Hormone Replacement Therapy E4 Women

[simatai33]

The Danish study was based on conjugated hormones - these are SYNTHETIC and not bio-identical like Estradiol or Progesterone. There is significant research on the dangers and side effects of synthetic hormones. Personally I don’t feel there’s an increased risk of dementia with low dosage natural HRT that is started right before or at start of menopause and not taken longer than 5 years. Low dosage: 1mg or less estradiol and 100mg Progesterone (taken at night). This is only if you have problems with menopause: hot flashes, sleep disturbance, depression/mood swings. The main reason I took it was due to hot flashes and poor sleep. Years of poor sleep will definitely increase risk for dementia.

[TPE]

The Danish study was based on conjugated hormones - these are SYNTHETIC and not bio-identical like Estradiol or Progesterone. There is significant research on the dangers and side effects of synthetic hormones. Personally I don’t feel there’s an increased risk of dementia with low dosage natural HRT that is started right before or at start of menopause and not taken longer than 5 years. Low dosage: 1mg or less estradiol and 100mg Progesterone (taken at night). This is only if you have problems with menopause: hot flashes, sleep disturbance, depression/mood swings. The main reason I took it was due to hot flashes and poor sleep. Years of poor sleep will definitely increase risk for dementia.

Hello, simatai33! Welcome to the site and thank you for posting.

It's a relief to learn that some of the HRT related studies were flawed and what bio-identical hormones have to offer as opposed to synthetic. Thanks for contributing to this feed.

I'm uncertain if you have checked out apoe4.info or are completely new to the site. As a Support Team Intern I can share several tools & resources to help you get the most out of your experience here.
The Primer is a detailed and informative resource written by a practicing M.D. with ApoE4/4. It includes information about the biochemistry of the ApoE4 gene and offers a variety of research-based prevention strategies.

Some helpful tips to navigate the site include the How-To Guide. It includes topics such as navigating the forum, private messaging, and searching. One great tip is using the quote (") button when replying to a post. Using the button will automatically alert the member of your response.

If you are interested in learning more about other members check out Our Stories.

In case you haven't checked out the wealth of information on the Wiki site, you will find it here: Wiki Main Page

Thanks again for joining our forum and providing input. We would love to hear a little more about you if you are interested.

Warmly,
Therese (TPE)

[simatai33]

Thank you so much Therese! I am brand new to the site and still learning to navigate it. I am 53 years old Asian female, and a full time caregiver for my mom who has vascular dementia and has been diagnosed since 2015. My paternal grandmother had Alzheimer’s. I have not been tested for ApoE4 yet. I asked a couple doctors about it and they were somewhat dismissive. So I’m hoping to learn more so I can plan accordingly.

I also am in a unique position in that I teach ceramics twice a week at an adult day care on the Big Island of Hawaii. About 85% have some form of dementia. I teach six students per day for 2-3 hrs/day. I have had close to 100 students take classes with me over the last two years, so I have seen the whole spectrum of dementia with my students, from beginning to end stages.

Thanks so much for your encouragement and warm welcome!

[TPE]

Thank you so much Therese! I am brand new to the site and still learning to navigate it. I am 53 years old Asian female, and a full time caregiver for my mom who has vascular dementia and has been diagnosed since 2015. My paternal grandmother had Alzheimer’s. I have not been tested for ApoE4 yet. I asked a couple doctors about it and they were somewhat dismissive. So I’m hoping to learn more so I can plan accordingly.

I also am in a unique position in that I teach ceramics twice a week at an adult day care on the Big Island of Hawaii. About 85% have some form of dementia. I teach six students per day for 2-3 hrs/day. I have had close to 100 students take classes with me over the last two years, so I have seen the whole spectrum of dementia with my students, from beginning to end stages.

Thanks so much for your encouragement and warm welcome!

We're so glad you're here! Thanks for sharing a bit about yourself. You've definitely come to the right place to learn the ins and outs of dementia and self care in that regard.
What a gift you're giving to teach ceramics at an adult day care center. I smile just thinking about it. Your students gain so much on so many levels.
All the best to you as you care for your Mom. I am sure there are others here who are also caregivers. Please don't hesitate to reach out, ask questions and request support when you need it.

Warmly,
Therese

[Beattheodds]

I have read through many of these great posts on the topic of HRT. I did a search but did not find any posts of HRT causing dense breasts. I have developed dense breasts. I had Atypical Ductal Hyperplasia last year and my oncology surgeon, high risk breast clinic, and Dr. Kristi Funk, a well known breast surgeon and author, all suggested to discontinue my BHRT. They also wanted to put me on Tamoxifen. I said no to the tamoxifen but I did go off my BHRT. Almost immediately I saw an significant increase in my cholesterol and A1c. I am reading and watching some of the suggested physicians on this forum and seems like more recent reseach suggests that BHRT actually reduces the risk of breast cancer! However, there is research quoted by Dr. Funk that indicates HRT does cause breast density, which leads to increase risk of breast cancer. This is all so hard to decifer - I need to balance my APOE4 risks with my risk of breast cancer. Any further readings or suggestions?

[SusanJ]

However, there is research quoted by Dr. Funk that indicates HRT does cause breast density, which leads to increase risk of breast cancer. This is all so hard to decifer - I need to balance my APOE4 risks with my risk of breast cancer. Any further readings or suggestions?

Just curious, did you have dense breasts before you started HRT? Anyone else in your family have dense tissue (ie, is it a genetic thing)?

[NF52]

However, there is research quoted by Dr. Funk that indicates HRT does cause breast density, which leads to increase risk of breast cancer. This is all so hard to decifer - I need to balance my APOE4 risks with my risk of breast cancer. Any further readings or suggestions?

Just curious, did you have dense breasts before you started HRT? Anyone else in your family have dense tissue (ie, is it a genetic thing)?

Note: Hi SusanJ and Beattheodds,

I adjusted Susan's first quote to have an = sign, instead of a hyphen (-) to be sure your got a notification.

FWIW, I'm going to later add a post with news last week of a massive analysis by the NIH of data on 10 million women over the age of 65 who died between 2007 and 2020 based on whether or not they had any form of HRT and whether or not they had a diagnosis of a disease (ex. breast cancer or dementia) and how many died from that disease. Overall positive for all forms of HRT; unfortunately, Medicare and Medicare Advantage records don't allow for analysis by ApoE4 status and diagnosis of dense breasts.

[NF52]

The National Institutes of Health on April 9 published an in-depth analysis of health outcomes (diagnoses of cancers, dementia, heart disease, etc) and survival (deaths of women from various health conditions) on more than 10 million women receiving Medicare from 2007-2020 and/or Medicare Advantage from 2017-2020 who enrolled near age 65 in years when Medicare Part D became available.

Because of previous fears about HRT, usage of all forms of HRT dropped almost 50% from 2008 to 2020, from almost 12% of women ages 65+to about 6% in 2020, with vaginal estradiol, which they term E2, the most commonly used.

Image 4-21-24 at 2.00 PM.jpeg

Below is some of the info from a very detailed analysis. Unfortunately, Medicare and Medicare Advantage records, which is what NIH was given access to analyze, for obvious reasons don't include ApoE4 status or whether women were diagnosed with the risk factor of "dense breasts".

Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses

ABSTRACT:
Objectives:
The study aims to assess the use of menopausal hormone therapy beyond age 65 years and its health implications by types of estrogen/progestogen, routes of administration, and dose strengths.
Methods
Using prescription drug and encounter records of 10 million senior Medicare women from 2007-2020 and Cox regression analyses adjusted for time-varying characteristics of the women, we examined the effects of different preparations of menopausal hormone therapy on all-cause mortality, five cancers, six cardiovascular diseases, and dementia.
Results:
Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%). For the use of estrogen and progestogen combo-therapy, both E+ progestin and E+ progesterone were associated with increased risk of breast cancer by 10%-19%, but such risk can be mitigated using low dose of transdermal or vaginal E+ progestin. Moreover, E+ progestin exhibited significant risk reductions in endometrial cancer (45% or adjusted hazards ratio, 0.55; 95% CI, 0.50-0.60), ovarian cancer (21%), ischemic heart disease (5%), CHF (5%), and venous thromboembolism (5%), whereas E+ progesterone exhibited risk reduction only in CHF (4%).
Conclusions:
Among senior Medicare women, the implications of menopausal hormone therapy use beyond age 65 years vary by types, routes, and strengths. In general, risk reductions appear to be greater with low rather than medium or high doses, vaginal or transdermal rather than oral preparations, and with E2 rather than conjugated estrogen.

Here's data on how many women of the 10 million women who died during those years were diagnosed with dementia before death, and how many had dementia listed as the cause of death. The lower rates of death caused by dementia were true also for congestive heart failure, stroke, ischemic heart disease and colon cancer. Causes of death given only total 41% for all women who died, presumably because other causes were not studied because not seen relevant to HRT

Table 2
Dementia
Total Deaths # (%) . Dementia Diagnosis Dementia on cause(s) of death
 Any HT 1,500,513 72,369 (4.8%) 41,445 (2.8%)
 No HT 9,333,629 410,046 (4.4) 399,835 (4.3)

TL/DR: More details on types of HRT and dosing:

We classified HT by types, routes, and dose strengths, as applicable. We included three types of estrogen (estradiol [E2], conjugated estrogen [CEE], and ethinyl estradiol [EE]), two types of progestogen (progesterone [natural] or progestin [synthetic]), and a total of nine different estrogen-progestogen combinations (E2 alone, E2+ progesterone, E2+ progestin, CEE alone, CEE+ progesterone, CEE+ progestin, EE+ progestin, progesterone alone, and progestin alone). EE was never prescribed alone and always combined only with progestin. Routes and dose strengths were solely based on the estrogen part of preparations. The routes included oral, transdermal, vaginal, and injectable. We developed an average daily estrogen dose based on DailyMed13 dosing instructions for each of 138 individual HT products (Supplemental Digital Content 1, https://links.lww.com/MENO/B236), which accommodated intermittent regimens (eg, 21 days on and 7 days off). We defined a “standard” dose for estrogen type and route based on the literature and the distribution of daily estrogen doses as 0.625 mg, 1 mg, and 5 μg for oral CEE, E2, and EE, respectively, and 200 μg and 50 μg for nonoral CEE and E2, respectively. For each drug type, we categorized the average daily estrogen doses into high, greater than 1.45 times the standard; low, less than 0.45 times the standard; and medium, between the lower end of the high and the upper end of the low bounds. We considered each combination of estrogen-progestogen preparation, dose strength, and route as separate covariates (total 40; 16 ET and 24 EPT preparations). We considered women to be exposed to a study drug if they ever had a prescription for that drug before an outcome event.

[Beattheodds]

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[Beattheodds]

However, there is research quoted by Dr. Funk that indicates HRT does cause breast density, which leads to increase risk of breast cancer. This is all so hard to decifer - I need to balance my APOE4 risks with my risk of breast cancer. Any further readings or suggestions?

Just curious, did you have dense breasts before you started HRT? Anyone else in your family have dense tissue (ie, is it a genetic thing)?

SusanJ, it developed while I was on BHRT. I do not know of any family members who have dense breasts but my sisters are younger than I am. My Mom did not.