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[joziel]

Wow very interesting bomb. Thanks for all those studies....

Especially this last paragraph in the 2nd paper:

"The absolute increase would be about 2·0 per 100 women (one in every 50 users) for oestrogen-plus-daily-progestagen MHT, 1·4 per 10 women (one in 70 users) for oestrogen-plus-intermittent-progestagen MHT, and 0·5 per 100 women (one in 200 users) for oestrogen-only MHT. There is little difference in the absolute excess incidence by age 70 associated with starting 5 years of MHT use at ages 45 years, 50 years, or 55 years. Thus, addition of a daily progestagen increases the excess risk of breast cancer from one in 200 users to one in 50 users." https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext

So - much safer for BC risk to take P sequentially rather than continuously. Although I think this used synthetic progestins and not body identical P?

Really, if I had to choose between a slightly elevated risk of BC and a slightly elevated risk of endometrial cancer, I'd choose the latter. Because it's much less common (so absolute risk actually isn't that great, even if increased) plus there are many more 'warning signs' in terms of excess bleeding etc to look out for. Zero warning signs of BC....

This is also interesting:

"Estrogen alone or in combination with a progestin improves lipoproteins and lowers fibrinogen levels without detectable effects on postchallenge insulin or blood pressure. Unopposed estrogen is the optimal regimen for elevation of HDL-C, but the high rate of endometrial hyperplasia restricts use to women without a uterus. In women with a uterus, CEE with cyclic MP has the most favorable effect on HDL-C and no excess risk of endometrial hyperplasia." https://pubmed.ncbi.nlm.nih.gov/7807658/

With the sleep, I feel like I am getting good quality sleep on vaginal P. When I took oral, if I got the sedative effects they felt really weird and not like they resulted in 'normal' sleep. Which fits with Dr Gersh's concerns about oral P potentially increasing the risk of dementia because it acts basically like a sedative or sleep aid.

And yes, please give us the last link to Dr Gersh's summary - the link is the same as the rodent study at the mo

[bombsh3ll]

Hi sorry here is that link again:

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://annhathawaymd.com/wp-content/uploads/2021/04/heart-2021-hrt-gersh-okeefe-4.pdf

in case the link doesn't work, the article is called Postmenopausal hormone therapy for cardiovascular health: the evolving data Felice L Gersh,1 James H O’Keefe,2 Carl J Lavie

it will probably come up in a google search.

[joziel]

Thanks, looks like we can read the abstract here: https://pubmed.ncbi.nlm.nih.gov/33619206/

[pepperminty]

Hi Joziel,

is there any data to support this or is it a theory of Dr Gersh?

With the sleep, I feel like I am getting good quality sleep on vaginal P. When I took oral, if I got the sedative effects they felt really weird and not like they resulted in 'normal' sleep. Which fits with Dr Gersh's concerns about oral P potentially increasing the risk of dementia because it acts basically like a sedative or sleep aid.

PMx

[joziel]

There is no research either way, because oral P hasn't been used for long enough for us to know yet. But the metabolites which are created from using oral P are not at all present earlier in our lives with body identical P. We do not naturally ever have such high GABA levels as we get from taking oral P. We know that other sedatives increase the risk of dementia.

So really - rather than research proving that it causes dementia, we should have research proving that it doesn't cause anything unwanted to occur. We would never, in any other situation, just start random drugs on a huge population at high doses without any prior testing of them being used over decades - yet that's exactly what has happened.

[bombsh3ll]

I think given that we just don't know, an individual decision has to be made based on existing information, weighing up the potential pros and cons.

For me, there's enough to convince me to use it vaginally and cyclically from the start.

However if for example someone isn't getting any good quality sleep unless they take it orally and continuously, their quality of life and known effects of not sleeping on brain health may tip the balance the other way for that individual.

[joziel]

Yes, it is probably better than using big pharma sleep aids.... if that's the alternative.

[pepperminty]

Very interesting,

lets face it there is a risk to everything we do in life, it is about risks and benefits.  Everyone's genetics are individual and responses to things are individual too.  I wish we had more data . We would if it were a male issue.

PMxx

[joziel]

If it were a male issue, there would be free of charge HRT clinics on every street corner, available for drop-ins, staffed by knowledgeable doctors.....  not to mention routine bloods done regularly!

[pepperminty]

If it were a male issue, there would be free of charge HRT clinics on every street corner, available for drop-ins, staffed by knowledgeable doctors.....  not to mention routine bloods done regularly!

It is such a shame that females are still experiencing medical gaslighting. It is to one's own peril if you don't research it yourself. And don't get me started on the long term damage and the risks of some medication that is routinely dished out to women. Where are the curious doctors that look at the patient as a whole and do there own research. They are very few and far between.

PMxx

[bombsh3ll]

I think it is a systemic issue more than an individual doctor problem, although certainly there are some who should not be in a patient-facing role.

Most I believe genuinely do want to help but with 8 minutes allocated per patient and high levels of burnout it simply isn't possible to do more than the bare minimum - curiosity just doesn't get a look in.

Plus historically very little resources have been allocated to research and education in women's health, coupled with the hysteria paradigm which is very much still alive and kicking, and any peri or menopausal woman who goes in without being very well informed and a black belt in self-advocacy is really very unlikely to receive optimal care.