To HRT or not to HRT

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
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Chrisweides
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To HRT or not to HRT

Post by Chrisweides »

Hello dear fellow APOE4ers,

I have just started HRT because of really bad anxiety and my doctor thinks it might be hormones. I am 50, female, hysterectomy but still have stump and ovaries.

I tried to read everything in here about hormone replacement but I admit I am overwhelmed. Do I understand correctly that pure estrogen therapy is best for alzheimer prevention, cycling progesterone is second best and continuous progesterone neutral? Because I got prescribed a rather large dose of progesterone for sleep. I still have bad insomnia. It seems to help with falling asleep but not sleep maintenance.

Can one of the knowledgeable people here tell me ina nutshell what APOE4 women have to take care about concerning hormone replacement therapy?

I would really be grateful because my doctor(s) really don’t know the first thing about modern HRT and brain health. I don’t understand why they care so little.

Best
Chris
50 years old. APO E3/4. Mother, grandmother and great grandmother had/are starting with dementia. Afflicted with anxiety disorder atm. Very eager to save brain and live a long healthy life. Grateful to you all for your knowledge and kindness!
Anna
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Re: To HRT or not to HRT

Post by Anna »

I see a Bredesen-trained functional medicine doctor who is also a board-certified OBGYN. I had surgical menopause at age 50, and the surgeon actually said he was not really trained in measuring and balancing hormones. The sudden drop in hormone levels was brutal! The brain suffers when hormones decline significantly. Too many doctors think that if you don't have a uterus, you don't need progesterone, but there is a Stanford study that shows that progesterone is important for brain function (I would have to dig to find the reference.). My functional medicine doctor tested (and continues to monitor) all my hormones before changing anything, and everything was low or suboptimal (including estrogen, which I was already taking). HRT (estradiol, compounded progesterone, subQ testosterone, and a tiny dose of DHEA) has made a huge difference for me in many ways. I will need to switch to an estrogen patch soon due to age (which increases stroke risk with oral estrogen), but I have no plan to change anything else soon. All of it except the testosterone is daily.

There are many possible causes of anxiety, including hormone imbalances. Some other things to explore are blood sugar swings, insufficient sleep, low magnesium, low B12, low or high thyroid, your diet, and of course, your life situation, past trauma, inner dialogue, etc (I'm a therapist, so I can't ignore that piece!). I find that exercise, meditation (I like Headspace), and spending time with friends help a lot, as well as resisting the temptation to be busy all the time. I too usually fall asleep ok but sometimes struggle to stay asleep. I think this might be from high cortisol levels during the day, and I find that how I start my day makes a difference (like doing a guided meditation before getting out of bed in the morning).

I hope this helps!
~Anna
4/4 but so much more
Chrisweides
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Re: To HRT or not to HRT

Post by Chrisweides »

Thank you very much! Yes that does help. As APOE4, I get that HRT in general is beneficial (unless started way too late) but the specifics elude me. I wish there was a doctor anywhere near who is really knowledgeable about this.

I am exploring all these other avenues too. I am basically holding a gigantic hose to the inferno and hope one or a combination of therapies helps. It’s that unbearable. „Anxiety“ is sich a tame word for the sheer naked fear in me. But I will get out of this. Just don’t want to make a serious mistake on the way.

Thank you again, Chris
50 years old. APO E3/4. Mother, grandmother and great grandmother had/are starting with dementia. Afflicted with anxiety disorder atm. Very eager to save brain and live a long healthy life. Grateful to you all for your knowledge and kindness!
Anna
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Re: To HRT or not to HRT

Post by Anna »

You're welcome! I've been there with miserable insomnia and anxiety. They really feed on each other.

It would help if you could find a functional medicine doctor who knows how to help you manage your hormones -- possibly bioidentical hormones. You are in that window of opportunity to get started on HRT. I don't know when it's too late. I got started on estradiol right after my hysterectomy but did not add other hormones until later. Anne Hathaway MD is a good resource for info on HRT. She is well-informed about preventing cognitive decline.
~Anna
4/4 but so much more
Chrisweides
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Re: To HRT or not to HRT

Post by Chrisweides »

Thank you - that page sadly doesn’t work anymore. Shame, really. I can’t find any comprehensive resources apart from the primer here
50 years old. APO E3/4. Mother, grandmother and great grandmother had/are starting with dementia. Afflicted with anxiety disorder atm. Very eager to save brain and live a long healthy life. Grateful to you all for your knowledge and kindness!
mike
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Location: CA - Sonoma County

Re: To HRT or not to HRT

Post by mike »

Chrisweides wrote: Thu Aug 18, 2022 1:31 am Thank you very much! Yes that does help. As APOE4, I get that HRT in general is beneficial (unless started way too late) but the specifics elude me. I wish there was a doctor anywhere near who is really knowledgeable about this.

I am exploring all these other avenues too. I am basically holding a gigantic hose to the inferno and hope one or a combination of therapies helps. It’s that unbearable. „Anxiety“ is sich a tame word for the sheer naked fear in me. But I will get out of this. Just don’t want to make a serious mistake on the way.

Thank you again, Chris
Chris, you might find this study interesting/useful

Brain Changes Diverge Between Men and Women
— White matter hyperintensities volume accelerate after menopause

https://www.medpagetoday.com/neurology/ ... definition
Sonoma Mike
4/4
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