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Thread: HRT for women

  1. #51
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    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.

  2. #52
    Senior Member irishgenes's Avatar
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    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.

  3. #53
    Moderator phlika29's Avatar
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    Many thaks irishgenes for giving that update. Very informative as always

  4. #54
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    Default 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.

  5. #55
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    Default 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. Hošnigsmann

    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

  6. #56
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    Default 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

  7. #57
    Moderator phlika29's Avatar
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    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

  8. #58
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    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.

  9. #59
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    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.

  10. #60
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    Unhappy 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
    SUFFER FROM NEUROPATHIC ROSACEA & OCULAR ROSACEA.


    *Vit D3,Theratears Omega 3.



    *LDN since October 2018.

    *REN skincare range. TARTE cosmetics.

    *Tried Clonidine, Moxonidine & Atenolol (None being taken at present ).

    *Yearly IPL treatments until 2009.

    * RLT Journey!" (Sept 09) **Using Britebox Revive..(Stopped ).

    * Use Optimel & Ilast cream for MGD Ocular rosacea.

    History of Hyperthyroidism (Graves) Lichen Planus (oral)
    PROUD TO BE DIFFERENT






    .

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