This is only remotely thyroid-related, but I hope it's ok to ask this question here anyway:
Should you never use estrogen (Estrogel) for more than five years? And what about progesterone? I am referring to the bio-identical versions of both hormones.
I am asking because I was put on Estrogel (transdermal) and Utrogestan capsules five years ago, at age 42; not because I was peri-menopausal, but because I had been diagnosed with adrenal fatigue. My doctor is a so called Hertoghe doctor.
Only now, five years later, are the first symptoms of peri-menopause beginning to appear (irregular periods; recently, a cycle of only 21 days; since then, 24-25 days, whereas they have always been like clockwork = 28 days). Along with the physical changes, I have also experienced some mood changes (more tired, tendency to feel discouraged, even depressed some days of month), and those symptoms make me more worried than physical symptoms which I feel I can easily deal with. After all, there is no telling when a woman will enter menopause. It could be a year from now, or ten years from now. I know the average woman goes into menopause around age 51, and I hope it will either be that or sooner for me...but there is no way of knowing. Therefore, looking back, I feel it was maybe stupid to start taking typical "menopause hormones" years before even getting there...simply because I was diagnosed with adrenal fatigue. Well, no way of changing that now. What I wonder most of all is: if I find I really need it, can I continue to use Estrogel and progesterone (bio-identical) for more than five years? The "five-year rule" is something I have found in articles online, but my doctor has never ever mentioned I should stop using E and P. At my latest consult, a couple of months ago, all my prescriptions were renewed for another year.
I have noticed (no scientific observation at all, of course) that I feel worse than ever during the week leading up to my period, and much better from the last day of period until about mid-cycle (ovulation). Some articles on estrogen deficiency vs estrogen dominance confirm this indicates estrogen DEFICIENCY as the fact that I feel better from the last day of period until ovulation means my body enjoys a higher level of estrogen. I cannot remember ever feeling this as clearly as I have lately, so maybe something has changed as a result of changing hormone levels...?
However, since I have already been using E & P for five years (although for other reasons), can I really continue using them until menopause, or should I stop using them altogether after five years (which will be in a couple of weeks)?
My mother was hypo and on thyroxine. She also took HRT for ten years, a few of those years were after menopause. She always swore that coming off HRT made her thyroid problems worse. She said she was fine on levo until she came off HRT and from then on she never felt right no matter what dose of levo she took. She got breast cancer, and was certain it was due to taking HRT. The cancer was the eventual cause of her death. Sorry if this was not what you wanted to hear
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Did your mother use estrogen only...? Dr Hertoghe mentions in his books that, unless you've had a hysterectomy, you need to combine estrogen and progesterone.
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Actually, I don't know. At the time, I didn't know much about HRT or thyroid at all, as it was before I got diagnosed with a thyroid condition. So it never occurred to me to ask and she wasn't very forthcoming with info on these things either. You might well be right about it being oestrogen only.
Hormone driven breast cancer (and prostate) will thrive on any estrogen in your body, naturally yours, HRTs and xenoestrogens like pesticides and detergents. So when breast cancer gets involved, all estrogens become off limits. My endo pushed HRTs, big business. End of him, he would have been the death of me. I spoke to a few breast cancer researchers and they surmised the endos and HRT docs just do not understand. No estrogen. Not dairy, not herbals, not transdermal. And one cannot balance it out or trade it off with progesterone either. I learned the hard way. I was using progesterone on my own, breast cancer developed in the one spot I often applied, about 7x a week. Surgery, eventual hormone chemo called Faslodex. Worked. Gingerbread: I really think your mom knew. That she was right. Anna: For me, in my own experience, it was NOT worth it.
I'm not absolutely sure. 3-5 years, I think. I put up with worsening symptoms for more than 7 years and started bioidentical HRT when I just couldn't stand it any longer
Lord no! They just got worse and worse as the hormones declined (I assume). I felt much better just before than after. Before perimenopause I was fine - never had PMT or anything like that (actually had amenorrhea most of the time).
Can I ask what type of symptoms you suffered - I suffer recurring bladder infections and vaginal atrophy. I have been prescribed Vagifem which helped symptoms for 6 weeks or so but now symptoms are returning - also have started to have severe joint pains and wonder can the Vagifem be the cause.
No infections. Vaginal atrophy, stress and urge incontinence, hot flushes every 90 mins followed by shivering, depression and apathy, exteme tiredness, brain fog and forgetfulness (like getting half way through a sentence and not knowing what you were saying), insomnia and anxiety.
Thank you so much for your reply- have all the symptoms you have. My GP told me Vagifem was all I can get as I am 66 years old and I can use it all the time. Explained I worry as leaflet states only use until symptoms settle and then discontinue. She said her understanding is different to mine - said now that I am using twice weekly I am taking 3 days break in between. I am going to make a private appointment with a gynaecologist and discuss with her. I suppose no matter what we are told we are the ones who have to make the decision. I know that once I stop Vagifem after couple of weeks I will be unable to walk any distance due to soreness and urge incontinence. I had both ovaries removed in 2011 but still have my womb - am not sure if this make a difference to treatment options available. Once again thank you for taking time to respond.
If you have a womb, as far as I know, you shouldn't take unopposed oestrogen. Are you sure the endo/gyno has read your notes and knows you didn't have a hysterectomy?
I went private as the NHS just doesn't do bioidenticals properly
She mentions that bio-identical hormones don't carry the cancer risk of synthetic versions but that it's still good to be monitored while taking hormones.
Yes, I see an OB-Gyn every year, but she is not the one who put me on HRT, as most docs are NOT like the Hertoghe docs...although, so far, every test has looked fine.
If I had known back then what I know now, I would not have started on HRT until I was meno- or post-menopausal. But, back then, I trusted doctor unconditionally...never gave it a second thought
Thanks for this article!!! I am beginning to think oral progesterone may not be optimal for me...although the Hertoghe doctors are very open-minded in some ways, in others, they are very set...!
Thank you so much, I have been looking into it lately as I have also been considering taking progesterone only for a while and see if that changes anything.
I think I may have made a mistake...that is, of trusting my doctor unconditionally. Then, I started to think, search the internet, read articles and posts...and I ended up unsure if estrogen and progesterone replacement for more than five years, possibly indefinitely, was really the way to go...so I really appreciate the input from others here!!!
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Why would you want to take HRT indefintely?
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I wouldn't...because I think that I understand now, after reading several books on the subject, that E and P production stop altogether after menopause, making it meaningless to continue taking them...?!
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Don't some people believe you can take it to stay youthful? I mean, isn't it a vanity thing to beat the ageing process?
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Possibly...as Dr. Hertoghe also practices "anti-aging medicine". However, that is not at all what I'm after. I just want my periods to stop, sooner rather than later, without causing me too much trouble on the way, if you see what I mean...but I am not at all interested in looking 20 all my life...a risk I may have to deal with, as I'm seeing a Hertoghe doctor...
For some, the transition from peri menopause to menopause is actually gentle - hardly any symptoms and then periods stop. For others the transition is horrendous, insomnia, hot flushes, not to mention brain fog and cognitive ability decreasing. An old friend of mine actually lost her job because of the symptoms of her menopause. She became dithery, forgetful and looked sweaty. After going on HRT, she seemed to settle back down to her old self. The GP said he was going to gradually tapper the hrt down. She begs him not to as she can't cope. It's not stopped her body aging. Just maybe her mind !
Interesting...! I am wondering, more than anything, if you should actually start HRT years before actually peri menopause...as I did. I have now been on estrogel and progesterone for five years, and while some things have improved, others haven't...which makes me wonder if I should have stayed on progesterone only for a few years, and only added estrogel later...
Anna - you haven't mentioned what tests have been done to see your oestrogen and progesterone levels and their ratio to one another. It is devilishly difficult to guess what may be happening otherwise. And things change as you have suggested...you may have been oestrogen dominant but now perhaps not. There ARE more natural approaches to balancing our hormones which *may* help. But perhaps first step is to find out what the levels and ratios are and whether they are optimal.
OK, but the first time hormones were measured, I had blood drawn in the doctor's office, and I cannot remember which day of cycle it was. After that, I have always had blood drawn at the lab on day 21 of cycle. Please bear this in mind when comparing the results:
2011:
progesterone 0.2 ng/mL
oestradiol 93 pg/mL
August 2016 (day 21 of cycle, on estrogen and 200 mg of Utrogestan):
Have you been tested to verify you are low in progesterone and or estrogen. Estrogen (from research I've done) should not be taken unless you need it, (get tested)I personally was estrogen dominant and progesterone low, I had to supplement progesterone and work at getting my estrogen down, estrogen feeds many types of female cancers. I have not taken any hormones and or supplements without doing my homework on what the doctor suggests, and questioning it if needed, (I have done tons of research for myself) luckily everything my wellness doctor has mentioned has been spot on with all my research. I likely will be on progesterone for a long time especially if my body has lots of estrogen, the added progesterone will help balance the estrogen. My mom and grandmother both had breast cancer, I think it could be likely they also were estrogen dominant, and this may have fueled their cancers, I know in my grandmother's case for sure.The progesterone is much safer to be on long term if needed. If you have not read Dr. Lee's books you may want to take a look, he has lots of info. It makes no sense to me for someone to take estrogen without ironclad proof you need it, it is not safe .do your research and question your doctor, if they suggest things that make no sense according to research, find a new doctor, hormones are not something to play around with.
I agree, I only wish I had thought about that sooner...! I have decided not to use estrogen any more, and to only use progesterone from now on (someone here recommended Wellsprings and it has been getting consistently good reviews). I have read that while the body almost always has enough raw material to make estrogen, progesterone levels will decline by +/- 90 % as you approach menopause...so how could you NOT be estrogen dominant...?!
It's only now that I am beginning to question even so called top doctors and their recommendations. It seems all the doctors I know about believe you should be on both E and P as soon as you're over 40, especially if you've also been diagnosed with adrenal fatigue.
Thanks so much for your valuable input, much appreciated
I would highly recommend reading Dr John R Lees book on What your doctor may not tell you about the menopause. It is very detailed and will answer all you questions.
He doesn't recommend taking the HRT or ERT as it used to be known, sadly the risk of cancer is increased.
I have noticed that Wellsprings have been recommended and although there cream is one that is recommended, it has a higher dose of progesterone than what Dr Lees recommends, and they say that natural progesterone doesn't have side effects, but like with anything if you have too much it will cause issues. I speak from experience :<
It's like with anything you need to get the correct dose for you, if you are thinking of tests then he only recommends Salvia tests, as the blood ones are not reliable (something even the GP agrees on)
Thank you so much for your input, much appreciated as I feel I am only now beginning to understand what this is all about. It's so each (actually too each) to just accept whatever hormones your doctor prescribes, without really asking yourself if they have side effects, especially when it comes to long-term use. Like you say: just because they are natural doesn't mean they are harmless!
I will try to order Dr. Lee's book as it seems to deal with exactly the things I am wondering about!
Thanks again, I am really grateful for all the help and advice I have been getting here.
Also research what he said later, after the book but before he died. He said he would not have taught what he did in the book had he realized. Time proves many things. I too did not know, found his later statements much after I read book and used progesterone.
Sorry, one thing I forgot to ask you earlier: do you currently use or have you used Progester-All? I have read so much about this cream, but never connected it with Dr. Lee. It seems to have an excellent reputation.
At one point, I guess you just tell yourself (like I did): "Ok, I am seeing a Hertoghe doctor, trained by Hertoghe himself, and I am paying a fortune for this consult and whatever drugs s/he prescribes, so why ask any questions?" And I am still not sure I feel confident enough to question doctor's opinion...mind you, all Hertoghe doctors work with natural hormones only and, if you've been thyroid and adrenal insufficient for years, maybe you cannot expect to go through "the change" as smoothly as women without endocrine disease...I just don't know, as I am just slowly getting there myself. However, all things considered, I am beginning to wonder if it's really that bad to use natural estrogen (estrogel) and progesterone, possibly even testosterone, if that is what your doctor prescribes for you...when your whole endocrine system seems out-of-whack...?
Hormones are complicated. I am almost 59 and not through menopause yet. Im still getting quite regular very light bleeding and I havent ovulated for quite a while. I have fibroids and possibly adenoymyosis. Not how you spell it Im sure? Try to cut very long story short. I had been telling docs for years that I was progesterone defficient. I got laughed at and told women of my age didnt need progesterone it was normal not to have any. I have suffered for 4 years with muscle pain, headaches etc. They just kept telling me at my age it was menopause and one day it would all go away. Well it didnt and according to them Im just a medical mystery all my bloods are "normal" and they are refusing me any treatment. 2 months ago I had blood tests done by BH. I am very low on vit d, low b12, low folate, raised tsh, normal total t4, low ft4 and low ft3! I have since discovered that low vit d is the root of all evil. When your ovaries fail and stop producing progesterone your adrenals should take over but without a supply of vit d they cant produce progesterone! So we have estrogen dominance and all the associated problems, also no proper thyroid function without progesterone. So its all a viscous circle we have to break in our own way as each of us have a missing part of our own puzzle that causes hormone imbalance and thyroid malfunction. I also had iodine and selenium defficiency. I have been supplimenting for a while. Its why I have normal total t4 and good ft4 to ft3 conversion but my mystery is why good total t4 and rubbish ft4? Anybody know please tsh only 2.68? Thanks.
"The strongest evidence for a lack of association between use of bioidentical hormones and possible development of breast cancer comes from data examining the use of the natural hormone progesterone, instead of synthetic progestins, as part of the HRT regimen (L’Hermite, 2008). Research indicates that increased exposure to natural progesterone does not increase risk for breast cancer and, in some circumstances, might even be protective (Campagnoli, 2005; Holtorf, 2009). In the single large-scale study examining risks for breast cancer in women taking hormone-replacement regimens with either natural progesterone or synthetic progestins compounded with estrogens, use of a progesterone-based replacement was associated with no added risk for breast cancer compared with controls, while women who took combined HRT that included synthetic progestins had a statistically significant increase in risk for developing the disease (Fournier, 2008a). This difference was particularly prevalent in the incidence of estrogen-receptor-positive (ER+) tumors, especially masses that were estrogen-receptor-positive (ER+) and progesterone-receptor-negative (PR-) (Fournier, 2008b)."
At 49 I skipped a few periods and then they just stopped. Within 6 months I was experiencing increasing hot flushes, a sense that my body seemed frail - I was finding it difficult to pull myself up from the bath- no sexual desire, no desire to exercise although i had always enjoyed running, working out etc. Mentally, i just felt everything was becoming an effort. Even making the bed! I tried every natural remedy going. Chinese herbs, acupuncture, sage, Wellsprings, folic acid, vit D, the list goes on. Sometimes i would have respite and think the particular remedy i was using at the time was working but i know now that at the beginning of meno we get respite because our hormones kick in again every now and then. Within a year my hot flushes were so bad i couldnt bare it. Literraly every 10 minutes and all through the night. My gp nearly fell off her chair when she heard i was waking 8-10 times throgh the night. I now use bio identical hormones. Biest and testosterone. I feel so much better. More energy, my body feels younger and no hot flushes although i still wake up hot a few times a night. I can live with that. My consultant says i can stay on the cream indefinitely and i prey i can because i dont want to back to how i was feeling. I chose bio identical which i have to pay for because my mother died from ovarian cancer ( although a very rare form that wasnt hormonal) and because bio identical and not hrt made from mares urine made sense to me. My mother took syrhetic hrt for 20 years without incident, however. Only time will tell whether the bio identicals are indeed better. They are difficult to study because the prescriptions are individual and not a one size fits all. It's a risk im willing to take and i have a pelvic scan yearly and regular mammograms.
One thing I have been thinking about is the following:
The so called hormone doctors in Belgium tend to put you on estrogen, along with progesterone and possibly testosterone, if you're a woman over 40. However, as far as I have been able to ascertain, progesterone levels will drop by as much as 90%, while estrogen levels will only drop by +/- 60% during the same time, meaning you tend to end up estrogen DOMINANT rather than estrogen DEFICIENT. In that case, you need progesterone only, not estrogen. I find it difficult, however, to decide whether I am estrogen deficient or dominant...as it seems symptoms can be confusingly similar.
I just got my latest lab results back (from Dec 16). This time, ordered by OB-Gyn who told me to go to lab on day three of cycle (unlike Hertoghe doc who tells me to go there on day 21 of cycle):
FSH 7.9 UI/L
LH 5.0 UI/L
Estradiol 17 pg/mL
total testosterone 0.32 ng/mL (ref 0.10-0.70)
Ref ranges for the others:
FSH:
follicular phase 3.0-8.1
ovulatory peak 2.6-16.7
luteal phase 1.4-5.5
menopause 27-133
LH:
follicular phase 1.8-11.8
ovulatory peak 7.6-89
luteal phase 0.6-14
menopause 5.2-62
Estradiol:
follicular phase 21-251
ovulatory peak 38-649
luteal phase 21-312
menopause <28
Strangely enough, progesterone levels were not measured this time.
In August 2016, my levels (on day 21 of cycle, when on Estrogel taken from day 5-25 of cycle) were:
FSH 5.0 UI/L
LH 5.4 UI/L
Estradiol 101 pg/mL
total testosterone 0.34 ng/mL
I am not sure how to interpret the latest results, as I have never had labs done on day three of cycle. I have been on Estrogel since 2012, along with Utrogestan (200 mg every night from day 15-25 of cycle).
I guess my OB-Gyn will prescribe synthetic hormones if she thinks I need it. Has anyone taken both synthetic and natural hormones and can compare them? Hertoghe doctors will only prescribe natural hormones but, as far as natural sex hormones are concerned, I am not sure I have had great results so far...of course, I have no idea how I would feel without them.
Any input would be greatly appreciated as I am now entering a completely new phase of my life (I turned 48 ten days ago). I would especially appreciate if anyone has used testosterone successfully.
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Using estrogen and progesterone cyclically or continuously...interested in other people's experiences!
