Estrogen and progesterone - how long can you safely use them?

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)?

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  • 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 :(

  • 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.

  • 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.

  • I've been taking them for more than 5 years, but doctor advises a pelvic scan every year. Didn't start until post-menopause.

  • Angel_of_the_North

    how long into post meno did you start HRT. I am now 3yrs and have just been given some Evorel Conti patches

  • 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

  • You may be estrogen dominant. Very interesting discussion on this subject:

    highintensityhealth.com/161...

    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...!

  • Wellsprings Serenity bio-identical progesterone cream gets good reviews on this group:

    wellsprings-health.com

  • 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!!!

  • Why would you want to take HRT indefintely?

  • 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...?!

  • 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?

  • 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...

  • Ah I see :)

  • 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):

    progesterone 4.3 ng/mL

    oestradiol 101 pg/mL

    Reference ranges:

    follicular phase:

    oestradiol

    21-251

    progesterone

    <0.3

    ovulary phase:

    oestradiol 38-649

    no ref ranges for progesterone

    luteal phase:

    oestradiol 21-312

    progesterone 1.2-15.9

    menopause:

    oestradiol <28

    progesterone <0.2

  • 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:-)

    Anna

  • Good morning Anna69,

    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)

    Take Care

  • 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.

  • 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.

  • Hello Anna69,

    I will PM you with the info

  • 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.

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