Thanks for the write up.
My nipples started aching when I read 3mg of estrodial per week. Holy moly that's a lot.
You don't get bloating or any sides at that dose? Or does the progesterone sort of reduce the sides?
Lol, nope. I was ok at first at my prescribed dose, but started having hot flashes creep back in. I did a slow titration until symptoms resolved.
Dosing is individual, especially when you take SHBG into account. I read a post from a woman today who is on 1.8 a week with serum e2 of mid 200s, another at 2.45 put her over 350. My dose of 3 is gets me about 225. I use FSH as a guide, keeping it right around 5. I also track anti mullerian hormone and needing a higher dose is when AMH halved.
No bloating or anything. From the reading I’ve done from other women, it’s typically the progesterone that causes bloating and is often not well tolerated until estrogen levels are up. Too much progesterone is what makes my boobs swollen and my skin breakout.
thats womens HRT doses, no?
As far as I’m aware, yes. 1-2 is standard starting and women in full menopause are at 3-5. There aren’t many clinicians who prescribe injections, even with estradiol cyp and val drug inserts listing menopause as an indication for use. It’s not in any international prescribing guidelines and probably won’t be due to it not being profitable enough.
Yeah like I said it depends on the endogenous level...
Depends if the stuff you've got is dosed correctly and how quickly it absorbs. Sometimes during perimenopause women over produce estrodial so if you administer small amount it can cause supra physiological levels.
I understand why this logically makes sense, but it’s not really the case. Ideally estradiol is replaced enough to suppress endogenous production just enough to eliminate those spikes that cause symptoms. The issue becomes that clinical guidelines state to not test serum, so women typically end up underdosed and those spikes still happen with exogenous amounts shooting it too high.
Progesterone doesn't have an ester so what's the dosing protocol for HRT? Daily dosing during the luteal phase?
No wonder why compliance is so poor.
Progesterone like this isn’t part of any hrt guideline. If oral isn’t tolerated or doesn’t control bleeding, then international guidelines state that an IUD or synthetic progestin is the next step. Even using it as a suppository is technically off label and drs seem to get obnoxiously aggressive about using it for hrt, stating there’s no studies to support it. They don’t use their brain and reference the successful uses in fertility treatments. It’s illogical especially considering that studies focused on medroxyprogesterone acetate arms were associated with higher incidence of negative outcomes. The drs never even went to bioidentical progesterone once the link was discovered, just hopped to SERMS. This leads to women either quitting hrt entirely or having unnecessary biopsies and hysterectomies.
As it stands, guidelines state that the minimum progesterone exposure while in peri is 200mg for 12-14 days, and 100mg daily for postmenopausal or women who want to stop cycles. I personally never had my cycle impacted by daily use, even when going up to 300mg. (LCMS for oral progesterone is the most accurate, btw. It runs concordant for me.) It showed that levels should be adequate to prevent mid cycle bleeding, but obviously not accurate for tissue saturation. I choose inj because I want sex without extra stuff in my vag, and don’t want to boof anything.
In women the sudden drop in progesterone post partum and it's metabolite allopregnenalone is implicated in post partum depression and in PMDD.
If they could find a reliable delivery mechanism for these two hormones they would save so many lives. I'm sure they are trying.
I don’t think they are trying. Drs could prescribe oral progesterone postpartum, but it’s not on their radar. Women weren’t even required to be included in clinical trials until the 90s. Dr Goldstein is a prominent ob/gyn and sits on the Int’l Meno board, who says he’s been part of conversations and seen promising data on women’s health, where it didn’t go to trial because decision makers said it wasn’t profitable. Shit, my gov’t only recanted its initial decision to cut women’s funding for the WHI, only after huge backlash.
We still get thrown birth control starting in teen years. I’ve had debilitating migraines since puberty, that were largely alleviated once starting hrt. Drs repeatedly said there wasn’t a link to hormones because mine existed outside of the luteal phase. Men have multiple dick pill options and women got Vyleesi, (pt 141), and Addyi. Addyi was shown to positively increase sexual experience by 1 per month. The side effects suck, and it has to be taken for 4-8 weeks before it’s fully effective if it works at all. I believe only 4 countries even have a proper testosterone product specifically for women. It’s all piss poor.
We aren’t valued beyond reproductive years. You would think scientists would realize that when women’s health declines, so do men’s. There’s a sharp decline in men’s health when their partner dies. Humans overall will benefit if women’s health is prioritized.