HRT for women

[irishgenes]

Still In Remission

Guest, if you are 19, lack of estrogen is probably not the cause of your rosacea unless you are on a birth control pill which has low estrogen in relationship to progestin. You could have acne due to your skin's vulnerability to your own testosterone, though. If you have acne along with rosacea, it is hard to tell the results of each disease apart. The right birth control pill could help your skin if you have the papules of rosacea, but it is not likely to stop flushing at your age.

Just thought I'd come back and report that I am still free of my rosacea, since Dec. of 2005. I did start to have a problem with the estradiol gel, though. I started having swelling and soreness under my arms, got a saliva test, and found that my estradiol levels were 10 times higher than normal. I read on the Aeron Labs website (they do saliva hormone tests) that this happens with many women who are on the gel or cream form of estradiol. The hormone overwhelms skin receptors and the excess is stored in the red cells of the salivary and sweat glands. The website does not say this is a bad thing, but I was upset to read about these supra-physiologic hormone levels. It doesn't seem like a good thing to me! This only happens with the gel or cream forms of estradiol. The pills go through the liver and the patch goes directly into the bloodstream at levels close to what the normal pre-menopausal woman makes.

So I decided to try the patch again. I had tried Estraderm patches 11 years ago, but they didn't work even though I was wearing a full 100 mcg dose plus a 50 mcg dose. However, the patches are much improved now. The Vivelle dots are much smaller and more comfortable, and they can be cut to the size you need. Masters Marketing sells Estradots (Vivelle) in 25, 37.5, 50, 75, and 100 mcg sizes---8 to a package. But you can get the 100 mcg size, draw lines on it with a ruler, and cut off 1/8, 1/4, or whatever you need with little sharp manicure scissors like Revlon sells. This way you can titrate your dose exactly.

I now use a 100 mcg patch, plus half of a 100 mcg patch (total=150 mcg.), changing the patches every 3.5 days. The swelling under my arms (sweat glands?) went down two weeks after I switched from the gel. When I use the pill form of estradiol (Estrace or generic), I use 1.5 mg. per day, so you can see the relationship in dose. The patch dose is a lot smaller, but more effective because of the steady trickle. I never have even a minute of the ocular rosacea symptom any more with the patch. I add a little extra estradiol during the time I am forced to add progesterone, since progesterone is an estrogen blocker. I hate progesterone and only use it 12 days every 3 months.

[Bonnie]

Hi Irishgenes,

I am glad to hear that you are still holding back the rosacea. My face is also doing much better since I finally got my hormones leveled out. Although I do have problems if I try something new on my face or use certain supplements.

I was wondering if you have had a mammogram since being on the hormones? And if your breast density has changed.

Mine has changed by becoming more dense and knotty feeling. This is making me a little nervous about taking hormones.

I also worry about what will happen to my face and body when my doctor decides that I have been on them long enough and wants me stop taking them. Have you and your doctor talked about this?

Thanks,

Bonnie

[irishgenes]

I had yearly mammograms for the first few years I was on hormones, but I never get them any more and never will unless I feel a lump. After reading the books "Malignant Medical Myths" by Joel Kauffman, PhD., and "Should I Be Tested for Cancer? Maybe Not, and Here's Why" by H. Gilbert, MD, I realized that mammograms are just part of the cancer industry's scare tactics, and they cause more harm than good. So many women are having mastectomies for DCIS (ductal carcinoma in situ) simply because doctors are afraid of malpractice if they don't treat it. Yet 80% of DCIS will never metastasize, so it is not really cancer. Those books go into all the statistics of all the major studies and prove without doubt that mammograms do not make anyone live longer. The so-called improved cancer cure rate is simply due to earlier diagnosis of so-called cancers which weren't really cancers.

Women don't understand that all the agony of being told they have breast cancer, having a mastectomy, chemo, radiation, living the rest of their lives in fear, etc., could have been avoided if they never had a mammogram. They had an 80% chance of dying of some other old age disease never knowing they had DCIS, just like nearly all old men die of something other than the prostate cancer that most of them have when they die. It might be worth it if you were among the 20% (whose cancer would metastasize) if you could "catch it early", but the books shoot down that theory, too. I was totally shocked that the truth is so far from the conventional wisdom and the advice of nearly all doctors, but at the same time I was relieved of the continual breast cancer fear that is instilled into every woman by the hugely profitable and largely ineffective cancer industry. I advise everyone to read those two books. They really changed my life. I learned exactly how statistics are manipulated, how ignorant the average doctor is, and how the health care industry is all about money.

The only time I got sore cysts is when I took too much progesterone, and for me the standard 200 mg. oral progesterone dose is too much. I developed cysts overnight, and after quitting the progesterone, it took about a week for the cysts to disappear. Right now I am trying to find the minimum effective progesterone dose for me. If you take the right dose of hormones, you shouldn't have any soreness or cysts.

I do not worry about what some doctor will decide to do about my estrogen prescription because there are other doctors (and there is Masters Marketing!) I would never let a doctor make the final decision for me about my own body. I'm 61, still on estrogen, and they will have to pry it from my cold dead fingers to take it away from me. If the only way I could get it was to buy it in some dark alley, I would do it.

[patty]

Irishgenes, I agree with most of what your saying, but I can't agree with your view on mammograms. Everything those doctors' proclaim in their books may be true, but why would you or any woman want to risk being in that 20% that will become cancerous?
Having a mammogram is no big deal, and the comparison of your breast tissue from year to year is what may save your life when there is a spot in question. Waiting for a lump is too much of a risk. By then, you are in big trouble. I would rather, [and have been] be told that the spot is nothing, than have never known that there even was one.

[irishgenes]

Having a mammogram is a big deal because a large percentage of women have microcalcifications with age and will be repeatedly biopsied and finally told that they have "cancer" (DCIS) and must have a mastectomy and radiation or chemo, both of which cause future cancers. I just read about a woman in People magazine the other week who went through 4 of these biopsies over 4 years and told the doctors to just cut off her breasts. She didn't have cancer, but she just couldn't stand the stress. They did cut off her breasts, and couldn't find any cancer.

You have to read the books to understand why finding out that you have breast cancer before a lump can be felt with the fingers does not increase your life expectancy. The so-called cures are simply statistical manipulation. Deaths from side effects of treatment are not even counted as cancer deaths. It is too complicated for me to discuss in detail here. I'm just saying to any woman who has a constant fear of breast cancer, "Read these books. Learn the truth and decide for yourself."

I know that only a tiny percentage of women will actually read the books. It is hard to believe that what you've been told all your life is a lie. The cancer industry thrives on fear and myths that have been repeated so often that even doctors believe them. Of course, cancer doctors are allowed to directly sell patients cancer drugs at a huge mark-up, something other doctors can't do, so they have a financial incentive to rationalize their toxic treatments as being curative when they are not.

[patty]

I am well aware of calcifications that can occur in the breast. My mother had a large one removed many years ago. Even then the doctors were positive that it was a calcification, because there was no fluid that was able to be biopsied. It was removed because of its' unusual size. In my own experience, I had a spot in question after a mammogram, requiring another mammo, and a sonogram. The assumption with everyone involved was that it was probably nothing and it was. Scary yes, but I will never miss a mammogram ever again. Todays technology is making it so that inaccurate diagnoses are fewer. I feel sorry for the woman who cut off her breasts. I didn't read the story, but there had to be something wrong in the care she was getting in the first place, since her doctors were willing to remove her breasts because she was stressed out.
Being aware of ones breast health is so important whether you do self exam only or also rely on a trusted doctor.
I guess we should agree to disagree on this matter to avoid getting off topic.

[irishgenes]

Hi, folks. Almost two years now since I have had any rosacea after figuring out that mine was due to not enough estrogen. Just reporting that a female relative, age 45, called me recently, and told me that she thought she had a urinary infection because she had become incontinent. Turned out it was not an infection, but doctor wanted to put her on Detrol. She had also been having depression, fatigue, anxiety, facial flushing, and rosacea papules. I told her it sounded like menopause to me, and she should try some estrogen. Since she still has occasional periods, I suggested .3 mg. twice a day of estradiol gel. Fortunately, that turned out to be just the right dose for her at this time of her life, although a lot lower than what I use at 61. She has had two weeks now with no flushing, no more pimples---rosacea gone. Her mood is great, she no longer needs Depends diapers , and she has lots of energy. She says estrogen is wonderful, and I agree. Another "anectdotal" case solved!

In the question of whether estrogen controls rosacea in peri- or post-menopausal women, anecdotal evidence may be better than scientific trials. Why? Because every woman in a scientific trial will be taking the same dose of estrogen (nearly always Premarin) and usually only once a day. But estrogen dosage, timing, and type of delivery (patch, gel, pill, ring) is something that has to be very specifically tailored to each woman. And, really, you are the only one who can do it because you are the only one who knows what is going on in your body every second of the day. How can some doctor who sees you a few minutes twice a year know what you need? The truth is he can't.

Good luck to all.

[phlika29]

Many thaks irishgenes for giving that update. Very informative as always

[Elaine]

Progesterone options while using estrogen

Hi all,

I just wanted to let you know that there are alternatives to oral progesterone if you need to take progesterone to avoid endometrial growth while you are taking estrogen. The same Prometrium capsules that can be taken orally can also be used vaginally, inserted into the upper third of the vagina just like a tampon. You can find the references on PubMed if you look for the author Cicinelli E 2002 and 2005 papers (pubmed #12237627 and 15950667).

Vaginal delivery keeps levels high enough to prevent endometrial cancer but avoids the side effects of oral dosing, because of something called "uterine first pass." Basically, because of the way blood vessels are set up in that area, more goes into the uterus than into the rest of the body. One reference for this is Einer-Jensen N, pubmed #12456603 , or 15136116). Crinone gel is also an option if you can get it.

I was very pleased to run into this forum when researching rosacea for a friend, and to read the knowledgeable posts of irishgenes. I'd say her input on hormones and breast cancer (and recommended books) is right on the mark, and I second the thumbs up for the Vivelle Dot patches-- they're really way smaller and thus less likely to irritate than a lot of the others. Especially watch out for patches that stay on a full week-- that may seem convenient, but skin doesn't like being under there for that long, I can tell you from a family member's experience...

By the way, I called Dr. Vliet's office and they said she's still writing the new book that was supposed to be out earlier this year; maybe it will be done by the end of the year. I wish Uzzi Reiss would update his too, but it's still a great resource. I'm looking forward to reading the book by Dr. Redmond that several postings have mentioned; it looks like it has been re-named "It's Your Hormones" for the paperback edition.

[Elaine]

Hormone clinical trial- what we're trying, and input wanted

Hi all,

The nonprofit foundation I am involved with is planning to support a clinical trial on hormonal treatment of rosacea, first inspired by this discussion. I've posted separately in the "medical news" section but am posting here to let women interested in this thread know what sort of regimen we are planning to try, and ask for input/experience to help us decide between two choices in one of the study arms.

I first became aware of rosacea when a friend began to struggle with it upon turning 40. I found this site and the anecdotal evidence of women's rosacea being helped by estrogen supplementation. It then turned out, on examining the literature, that there is biological rationale for why this approach might help many women, but nobody has properly tested it.

We are planning a hormone supplementation/stabilization study right now, complete with placebo groups, and it would be great if we could get some input before finalizing the study groups. In particular, one of the hormone regimens we are considering trying is available over the counter; if anyone would be willing to do a spot test of it for a few weeks, it could tell us that it's a good idea or save us pursuing a dead end! (There is a prescription item we can study instead if the OTC one doesn't seem effective for Rosaceans who give it a try.)

The study will be on women (mostly 35+) in Southern California and have two groups in addition to placebo: a systemic hormone treatment group and a topical hormone treatment group. The systemic hormone treatment group is designed to get some of the benefits of the Pill, but without the hard-to-predict side effects that come with the high doses of synthetic hormones in the Pill (the androgenic synthetic progestins in some pills can actually make acne worse). Specifically, we may start with one 0.1-strength Vivelle Dot estrogen patch (the largest HRT size), and then add another small or medium patch as necessary to get an estrogen blood level of 100-140 pg/mL. (The absorption from the patch varies from person to person.)

The progestin component (to protect the uterus and keep bleeding regular, but also because progesterone, as opposed to problem synthetic progestins, may have additonal skin benefit explained below) will probably either be compounded progesterone vaginal cream 25 mg/day; or nightly oral 100 mg Prometrium capsule
plus daily oral 10 mg dydrogesterone (Duphaston) tablet obtained from Europe. Use of both hormones would be continuous except for 3-4 day breaks from the progestin for a bleed every month or two months. Rationale for this protocol is below.

The part I'm particularly interested in getting input on (and people's experience!) is the topical hormone cream group. We are considering using compounded prescription estradiol cream 0.01%, which has been studied in other clinical trials and shown to help with collagen formation and with wound healing (see for example the review paper J.B. Schmidt, "Perimenopausal influence on skin, hair and appendages or G. Hall, "Estrogen and skin: The effects of estrogen, menopause, and hormone replacement therapy on the skin").

However, this is an item that women would have to get prescribed by their doctors, and many doctors are suspicious of, or simply not familiar with, writing prescriptions for compounded medications (not to mention that not all compounding pharmacies have equally strong quality control systems, and you have to know which ones are best). It turns out that there happens to be a product on the market available over the counter that might have similar effects, and we're wondering if it's any good. If anyone would be willing to give it a spot test (maybe test it on one spot under your bangs, and if all goes well try using it for a while on one half of your forehead for a few weeks to see if any difference develops), we would be much obliged, and have a sense of whether we should stick with the prescription item or try the one that is more readily
available. (Just to reiterate, we are a nonprofit foundation that works on medical research-- we have no interest in selling a particular product, just in doing a proper study of some of the approaches that people report to be helpful and that make sense based on the literature.)

The OTC item is a combination of a very weak estrogen, estriol, plus a tiny bit of progesterone, not enough to make much of a difference systemically. Estriol falls in a gray area as far as the FDA is concerned and so isn't currently regulated as a drug; that's why it can be gotten OTC. The nice thing about this low amount of estriol is that it's so low one doesn't need to worry about getting it on a male partner should there be one in the picture, and it's not going to noticeably raise systemic estrogen levels or stimulate the uterus. However, it's plenty enough to have an action in the skin (it's actually twice as concentrated as the amount successfully tested in the clinical trials described in the above review papers).

The progesterone, too, is a very low amount (apparently too low to make it a prescription item). It's real progesterone, not the synthetics like in the Pill that can cause problems because they are androgenic (meaning they act a little like testosterone, exactly what you DON'T need if you have papulopustular
rosacea!). You'll read on the Web and in product claims that this level of progesterone can help with menopause symptoms, but actually, systemic absorption of progesterone is very poor through the skin because a lot of it is metabolized in the skin. Which is exactly what we want in this case, because progesterone

"has a pronounced antimineralocorticoid effect, which causes a compensatory rise
in the aldosterone levels, and exerts an `antiandrogenic' effect which is not
associated with binding to the androgen receptor, but a competitive inhibition
of the 5-alpha-reductase activity in the skin.
...
"progesterone ... may competitively inhibit the activity of 5a-reductase,
resulting in a reduced conversion of testosterone to the more active
dihydrotestosterone." (Kuhl H 2005)

Translation: Progesterone may counteract the effects of testosterone on the skin, without the negative effects throughout the body of pharmaceuticals such as Accutane (which as we all know, works by drying up everything in its path) and anti-androgens such as CPA, spironolactone, and drospirenone (the one in Yaz and Yazmin), which can impact energy and sexuality along with skin.

The OTC product combining estriol and low-dose progesterone is called "Natural USP Estrogen (Estriol) Cream With Natural Progesterone 3oz by Pharmacists Ultimate Health" and is available on Amazon for around $27 (or maybe you can ask your health food store to order it). I've had a hard time finding much whether this company has decent quality control; if anyone wants to do some additional Google searching, it would be much appreciated. Again, I'm hoping that someone would be willing to give this product a spot test to help us decide whether the topical progesterone helps (there is some discussion on the rosacea Yahoo group from women saying it has helped them) or we should just stick with the prescription estrogen-only cream.

Why would you play guinea pig trying this stuff? Because it might possibly help-- AND if you can help us design a successful clinical trial, the results will then be in the medical literature, allowing women with rosacea to have real medical studies they can print out and take to their doctors rather than having anecdotal evidence like the experiences in this thread pooh-poohed.

To close, a list of some of the papers on estrogen and progestin and skin, for those interested in digging into this a bit more on PubMed or Google Scholar. I look forward to hearing any of people's experiences with hormone supplementation (systemic) or direct facial application, and especially from anyone willing to give the topical stuff a spot test to help us decide which kind to use.

Many thanks in advance! --Elaine

Estrogen and skin: The effects of estrogen, menopause, and hormone replacement
therapy on the skin
Glenda Hall, MD, and Tania J. Phillips, MD, FRCPC

Letter: Estrogen and the skin
Jenny E. Murase, MD, Jashin J. Wu, MD, and Gerald D. Weinstein, MD

Hormonal Effect on Psoriasis in Pregnancy and Post Partum
Jenny E. Murase, MD; Kenneth K. Chan, MD; Thomas J. Garite, MD; Dan M. Cooper,
MD; Gerald D. Weinstein, MD

A prospective, randomized, double-blind, placebo-controlled study on the
influence of a hormone replacement therapy on skin aging in postmenopausal women
P.-G. Sator, M. O. Sator*, J. B. Schmidt, H. Nahavandi{, S. Radakovic, J. C.
Huber* and H. Ho¨nigsmann

PERIMENOPAUSAL INFLUENCE ON SKIN, HAIR AND APPENDAGES
J. B. SCHMIDT

Treatment of skin aging with topical estrogens
Schmidt JB

Acne: Hormonal Concepts and Therapy
DIANE THIBOUTOT, MD

Estrogen and progestagens differentially modulate vascular proinflammatory
factors
Lorraine Sunday, Minh Minh Tran, Diana N. Krause, and Sue P. Duckles

Inhibition of Testosterone Metabolism and Lipogenesis in Animal Sebaceous Glands
by Progesterone
J. Girard, A. Barbier, and C. Lafille

Percutaneous administration of progesterone: blood levels and endometrial
protection
Frank Z. Stanczyk, PhD, Richard J. Paulson, MD, and Subir Roy, MD

Topical Cyproterone Acetate Treatment in Women With Acne
A Placebo-Controlled Trial
Doris M. Gruber, MD; Michael O. Sator, MD; Elmar A. Joura, MD; Eva Maria
Kokoschka, MD; Georg Heinze, MSc; Johannes C. Huber, MD, PhD

Progesterone and progestins: Effects on brain, allopregnanolone and -endorphin
N. Pluchino, M. Luisi, E. Lenzi, M. Centofanti, S. Begliuomini, L. Freschi, F.
Ninni, A.R. Genazzani ∗

Pharmacology of estrogens and progestogens: influence of different routes of
administration
H. Kuhl

[Elaine]

Update on hormone study: Not happening, but you can still try the experiment yourself

Hi all,

Just wanted to give you an update on the rosacea and hormones study we were planning to fund. Three things have happened that mean we won't be running it: the researcher has moved universities, we have gotten busy with other studies, and there has not been a big response from Rosaceans trying it out such that we would be going in extra-confident that this seems like a treatment that works anecdotally and thus ought to be studied scientifically and publicized.

However, you can still try out the treatment if you want to experiment and do a spot test (for example, on one half of your forehead or one side of your face). The weak estrogen/progesterone cream we mentioned is no longer manufactured, but the manufacturer (and others) still makes separate estriol (an ultra-weak estrogen) and progesterone creams. In your searching, you'd look for USP progesterone cream, or, better, go to a knowledgeable health food store and ask them for their most reputable brand of USP progesterone cream. You'll want to limit your use of this to the spot you're trying out, since you may be one of the people who absorbs it well enough that you could get systemic effects if you use their full suggested dose (which could be good or not, but you're probably not in the mood to experiment more than necessary).

Alternately, you can try a little bit of estrogen gel, which you can find online by searching "Oestrogel is the same as Estrogel in US". This formulation is alcohol-based, though, so it may be a bit harsh on dry skin. You can either use the amount they suggest in the place they suggest (i.e. shoulder or arm) if you want to raise your estrogen levels, or use a lot less, directly on the spot-test area, to see whether it makes a difference when applied directly to the affected skin. Based on other the way hormones work and other people's posts on the Rosacea Forum, it's pretty likely that raising your estrogen level will help some; but we're particularly curious whether if you don't want to be messing around with your estrogen level, applying a much smaller amount directly to the affected skin (an amount that isn't likely to affect your whole body) will help.

Best wishes to everybody, and do post if you have any interesting results.
Elaine

[phlika29]

Elaine

I am sorry to hear that the trial is not going ahead. I am surprised that there were not more women wanting to get involved as I am sure, like me, they find that their rosacea varies at different stages of their cycle.

Please keep us informed of any developments in this area.

Best wishes

Sarah

[Russie]

I am very interested in this as well. Please keep us informed. My gyn wanted to give me Premarin to help with the "hot flashes". I am only 33 years old. I told him NO, but am interested in bio hormones and he is not....so there you have it. Very sad on his part.

[WrinkledClue]

Estrogen is wonderful, yes. I got BioIdentical Estrogen, and thought my rosacea was cured.

It was; that is, until the bioidentical estrogen gave me a massive blood clot, and my dr pulled me off the estrogen.



So please be careful with hormones. It is NOT just the equine estrogen that causes problems. BioIdentical estrogen can also cause problems in some women.

I was extensively tested and had no other clotting factors. It was the estrogen.

I'm controlling the flushing now with Clonidine and Remeron.

[Judworth]

Trying to stay calm!

Hello All,

I was diagnosed with rosacea in 2002, my symptoms were/are mainly extreme flushing

and are VERY hormonal/emotion related!

I have yrly IPL treatments which up until now (and with careful skincare) I have managed to
keep my flushing well under control.

Despite a recent IPL in June of this year, I think I am now having hot flashes (I am certainly
of that age, although still have regular monthly periods).

Last evening was the Mother of all rosacea flushes...........I am now begining to think that
it is the hot flushes that are triggering the rosacea flushes!

What can I do?

I am very hesitant to visit my GP as I am sure they will prescribe drugs, I have an active
life-style & a healthy diet.

I was once put on beta-blockers for hyperthyrodsm and had daytime halluinations!

Please any suggestions?

What if any, is your experience of Black cohosh or Red clover?

Judworth