophy etc but I have had limited trials of low dose bio-identical in the past 5 years and have had side effects such as bloating, water retention, PMS-like symptoms and cramping. I’m 71 and wondering after all this time not having estrogen and progesterone in my body (blood tests showed almost none) that my body no longer knows what to do about these hormones! I read the best time to start HRT is right after menopause. I really never had the need to consider HRT until the past 5 years. Thankfully, my daily walks, having been a strong and physically active woman all my life and supplements have kept me from osteoporosis but I am in osteopenia with 2 vertebrae now showing osteoporosis due to arthritis and I cannot even consider osteoporosis drugs because I am extremely sensitive to drug side effects.

Has anyone tried bio-identical transdermal estrogen/progesterone therapy and started it at over 70 years old? (Or even started the patch after age 70) I feel like the lack of hormones are wreaking havoc on my body-sleep, mood, energy, vaginal dryness and atrophy etc but I have had limited trials of low dose bio-identical in the past 5 years and have had side effects such as bloating, water retention, PMS-like symptoms and cramping. I’m 71 and wondering after all this time not having estrogen and progesterone in my body (blood tests showed almost none) that my body no longer knows what to do about these hormones! I read the best time to start HRT is right after menopause. I really never had the need to consider HRT until the past 5 years. Thankfully, my daily walks, having been a strong and physically active woman all my life and supplements have kept me from osteoporosis but I am in osteopenia with 2 vertebrae now showing osteoporosis due to arthritis and I cannot even consider osteoporosis drugs because I am extremely sensitive to drug side effects.