Did you know that it’s best to start treatment with estrogen BEFORE 60? The study that scared everybody from taking estrogen 25 years ago had many flaws. I will review them. It’s estrogene in conjunction with synthetic progesterone, gestagen, that can lead to an increased risk for breast cancer and heart issues. And especially if starting after 60. It’s also very important what kind of estrogen you take. Estradiol, which is plantbased, is better for us than conjugated estrogens. Premarin. Premarin is made from the urine from pregnant mares. The mares are being abused in the process; horrible to read about. And transdermal is better than oral.
Nb! When you take ORAL estrogen, the total hormones become higher. The free hormones must be taken.
Natural progesterone is also better than synthetic. It’s also plant based, derived from the same plant as oestradiol, wild yam. It’s only the natural that is called progesterone, synthetic is called things like gestagen and progestins.
If you still have your uterus, it’s very important to take progesterone when you use estrogen. If not, the uterine wall might become thicker. It seems it’s mostly natural progesterone in pillform that has this effect on the uterine wall. Though my progesterone cream kept my uterine wall normal.
One does not find any increased risk of breast cancer when estrogen is combined with natural progesterone, only when combined with synthetic. Natural progesterone also has a beneficial influence on the cardiovascular system.
Testosterone is also very important for us women, not only for men. It’s important for sexual excitement, the ability to orgasm, muscle strength and our bones. And the ability to hold our water! Anyone having issues with that?😜
We live so long today. But our bodies are made for the Stone Ages. I am sure it was ok at that time, that hormone levels declined after 40. As they dies around that age🤣. But for us, living till 80 and 90 years old, we cannot live without our hormones in all that time.
Hormone replacement was widespread before 1990. But in the mid 90 ies a big study from the US appeared. The Women’s Health Initiative study. It postulated, that estrogen replacement therapy meant an increased risk for breast cancer and cardiovascular issues. This led to a sharp decline in the use of estrogen after menopause. I will examine this study in detail. They have been using a lot of poor quality synthetic hormones in the US. I don’t think they do that anymore, I believe focus is more on bio identical hormones now.
They are real good at making compounded hormones in North America, both in the US and Canada. They have hormones made individually. But apparently there are forces trying to put a stop on that at present. The compounded is something I have envied them “over there” , so that is sad.
They are much better at hormones in North America. Despite the negative estrogen studies coming out of the US, they are better at hormone replacement. Not only estrogen and progesterone, but testosterone as well. It’s much more difficult to get that here in Scandinavia at least.
Estrogen has gotten such a bad reputation. But I just got to have it. I starting feeling so bad when I hit menopause , I became very anxious. A very particular feeling I had not had previously. I have had lots of anxiety in my life, but this was like a butterfly in my chest at all times. It took me a long time to realize that it had anything to do with menopause.
You will probably not believe this. but after I had picked up my first Estrogel containing estradiol, I rubbed some on immediately. Within 1 hour or 2, I felt that awful feeling just slide off. Such a relief! Two years of stress were over. I am not stopping estrogen anytime soon.
I personally don’t use a big dose, about half of the recommended dose on the bottle. Which is 1,5 mg. Mostly because of all the negativity around estrogen. Though I also read, 600 to 700 mcg is a regular dose in many countries. But is estrogen dangerous?
Is estrogen dangerous?
That is what we have been told. But probably not. Please read this article, that I have translated from Norwegian, link to article. It’s a review of the whole estrogen debacle, published in the Norwegian Physicians Association’s journal, Tidsskriftet. It’s easy to understand, written by 3 Norwegian endocrinologists.
It’s a review of the big american study from the 90 ies. The one that claimed, estrogen replacement led to an increased risk for breast cancer and cardio vascular issues, espc. blodclots. They question this study, The Woman’s Health Initiative Study . It is actually difficult to find full text links.
Where does the study go wrong?
Already in 2005, there was strong criticism of the study. For one thing, many of the women in the study had serious health issues. Several had high cholesterol and heart issues. And on top of that, most were over 60. Only 33 % were under 60. Link
What does the Norwegian article say?
The Norwegian physicians point out, that women who started the conjugated estrogen and gestagen used in the study, before 60 (50-59), had a totally different risk profile. There were much fewer incidences of breast cancer and stroke in this group.
Those in the “younger” group on mono therapy, estrogen only, had NO increased risk.
Both groups had less fractures, colon cancer and diabetes. There has been way too little focus on the benefits of hormone replacement. Not even on the obvious, increased quality of life. Which is the main thing.
Several studies have since shown the same thing, that there are many positive effects on health if you start HTR before 60.
Early start has been shown to keep the inner layer of blood vessels from thickening. And a Danish study, Danish Osteoporosis Prevention Study, link studied 2000 women (45-58) being divided into 2 groups. One group recieved hormone reatment, the other nothing. Those who had a uterus were given estradiol and synthetic progestrin, those without, only estradiol. There were fewer fractures in the group on HRT. But they also looked at lots of other parameters. One did not find any increased risk of breast cancer. 18 years later, there were fewer cardio vascular incidences in the HRT group. The risk of stroke and blood clots were the same in the two groups.
And this was with synthetic progestin. Natural progesterone is better for us than the synthetic, see below.
It is really strange that this study has had such an influence, considering how many flaws it had. And the fact that it has been criticized for so many years. And there are so many findings contradicting it. All the same, all this faulty info has lingered. This is a good example of how many doctors operate. they don’t read studies themselves. These myths and superficial conclusions become the common practice. Once it has become common practice, it is very hard to change. So get your shit together, docs, read and think for yourself. I had such a doctor in Rolf Johansen in Spikkestad, Norway, see “My story”. What a difference such a doctor makes!
Conclusion, The Women's Health Initiative Study
- Many of the participants had health issues
- They were “older”, only 33 % were under 60.
- The study didn’t distinguish between those who started estrogen/gestagen before 60 and after 60.
- They used conjugated estrogens and gestagen.
- It was the group starting after 60, and taking estrogen/gestagen who had an increased risk of breast cancer and blood clots.
- For those taking estrogen only and starting before 60, one saw no increased risk.
- The study neglected the positive effects one found, in relation to osteoporosis and colon cancer.
- Did not concider the improved quality of life.
What is conjugated estrogens?
Conjugated estrogens is Premarin. Premarin stands for “pregnant mare’s urine”. It’s a very bad thing. It has 30 different components, only 17% is estradiol. It’s bad both because of how it works in our bodies, but even more because of how it is produced. It comes about through animal abuse.
The mares are kept in tiny stalls, are never let out. they have a catheter at all times, which creates a lot of discomfort, of course. They get little to drink, to concentrate the urine! They are being kept constantly pregnant for 12 years.
There are 19 remote farms in Canada where this abuse is going on. You can read more on PETA’s homepage, here.
I feel bad writing about this. And even worse, plantbased estradiol and estriol is BETTER for us. We humans can be very cruel.
What is estradiol?
Estradiol can be found in both organic and synthetic form. Estradiol is the most active of the 3 estrogens, the other two are estron and estriol. The synthetic form is what is used in p pills, ethinylestradiol. It’s apparently difficult to make p pills with natural estradiol. One needs such large doses that one becomes nauseous, get edema and discharge. But I am thinking, has one tried combining estradiol with natural progesterone, and not gestagen? There is now a pill withbio identical estradiol, where they have managed to bring down the estradiol content. But with added gestagen, which stops the bleeding very effectively.
Ethinylestradiol is difficult for the liver to break down, and it’s very bad for the animals when excreted.
How do they make oestradiol?
They make it from soybeans or Wild Yam. It’s a chemical process. Estradiol is the most potent form of oestradiol. Estriol is much weaker.
Estradiol vs Premarin
There are few studies comparing estradiol and Premarin. I would never use Premarin, knowing how it is produced. But is one better than the other?
Yes. The few studies we do have, shows that estradiol is better. But I don’t think one can draw very categorical conclusions. Estradiol adheres only to estrogen receptors, which is good. Premarin consists of 30 different components, where only 17% is estradiol. It adheres to many more receptors in the body than just the estrogen receptors. Which is a problem.
Estradiol, not Premarin, is positive when it comes to dementia.
In a study they found that in a group of women at risk for dementia, estradiol prevented degeneration of key areas in the brain. The hormone treatment started at menopause. Premarin did not have this positive effect, link to the study.
Premarin causes more inflammation
In a study where post menopausal women were given estradiolcream, Premarin or placebo. One saw that Premarin increased CRP at the same time as it inhibited an anti inflammatory marker in our body, IGF-1. Whereas estradiol had no such negative effect. This is very important of course. If it is one thing we don’t need more of, it’s inflammation. 😱
Estradiol, not Premarin, gave girls with Turner's syndrome female characteristica
In a study with girls with Turner’s syndrome, that is they lack a chromosome and will not develope a uterus, and will have issues with the skeleton. 10 year ol girls were given either Premarin or transdermal estradiol for one year. This is the kind of study that becomes unethical, as there are such positive results for one of the groups.
The group taking estradiol got a marked better bone density. And in the group on estradiol, 66% of the girls developed a uterus. 0% had developed a uterus in the Premarin group. These are enormous differences.
So all in all, I believe estradiol is better in every way. I hope you in North America will rise up against Premarin. Put a stop to this animal abuse. I don’t think many know about how this product is produced. Let’s stop taking it. Tell your doctor how these mares are being treated. Please!
Estrogen and the thyroid
The fact that we women are more prone to thyroid disease, hypo thyroid, goiter and thyroid cancer, indicates that estrogen does play a role in the thyroid’s function. One knows that estrogen increases thyroglobulin, and by doing so, the total hormones, T4 and T3. When taking estrogen, one only sees this effect with ORAL estrogen. Not when using transdermal, gel or patch.
The free hormones are also affected. This is a meta study, saying that oral estrogen does lower FT4, and therby also the FT3, link to PDF.
In healthy, euthyroid women, T4 and T3 increases due to higher levels of TBG binding the hormones. They get a higher TSH, stimulating the production of more T4 to compensate. We hypothyroid cannot do that, of course. Or at least only to a small degree. So we need to increase our dose. But do it based on bloodwork.
You are very welcome to tell me your experiences in the comment section. How much have you had to increase? In the study, they refer to 25 or 50 mcg T4 medicine a day. For us hypothyroid in menopause or after, I believe it is best to avoid oral estrogen. That will be difficult for younger women on contraceptives, but there are other options besides the Pill.
So if you do take oral estrogen, you need to make sure to have the frees tested. We have issues with having them tested here in Denmark. But I guess this is not such a problem in other parts of the world.
They are also looking at how or if estrogen has a direct effect on the cells in the thyroid. And it looks like it does. Here is a review on it, if you want to read more, link to study. i find it quite complex, I must admit.
It does look like estrogen has a direct effect on the thyroid. also on cancer cells in the thyroid, making them grow faster. Not so good.
It might seem a little strange to have a favorite hormone. But progesterone is my favorite. I started using natural progesterone already in my thirties. I don\t think it was very many who did that in Norway at that time. I had heavy PMS. thank God THAT is over 😜 So I tried a compounded progesterone cream. I believe it must have been a synthetic progestin. It’s called progesterone when it is a natural product, derived from plants. And progestin or gestagen when it is a synthetic product.
Anyway, I felt unwell on it. I reatined fluid, got headaches. Luckily I had a friend who knew a lot about health. He was a chiropractor, and alternative inclined. He told me about natural progesterone cream.
I used it for years and years. But after I had a hysterectomy because of fibroids, not really necessary to remove the uterus for that, by the way, I read online, that one should not use progesterone in that situation. THAT IS WRONG. You can absolutely use progesterone even without a uterus. My functional doctor told me this, and now i am using it again. Thank God!
What is so good about progesterone?
It’s so good because it calms a woman’s nervous system. It maintains emotional balance, at the right levels, of course. Too much progesterone has the opposite effect. It also calms the heart. That is very important for those of us who take T# medicine, in one form or another. Many grown women have issues with heart palpitations when taking T3. They cannot get to the FT3 level they really need. In that case, progesterone can be a part of the puzzle to calm the heart. There are also other pieces in that puzzle. I have a FT3 between 6 and 6,5 pmol/L. I have no issues with palpitations or irregular heart beat. Vitamin K has also made a big difference for me.
It’s very good for PMS. If you have a lot of fluid, emotional imbalance, irregular menses or heavy bleeding, progesterone can help. You apply it last 12 days before menses.
How does it work?
Progesterone is made primarily from cholesterol. Most of it is bound, primarily to albumin.
It affects the diuretics. It triggers the catabolic metabolism, that is the break down of larger molecules in our digestion. It makes the smooth musculature relax. That is the musculature in our inner organs. It increases the excretion of calsium and phosphor. It raises body temperature. It is an analgesic and sedative. It has a positive effect on the immune system, relaxing an overactive immune system.
This info is from this study by P A Rigidor form 2014, link . There you can also read all about how it works in pregnancy and the menstrual cycle. I don’t go into that here, as the focus here is more on hormone replacement.
It’s difficult to say how much progesterone to use. Of course, it’s individual, depending on one’s levels before starting.
Us who don’t mestruate anylonger, can use progesterone every day.
You who menstruate, use it the last 12 days of your cycle.
Dr. Lee, one of the pioneers in dosing with progesterone, recommended only 20 mg a day. I used that for many years. At that time, Dr. Lee was the big authority. It also says 20 mg on many of the natural progesterone bottles.
I find it quite confusing, how much to dose. Dr. Hertoughe, the well known Belgian doctor, says 50 mg a day transdermally. In some studies they dose up to 300 mg a day. I believe that is in tablet form. Still, it seems like a lot. But a good overview says 100 mg orally if taking every day, 200 mg if dosing only the last 12 to 14 days of menstrual cycle.
I have started taking 50 mg transdermally. I might have taken even more. I have used a 20% cream from Ona’s the last few months. It’s a bit difficult to dose. I have now learned 50 mg is just a pea size. Ona’s says there should come a 1 ml spoon attached, but I have not gotten one.
Update: I have become very overdosed on progesterone taking 50 mg a day trans dermally. I recently took a saliva test, and the level was way over. Right now I have stopped all progesterone, and will retest. I have been taking 50 mg oral pregnenolone as well, which probably hasn’t helped any. I think these very concentrated creams can be dangerous. It’s very difficult to dose. I will go back to the 20 mg I used to take after my progesterone level has come back to normal. And will make sure to test. Remember, it’s only saliva test that will do when doing transdermal. Not blood test.
I suspected that I was overdosed. I have felt very uncomfortable, very on edge. I have not felt like myself. Also very tired in the morning. Now, after stopping progesterone for 2 weeks, I already feel much better. So don’t do like I did
Ona’s have given me permission to copy this comprehensive list of progesterone products from their home page, https://www.onasnatural.uk/ . I belive they have a US site as well. I am not recommending this company more than others. I have used Life flo, Progestacare and Now foods myself. Now foods is very difficult to rub in, you rub and rub. And you can get it in tablets and vaginal products, like Utrogestan. I don’t understand why it is called …gestan, as it is a progesterone.
Cream or pills?
I was very surprised when I read this article, from SAHAMM, http://www.sahamm.org/transdermal-or-oral-progesterone/. It comes up as unsafe, but as long as you are not using a credit card on a site, that does not matter. It’s just that they haven’t taken care to encrypt the site. It is a serious site.
Natural progesterone in oral form can be difficult for the liver to break down. that was one of the reasons why they made synthetic progestins. But now they have made a micronized form that is more easily absorbed.
In that article, they refer to studies showing that transdermal progesterone doesn’t increase serum levels very much! One finds markedly increased levels in the capillary blood and saliva, but not in serum. There are also studies showing that transdermal progesterone does not have a positive effect on the uterus lining. And that is very important, of course. But it did for me, at least. In Denmark, it is easy to see a gynecologists. They are conscientious about measuring the uterus lining once a year on patients taking estrogen. My lining stayed nice and thin on natural progesterone.
Measuring the uterus lining is a good thing to have done if taking estrogen. If taking progesterone only, it’s not necessary.
Is it important to use progesterone when using estrogen?
Yes, it it very important. The uterus lining can thicken on estrogen. And that is not a good thing. I believe too many doctors are lax regarding this.
I have only used the progesterone cream, so I don’t know how the pills work. The cream works great for me. But it does look like, if you have your uterus, then oral progesterone is safest. If you don’t have a uterus, the cream works very well. Even for many WITH a uterus , I think it is ok. As long as you once in a while have your uterus lining checked. While estrogen is best transdermal.
My uterus lining remained very thin using the cream, though. The gynecologist meant to give me gestagen. But accepted my natural progesterone cream. And as time went by, she was so impressed with how it kept my lining thin, she wanted to know where I got it.
Studies show, that progesterone works just as well as synthetic in terms of keeping the uterus lining thin, link to study on uterus lining
Is natural progesterone better than synthetic?
Yes, it is better for us. Progesterone and progestin behaves very differently in our bodies. The natural binds only to the progesterone receptors, while the synthetic also binds to many other receptors in our bodies.
As we have seen, there is an increased risk for breast cancer when taking Premarin and synthetic progestins. A large metastudy, says, the risk can vary between the various progestins and gestagens, link to the study. But why not just keep away from it?
And in that meta study, it is confirmed, there is less risk for breast cancer if you take estrogen with natural progesterone. They analysed 3 studies, and found, that there was no increased risk of breast cancer when taking estrogen with natural progesterone. When taking synthetic progestin there is an increased risk
Estrogen has a positive effect on cholesterol levels. Synthetic progesterone reduces this positive effect. But NOT natural progesterone.
This is also from the meta study. It also states, that progesterone in menopause has positive effects on the cardio vascular system. Here is the conclusion from the study:
“Progesterone or corpus luteum hormone can be used safely and effectively to treat menopausal symptoms or for hormone substitution in menopausal women, as it constitutes a bio-identical preparation which can be used to correct deficiency symptoms. Administration to achieve the necessary transformation dose for endometrial safety through progesterone can be either continuous (100 mg/day) or cyclical (200 mg/day) for 12–14 days.”
This is an oral dose , it’s different when it’s transdermal.
I have taken most of this section from Dr Westin Childs, link. He has a great post on progesterone, but he does not include the info, that blood tests don’t show an accurate level when one takes progesterone in a cream.
- Moderate weight gain
- Water retention
- Low spirits
- Tension and anxiety
- On edge and irritable
- Tired in the morning
- Pain and discomfort in the legs
- Low libido
- “Not feeling like oneself”
I have several of these symptoms at present, including the leg discomfort. It’s important to test, but here in Europe one often has to pay for hormone testing oneself. And even more so if it is a saliva test.
Testosterone? Isn’t that only for men? No, it’s not. It’s for us as well. And we become low after menopause. Before menopause we actually produce more testosterone than we do estrogen. Half in the ovaries and half in the adrenals, from DHEA. If you have had a hysterectomy with removal of ovaries, then production is cut in half over night. It’s very important to keep the ovaries and the cervix. We also continue to produce estrogen in our ovaries after menopause. . And the cervix helps to keep the urine bladder in place. And this is a big problem after hysterectomy , urine incontinence. I don’t know how well the ovaries keep on functioning after the uterus is out. But if they have been removed, then they don’t function for sure.
Healthy young women produce between 100 and 400 mcg testosterone a day. This is 4 times as much as the estrogen women produce.
Hypothyroidism and testestorone
When it comes to how hypothyroidism affects our testosterone levels, I find the science very contradictory. I really don’t know what to believe. In this Indian study by Saran et al, Effect of hypothyroidism on female reproductive hormones, it says that , in hypothyroid women, both estrogen and testoterone are lower than in thyroid healthy women. This was before they were medicated. Once euthyroid, the estrogen and testosterone normalized. But in this study from Slovakia, by Studen et al, link. they found increased levels of testosterone in those with Hashimotos and low thyroid levels. While those with hashimotos and good thyroid levels have normal, that is the same as the control group of post menopausal women. They did have higher progesterone levels, but they don’t discuss that.
I find these last results baffling. I find that hypothyroid women in general have low libido. So that we should have high testosterone seems strange to me. But anyway, most post menopausal women are quite low. And we have little energy to begin with, most of us at least. And sex has to do with surplus energy. Which we have little of. And us with Hashimotos have an auto immune disease, and that takes the energy out of us as well. If we were given the right treatment from day 1, with focus on the auto immunity, we might not get so tired. But that is not the case for most of us. So no wonder we don’t have that much libido.
I believe we all should be tested for testosterone, and offered some if low. You are lucky in this regard in North America, I believe it is much simpler for you to get your hands on some T.
How does testosterone affect women?
Testosterone contributes to libido, sexual arousal and orgasm through increasing dopamine in the central nervous system. It also contributes to the metabolism, muscle strength, healthy urinary tract, mood and cognitive function.
Did you see that , ladies? Testosterone actually helps us retain our urine, keep us continent. So low testosterone can lead to incontinence in women! WOW! Gimme some of that 🤣
Not to mention all the other things. I am low on testosterone myself. I would love to try some. I believe I will get some from my Norwegian doctor once this corona has passed, and I can travel. I have been taking DHEA for a few years, so hopefully that has increased my testosterone. Remember, half our testosterone is made from DHEA. I just cannot get it measured in Denmark
Deficiency can lead to not wanting to have sex, difficulties having an orgasm, tiredness, depression, head aches, cognitive issues, osteoporosis and loss of muscle mass. AND incontinence.
How much testosterone should I take?
A common dose is 5 mg. I read a study where they dosed both 5 and 10 mg, and found that 5 mg rendered the best results. Sorry, I can’t find the study. Maybe you reading this could tell us what doses and products you are on? There aren’t that many testosterone product for women, we mostly have to use the men’s products. And they can be very concentrated. Of course, in North-America, you can get compounded. Lucky you!
I always advocate for us hypothyroid being optimal on all parameters. When one has a chronic disease. one has to make an effort. And be as good as we can be. All women need to have balance in their sex hormones, of course.
With our often low libido, we hypothyroid should be offered testosterone after menopause. Our low libido affects our relationships. This is very important. We also have quite a bit of osteoporosis. Here, our sex hormones are also very important.
I don’t know if this will ever be a reality. We must struggle on, sisters! We women are strong, for sure.
Thierry Hertoghe, M.D. The hormone solution, stay younger longer. ISBN 978.1-4000-8085-4
Christiane Northrup, M.D. The wisdom of menopause. ISBN 0-553-38409-0
The women’s Health Initiative study. https://www.clinicaltrials.gov/ct2/show/NCT00000611
Critique of the Women’s Health Initiative study, https://www.fertstert.org/article/S0015-0282(05)03422-9/fulltext
A follow up review of the study, https://pubmed.ncbi.nlm.nih.gov/28898378/
Timing of estrogen teraphy and breast cancer This is a very bad review from 2019 that I fear will have a great impact. They don’t understand the difference between various estrogens and synthetic and natural progesterone. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891893/
Hormones and thickening of the uterine wall, https://pubmed.ncbi.nlm.nih.gov/8569016/
Danish osteoporosis study, https://pubmed.ncbi.nlm.nih.gov/8569016/
Estradiol vs Premarin and dementia, link.
Conjugated estrogen vs estradiol in girls with Turners’s syndrome, https://pubmed.ncbi.nlm.nih.gov/19318455/
Effects of transdermal vs oral estrogen, https://pubmed.ncbi.nlm.nih.gov/19318455/
Oral estrogen and thyroid levels, link to PDF
A study saying, FT4 is not much affected by oral estrogen, https://pubmed.ncbi.nlm.nih.gov/1585690/
Synthetic vs natural progesterone and breast cancer, https://link.springer.com/article/10.1186/s13643-016-0294-5
Progesterone in Peri- and Post menopause, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245250/
Trans dermal vs oral progesterone, http://www.sahamm.org/transdermal-or-oral-progesterone/
Effects of hypothyroidism on reproductive hormones, https://pubmed.ncbi.nlm.nih.gov/26904478/
In depth article on estrogen and the thyroid, https://www.hindawi.com/journals/jtr/2011/875125/