Abstract
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, it can be difficult to 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!
A reader alerted me to this important aticle on the The Women’s health Initiative study, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415400/. It’s very disconcerting info.
I thought those conducting these studies, just didn’t know better. That they were poor scientists and doctors. But reading this article, I realize, they deliberatly misled the public as well as doctors. One person in particular, Dr. Jacques Rossouw, chief of the WHI branch at the United States National Institutes of Health, seems to have had an agenda.
“Highly unusual circumstances” surrounding the early termination and reporting of the Women’s Health Initiative (WHI) estrogen-progestin trial in 2002 resulted in “misinformation and hysteria” that persist today, says Robert Langer. He was lead investigator of a WHI vanguard site and involved in early leadership of the study, including as chair of the principal investigators committee.
“Good science became distorted and ultimately caused substantial and ongoing harm to women for whom appropriate and beneficial treatment was either stopped or never started,” Langer wrote in a recent review in Climateric.
In June 2002, Langer and other WHI investigators gathered at a semi-annual meeting in Chicago, only to discover that the estrogen-progestin trial was stopping early. Langer says the decision was “based on a finding of likely futility,” not harm. But an initial results paper and press release — written in secret by a small group of study executives — cited an increase in breast cancer as the main reason for terminating the trial. It also cited an increase in heart attacks.
However, “the study results were not statistically significant for breast cancer harm,” or for heart attacks, says Langer. In fact, the only significant findings were an increase in venous blood clots and a reduction in hip fractures
So one group wrote a paper in secret. And released it. Citing results they hadn’t found. I mean, it’s shocking. And the impact this has had on us women!
But Dr. Jacques Rossouw defends this. He says:
“We knew that this was an important finding,” Rossouw says. “We wanted to make sure it got the widest possible exposure, and we achieved that objective. Now, were we wrong to do that? We feel that we had little alternative because we needed to change a practice that turned out to be incorrect.”
Rossouw agrees that many women and doctors now believe that “hormone therapy in general is dangerous,” even though the risks in younger women “are indeed extremely low.”
“The WHI, including myself, have somehow been blamed,” but the backlash “is not in our control,” he says. “It’s the professional societies to which these doctors belong that need to make sure that practice conforms to the evidence.” Rossouw also faults the media for using “headlines that scare people because it gets hype.”
That is pretty rich. You publish sensational results that you know is not true in order to stop the HRT treatment for women . Without having any heavy evidence that it’s harmful. Then you blame the media and the doctors! And you are not even embarrased or ashamed. It’s difficult to take in.
It’s a short article. Read it if you suffer from too much respect for doctors and scientists.
I do believe though, as I think I show in this article. Conjugated estrogens and synthetic progesterone are not that good for us. But scientists should look more to p pills than HRT. Anyway, no need to use these substances in menopause, as we have estradiol and natural progesterone.
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.
- They reported results they didn’t find.
- Did not concider the improved quality of life.
What are 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. And of course, estrogen plays a negative role in breast cancer. But that is especially when one is iodine deficient. Iodine is very important for breast health. Please have a look at my post, Iodine for nerds
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 retained 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.
Dosing
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 orally/day. 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 had started taking 50 mg transdermally. I might have taken even more. I had 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.
I got tired and had that strange feeling of not being myself that is typical of too high levels of progesterone. I felt on edge and irritable. My saliva progesterone said 1947 pg/ml. Where a normal level for a pre menopausal woman is 30,3-6,4 pg/ml in the follicular phase and 87-544 pg/ml in the luteal phase.
I have seen very high doses adviced in some Facebook groups on female hormones. I can’t understand that that is a good thing. I feel very unwell with very high levels. It’s not natural for the body.
I stopped supplementing for a few months and retested. 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. Remember, it’s only saliva test that will do when doing transdermal. Not blood test.
There are many progesterone creams. I have used Life flo, Progestacare, Now foods and Ona’s natural myself.
You can get progesterone in tablets and vaginal products, like Utrogestan. I don’t understand why it is called …gestan, as it is a progesterone. -gestan is the name for synthetic 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. 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.
Progesterone overdose
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
- Dizzyness
- 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
Testosterone deficiency
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
ESTROGENS IN MENOPAUSE, time to change the recommendations?
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.
Premarin and animal cruelty, https://www.peta.org/issues/animals-used-for-experimentation/animals-used-experimentation-factsheets/premarin-prescription-cruelty/
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/
Important article with strong critique of The Women Health Initiative Study, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415400/ . They actually lied about the results of the studies in order to get publicity.
Gosh, Liv, you are so generous with your time and effort: this site is such a well-researched mine of information!
I agree with you about the misinformation as a result of the Women’s Health Initiative. It’s heartbreaking to think of the generation of women who suffered unnecessarily – you and I both know from personal experience the importance of MHT to quality of life.
You’ve read this, I’m sure, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415400/
“Trial overstated HRT risk for younger women: A principal investigator of a landmark women’s health study says initial results that linked hormone replacement therapy (HRT) to breast cancer and heart attacks were misleading and distorted for publicity. Others involved in the study claim the findings were merely misunderstood. Fifteen years on, a new consensus about risks and benefits is emerging, but too late for a generation of women who abandoned or avoided HRT due to reported risks.”
I feel very fortunate to have learned about MHT when I did (albeit much later in perimenopause than I would have wished). There’s still a huge job to do in educating women about the changes they are facing, how early they can start, what symptoms may be, and the widespread benefits of MHT, but my god it’s so much better now than it used to be.
I use transdermal estradiol and a micronised progesterone – and don’t plan on stopping anytime soon! I’d really like to try testosterone too, but even here in the US it’s not widely prescribed. SOME doctors are well educated about the benefits, many are not – and actually refuse well-educated patients who request it (I vehemently disagree with this).
Anyway, just wanted to pop in and say thanks 🙂
Hi Sarah!
Thank you for those encouraging words. We agree on this. I see so many women who still believe these things. And they have been told by their doctors. No, I had not read tat article, and I am a little shocked by it. The Norwegian doctors writing that article critiquing The women health initiative study do not refer to it either. Their article is from 2018, and this is from 2017. I thought we talked about ignorance and sloppy science. But to read, that it was deliberate deceit is shocking to me. That Dr.Jacques Rossouw clearly had an agenda, and misled to achive it. I have incorporated it into my post, so thank you for that.
I too use an estradiol gel and a micronized progesterone cream. I have reduced my estrogen dose as I grow older. I am now 66. I can feel it in my breasts when I get a little too much estradiol. I personally do not want pre menopause levels of estradiol. When it comes to breast cancer and all kinds of fibromes and cysts in breasts and uterus, iodine is so important. Japanese women have so much less breast cancer, and it’s because they get much more iodine than us. I have a lot of info on iodine, it’s not something you take without reading a little about it. For those only wanting to
smaller doses, this post it enough, Iodine for beginners
I thought it wasen’t that hard for women to get some testosterone if deficient in the US. I hope the day will come when looking at the testosterone level in people with thyroid disease, will be a natural thing. Seeing as we have lower levels, I don’t undestand why it is so difficult to get some. But very few doctors know that this is an issue that is connected to thyroid disease. Make sure that your DHEA level is sufficient.
All the best, Liv
Ona’s natural progesterone cream does not require a doctor’s prescription. Where I live, Australia, the product cannot be provided without a prescription. Could this also be the case in other countries?
Hi Marion!
I can’t really answer that. I think it is prescription free in many countries. It’s legal to import here in Denmark. One can also get a prescription, but not for the cream. in the US it can be bought over the counter, but they also have a lot of compounded, personally tailored hormones. What’s important when getting a prescription, is to make sure, it’s natural progesterone. And not gestagen or progestin. Iherb carry both Lifeflo and Now progesterone.
All the best,Liv
What an information packed article! The chart with brands and prices will be helpful when I make my next purchase. I’m 18 years post menopause and use bioidentical estrogen, progesterone and testosterone creams. Some doctors suggest stopping estrogen and progesterone 3-4 days per month to clear cell receptors others don’t. What are your thoughts about that?
Hi Betty!
It’s a very good question. I cannot find any science on it. I just rub on every day of the month now I am 63. I kind of wonder at the premise, that the receptor would need cleaning. Why? Do they get cleaned naturally, I mean when people don’t take hormones? What about the thyroid hormone receptors? Or any other hormone receptor? Oftentimes these medical myths are created and perpetuated. But if someone has any good info on this, please let me know.
I went back to Dr. Lee. Of course, it’s 25 years old info. But as far as I know, he was the one who made us aware of progesterone’s vital importance.
For those menstruating, you use between day 12 and 26, counted from first day of menstruation.
For women in menopause not on estrogen, he recommends using 14 to 21 days of the month.
For women in menopause on estrogen, he advices halving the estrogen dose as you start progesterone. He says that otherwise one can get symptoms of estrogen dominance. He advices halving the estrogen dose once more after 2 to 3 months again.
Then using progesterone and estrogen together for 21 to 25 days a month. After this periode, stop dosing for 7 days.
Dr. Hertoghe advices using estrogen and progesterone for 25 days of the month after menopause.
So they both advice this intermittent dosing. I had actually forgotten about that. I think I will try it myself, see how I feel. I have done it many years ago. I think I will try 25 days on, 5 days off, following the calendar month. That little estrogen that dr. Lee advices is too little for me. I think I take app 750 mcg a day. I use a gel, so not that accurate. I also take more progesterone than he advices. He says 20 mg. I used to do 20 mg. Now I get 50 mg in a cream. I think 20 mg transdermal is too little. But you are lucky enough to get this compounded. And testosterone as well. Lucky you! We are so far behind here in Scandinavia.
This was maybe not so helpful. We must continue to investigate and try things out. Maybe someone reading this has something to add. Dr. Hertoghe’s book is really good. He also lists what mode of administration is more effective on all the hormones. He is talking about all hormones in his book. I recommend it. I believe I list it under “References”
Blessings, Liv
UPDATE
I tried the stopping for 5 days last month. By day 4 I felt crappy. Antsy, my hearth was nervous. That schedule is not for me. I might stop 2 days every month. I guess it would depend on one’s levels. Even though I apply hormones every day, I don’t think my levels are very high. I have a hard time getting them tested here in Denmark. Just starting a new doctor now, maybe she will be more helpful. One can always hope. Liv
Very informative article, thank you. How do any or all of these treatments play out with Antiphospholipid syndrome? I have that and my ob/gyn said absolutely not to any hormone treatment and wrote me a script for Celexa for my anxiety 🙁
Hi Kathy!
Glad you liked it. I cannot advice on that , of course. I am not a doctor. I didn’t even know what it was, but looked it up. It’s an auto immune condition where red blood cells proliferate and can create blood clots. I can only share what I myself would do. I would not use estrogen in any form. Even if one does not see increased risk of blood clots with estradiol, it would feel to risky. I would not use testosterone, as one sees an increased risk of blood clots in men on supplementation. They take doses like 50 mg, so much higher than we women would take. But even so. But I can’t see any increased risk of blood clots with progesterone. So if you feel any kind of hormone related symptoms, I would ask a hormone knowledgeable doctor about that. One does see a clotting risk with progestin, but in much higher doses than one would use. But not with the natural progesterone.
Besides that, I would use herbs for hormone issues. I have used a lot of Dong Quai ( Angelica Sinensis). It’s called the woman’s ginseng and they use it a lot in the East. And I have found, it really helps. It seems, parts of the plant can help with blood clotting too, https://www.healthline.com/health/dong-quai-ancient-mystery. You must talk to a doctor how it would work for you. But I don’t know it you have any hormone related issues. If or when you have hot flashes, acupuncture helps. The Chinese calls hot flashes, hot liver. And they are right, we in the West get a lot of discomfort in menopause because of our congested livers. So there is a lot one can do besides using hormones. Though I would be bummed to not be able to use hormones. I guess you take blood thinners or such for your condition. Fish oil and Ginko also keep the blood thin. Though maybe not good for you.
Blessing, Liv