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[Jillyboo]

If you're one of the few who need or prefer to remain on a cyclical form of HRT long-term you may like to pop onto Youtube and search for Felice Gersh an American doctor with an interesting take on the subject. I found her very refreshing and reassuring to listen to.

[discogirl]

thank you i'll have a listen x

[bombsh3ll]

Felice Gersh is a brilliant doctor, so knowledgeable and I share her philosophy of using physiological replacement for optimal long term health rather than minimal doses just to keep us off the floor. I love listening to her videos.

Whilst I personally don't feel my quality of life would be best served by cyclical therapy as I require hormonal stability and amenorrhoea to thrive, I am so pleased to see this option being made available to others.

[sheila99]

Interesting. The one thing I was waiting for that she didn't mention is what the physiological level of estradiol is. Does anyone know? And should we be taking nore in the first half of the cycle than the second as the body would have done?
  I'm on cyclical because I don't get on with utrogestan but I'm not convinced I'm any better than someone on conti.

[bombsh3ll]

I too strained my ears listening for Dr Gersh's recommendations for physiological estradiol levels. I don't know if it is in that particular video but in one she gives a range of 50-150pg/ml.

Note that is different units to pmol/L which we use in the UK. There are conversion calculators online - my level of 390pmol/L equated to 103pg/ml I think.

The lower limit of 50pg/ml also matches professor Philip sarrel's study in the 1990's which found that vaginal atrophy was prevalent below this level but much less so as women moved above this.

She doesn't recommend varying the estrogen dose as this gets too complicated but said she does have a small minority of patients who do a stepwise estrogen regime due to their preference.

[Jillyboo]

The main takeaway for me is that remaining on a cycle isn't as risky as it's often portrayed! 

I tried several continuous regimes in the past and they just don't work for me. My body feels a lot better all round on a cycle.

I wonder if the physiological level is the same as a 'bone sparing dose'? 

I've been on 2 pumps of Oestrogel for a long time - I can confirm I definitely have maintained good bone density if nothing else.

[bombsh3ll]

The risk of endometrial hyperplasia with cyclical really is marginal and can be further mitigated by having a scan every year or so to check the endometrium.

Personally I believe the right balance hasn't quite been struck between the risk of endometrial cancer, which is rare and typically presents early on with irregular bleeding, and breast cancer which is common and not always found early - this risk is very slightly greater with continuous vs cyclical HRT.

Other outcomes such as cardiovascular and brain health also show advantages for cyclical however not all controlled for age and progestogen type.

I think those who can tolerate an artificial cycle postmenopause are actually in quite a favourable position.