Perimenopause and menopause treatment options/best practices

[bananafeet]

I couldn't actually find the correct forum to post it, so I will post it here.

So I've been looking into female health and especially the prolonged period of perimenopause/menopause which seems to be an extended period of up to 10 years where the female body undergoes the most drastic changes since puberty.

It seems to be the case that women have never lived so long, and have never delayed having children for so long. This means that for the first time in a long time two things are happening at once:
1. Extended period of periods/menstruation and the associated hormone fluctuations wreaking havoc on mental health
2. Extended period of infertility/menopausal which can actually be longer than the peak fertile period (18-35)

It's well established that breastfeeding and pregnancy stabilise the hormonal system. So up until now women probably haven't been exposed to this many periods or this extended post menopausal stage.

It seems mother nature never intended these things to happen. Furthermore not to happen all at once.

So the question is how do we prepare to look after a women peri and menopausal for 40+ years.

The treatment options aren't great either. I will collect the data here as I go.

But as far as I've got is estrodial cream and progesterone cream or injections are the only long term viable options. They need to be cycled to imitate the menstrual cycle even tho the fertility is gone.

This is due to the antagonistic behaviour of progesterone on the ER and the prolific effects of E2 on the uterus.

 

[Rawnjohnson]

My wife began perimenopause about a year ago. We got all her labs done with good labs, and then started self guided treatment. She started with 5 mg test C per week, and that got rid of the hot flashes. She’s on 10mg a week now and that puts her at the top of women’s normal total test range. After a couple months with the test stable, she started on Estrodial cypionate. We slowly worked up the dose to get her mid-high normal e2 range for a woman. She feels great now. Energy, libido, mood are all like she was when she was young. She hasn’t had to mess with progesterone pills, but I know a lot do. My advice would be to slowly optimize one variable at a time, and when it’s in a steady state, work on optimizing another.

 

[bananafeet]

My wife began perimenopause about a year ago. We got all her labs done with good labs, and then started self guided treatment. She started with 5 mg test C per week, and that got rid of the hot flashes. She’s on 10mg a week now and that puts her at the top of women’s normal total test range. After a couple months with the test stable, she started on Estrodial cypionate. We slowly worked up the dose to get her mid-high normal e2 range for a woman. She feels great now. Energy, libido, mood are all like she was when she was young. She hasn’t had to mess with progesterone pills, but I know a lot do. My advice would be to slowly optimize one variable at a time, and when it’s in a steady state, work on optimizing another.

My understanding is that the progesterone is required to deal with the uterus lining being stimulated by estrogen.

This is why women have cycles of estrogen and progesterone. Testosterone is generally the most stable hormone in their system.

I'm still learning all this shit. But yes one hormone at a time is probably the best bet.

There are gels available for testosterone and estrogen. My understanding is the gel has probably less chance of virilisation due to the reduced exposure time. Even then I'd be cautious as virilisation is permanent....

AMS Guide to MHT/HRT Doses - Australia | Information Sheet

Download: AMS Guide to MHT/HRT Doses - AustraliaThis Information Sheet has been developed as a guideline only to MHT/HRT products available in Australia in November 2024. Hormone Replacement Therapy (HRT) is now referred to as Menopausal Hormone Therapy (MHT). The intention of this sheet is to...

hub.menopause.org.au

 

[Rawnjohnson]

It’s hard to find a doctor actually knowledgeable on women’s hormones. Most just want to give them pellet implants and be done. You’ll probably have to go through a lot of doctors to find the right one for her. Most likely a younger specialist in a larger city. Most older doctors either don’t keep up with new studies or are just burned out and don’t care. I read through the website you linked and it does look like progesterone is important for the uterus. My wife has had a partial hysterectomy, so she still has her ovaries, but no uterus.

 

[Photon]

@PiscesMoon

 

[bananafeet]

Great basic biology video:

View: https://youtu.be/H7pV_kzng2g

 

[bananafeet]

Good information on vaginal estrogen therapy. It's for women with cancer but it covers with references lots of biology including whether it goes systemic:

Safety of vaginal oestrogens for genitourinary symptoms in women with breast cancer

This article provides a summary of the data on the safety of vaginal oestrogens in women with breast cancer to help GPs advise their patients in this situation.

www1.racgp.org.au