Should I continue HRT?

Posted by lisaasnead @lisaasnead, Mar 10 10:40am

I am a 63-yr old woman that started HRT 6 years ago because of hot flashes. Initially I was taking estrogen orally. After a year I had a lump in my breast (benign) and decided to stop. My hot flashes came back within a month. I then started HRT by pellet, including estrogen, testosterone and progesterone (the progesterone was sometimes by pellet and sometimes orally, based on availability). My body took some time to adjust and to get the dosage right. After each insertion, I felt like I had PMS: gained 5-6 lbs which I slowly lost over 3 mos, bloated, swollen ankles, etc. This lasted for maybe 9 mos and after that I felt great! At one point I tried troches because the pellet insertion was always painful and sore for me. This resulted in spotting, which then required a uterine ultrasound and biopsy (everything fine). Later I decided to go off testosterone because of hair loss and at the same time, my doctor reduced the progesterone (without my knowledge) while keeping the estrogen the same and the spotting happened again. Now, I have switched docs. Had ultrasound and found a cyst on my ovary. She wanted to wait 3 mos to do a 2nd ultrasound before deciding to do a biopsy. Then, I started spotting again. Did biopsy which was negative. I think that this last spotting is due to my decreasing estrogen level since it has now been almost 5 mos since my last dose. Having a hard time getting advice from the PA as to whether to return to HRT. Awaiting results of my estrogen levels. I am concerned that if I wait too long, I will be starting all over again and have the same problems adjusting to it. Of course, if the hot flashes come back, I suppose that makes my decision for me. Curious if anyone else has had a similar experience, and how you handled?

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mcchesney | @kathleen1314 | Mar 11 11:49am

Just as a background, I have used hormones since my perimenopause and now I am in my 70's. I have my ovaries and uterus. I have researched and used many forms of HRT and found that BHRT, estriol, etc, topically and vaginally works well for me. I have bled in the past from using estradiol which caused a uterine hyperplasia with bleeding.

Your story is one that I have heard over and over again, especially with women who still have their uterus/ovaries. It seems that our bodies are more sensitive to any HRT plus our bodies may still be making hormones and our bodies react to hormones quicker and with a stronger reaction than women who do not have a uterus/ovaries. Plus, as per my gyn, even women with uterus/ovaries, some of them are not as sensitive to HRT interventions. It seems to be a very individualized reaction, and you must adjust based on your own body.

Doctors are used to prescribing for women without a uterus/ovaries and the pharma drugs are geared towards women without a uterus/ovaries, stronger estrogens like estradiol and less emphasis on progesterone, all which is more what a woman without uterus/ovaries might need or a woman whose body is less sensitive to hormone changes.

Also, hormone testing is not recommended by many menopause groups, so doctors don't use them as much. Using symptoms alone is difficult because the same symptom may appear with too much or too little hormone.

The reason that hormone testing is not used as much is because hormone testing in the past, especially saliva testing ,has not been the best for in particular, progesterone and estradiol , but that is changing with new testing procedures and standards. IVF clinics especially are using saliva tests more and more. Salvia already is the gold standard for cortisol testing. For women with topical hormones, saliva is the only one which checks hormones at the cellular level where the hormones are being used.

The 3 main types of hormone tests are saliva, serum, and the dutch test. Serum is not considered the best for topical because it does not check at the cellular level, saliva in the past had concerns about testing of especially progesterone, Dutch testing seems a good way to especially monitor for diseases like cancer, but the cost has been prohibitive and the cellular level of analysis is suspect.

So with a doctor who uses hormone testing and especially BHRT and the lower estrogen like estriol you should do much better, with the good results for which you are looking and without poor results like bleeding etc.

So I suggest that you call your local compounding pharmacist and ask for a few names of doctors who use BHRT, estriol, and hormone testing, especially saliva testing, personal recommendation based on my research and years of experience.
Or use this ZRT provider search to find compounding pharmacies etc https://myzrt.zrtlab.com/tools/findprovider

Personal story: Every time I have used estradiol in the past, I have bled. I found a doctor who used saliva testing and surprise I was making my own estradiol and testosterone so I was being over medicated with the estradiol prescription. So I have used estriol, progesterone and a small amount of testosterone, topically, vaginally for years. Just recently at the age of 73 my estradiol/testosterone fell for the first time in my testing life, so I am trying a low, low dose of estradiol which I have recently had to half. All of this led by my saliva test results and my symptoms, analyzed by my doctor and by the doctors and techs at ZRT. Testing and symptoms taken together with good doctors are the secret for me personally.

I also suggest that you find a good gyn that will do ultrasounds on you, maybe every 6 months. They have been invaluable to me, for peace of mind and to monitor my prescription. Too much estrogen and the uterine lining will be too thick; too little and the lining is too thin....both which as you know may cause bleeding. So keeping the lining about 4mm to 5mm is where I aim and adjust my hormones to reach. The saliva test adds another layer of checking which helps also, especially with a systemic analysis.

So yes, I think that correct BHRT will add to your life and give your better health, but it may take some time to find the best doctor and the best combo for you. Plus, that combo will change with time as you age so regular, hormone tests and ultrasounds will help you monitor and keep levels where they will help you and not cause you to wonder if all of this is worth "it".