Choose Wisely! Oral Vs Transdermal Estradiol: Which Is Safer For Your Health?
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- čas přidán 25. 07. 2024
- What's the best form of estrogen to take in menopause? Some providers insist that "Transdermal estrogen is the safest form." Others claim that oral estradiol is preferable to prevent certain risks. Let's explore!
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1. Studies Mentioned in This Video:
Oral estradiol/micronized progesterone may be associated with lower risk of venous thromboembolism compared with conjugated equine estrogens/medroxyprogesterone acetate in real-world practice.
www.maturitas.org/article/S03...
2. Early vs. Late Intervention Trial with Estradiol (ELITE)
www.nejm.org/doi/full/10.1056...
3. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial (Danish Study)
www.bmj.com/content/345/bmj.e...
4. Effects of Postmenopausal Estrogen Replacement on the Concentrations and Metabolism of Plasma Lipoproteins
www.nejm.org/doi/full/10.1056...
5. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases
www.bmj.com/content/364/bmj.k...
6. Lower risk of cardiovascular events in postmenopausal women taking oral estradiol compared with oral conjugated equine estrogens
pubmed.ncbi.nlm.nih.gov/24081...
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Thank you so much for validating my oral estradiol use! Transdermal estradiol would not work for me since I use a hot sauna 6 days a week, and exercise vigorously, causing a sweaty body!
Please say more. I use sauna regularly and exercise vigorously daily. Patches have not worked so I just switched to a gel. Hasn't worked yet. Did you try a gel?
Thank you! Start oral soon! I’ve been terrified to take them
Excellent information, thank you for explaining this!
This is the first time I've heard of this - very interesting!!!!
Fellow pharmacist here and very much appreciate your videos! I've learned so much from you to help me in my perimenopause journey. I am curious your thoughts on the influence of oral estradiol on the gut specifically the estrobolome. This is one argument I've heard against it but curious your thoughts.
How interesting. Thank you! I would love to hear how E injections fit into this, which a lot of us are using now.
Excellent job in clearly and concisely explaining the REAL risk to women depending on what type of HRT they use for estrogen. Thank you for presenting the research articles and in a clear manner for most people to understand. (however - one small error, but thought you would like to know) The "table 1" is NOT from the" first study" you mentioned (JAMA study), but from a more recent study in Maturitas 2023 Jun: 172:23-31. The information is all very much correct - the most important consideration. I did also notice that the table notes a risk of a DVT is much higher at >10% with just depression (assuming lack of movement can lead to DVT-which it can) and Diabetes > 8% (assuming hypercoagulability related to hyperglycemia...and reduced activity level). Again, EXCELLENT Job! Looking forward to finding time to see your other videos.
@davidlinton533 Thanks for watching so thoroughly. It’s possible I got a tiny bit rushed in mentioning which piece of information came from which study. I appreciate details like that. I’d love to hear what you think of my patient education resources. I saw that you signed up for my mini-course. I’d be down to get together on a call to talk things over. Let me know if and when that works for you.
What about transdermal natural estradiol/estriol cream....is it safer?
I have used every form of estradiol over 16 years. Transdermal bypasses the digestive system. I prefer the patches but my rx coverage makes it too costly so I now use oral. However I take it sublingually, again bypassing digestive system.
Hi. How do you take sublingually? Do you just put under tongue and not swallow the pill with water?
@@ijh7192 just put under tongue and let it disolve.
@@ijh7192 I also take it sublingually via a troche. It is prepared by a compounding pharmacy and is a lozenge that I place in my cheek which gets absorbed.
I just can’t get my oestradiol level up with the oestrogen patch anymore. It worked in my late 40s but not in my early 50s.
I heard from a Dr that Oral Estradiol is better for: MOOD -HAIR- SKIN than Transdermal Estradiol. Any studies on this?
I am actually one of the low percentage of women with a higher risk for blood clots than heart disease, even though my total cholesterol and LDL-C were slightly above reference ranges. Once I started transdermal E2 with oral micronized progesterone my cholesterol levels were all in range, go figure.
I was looking for information like this. Would be okay to take a generic kind? Most of them are very expensive because of the brand names. Thanks in advance!
@klasicpao In general, the generic versions have the same amount of estradiol as the brand name products.
But: how about the estradiol/estrone ratio on oral is higher than cream, is high estrone levels a bad thing in ur opinion?
I went from compounded estradiol pills to patches and now to compounded vaginal cream. Trying to get the serum levels right...I might go back to pills, just a higher dosage if this doesnt work.
I had stage 3B cervical cancer 3 years ago. Had chemo and radiation for 2 months and I'm in radiation induced menopause now. I have a strong breast cancer gene in our family, from my Mom's side. My Mom and a cousin died from it, her eldest sister and her daughter both had double mastectomy. With this family history and my own cancer history, can i take HRT?
I have been on oral estradiol for two years but wanted to try the patch. Two weeks on the patch and noticed my hot flashes, insomnia and joint pain returned. I am going back to the gyno office to request to go back on estradiol pills. The patch is way more convenient but not worth the return of my vasomotor symptoms.
I use Divigel because I get rashes with the patches. I use micronized progesterone.
I have papillary thyroid cancer(very small and early stage, so no surgery necessary for now). I developed the cancer after I started the HRT. I personally think the thyroid cancer is not related to HRT. Is any better form of option (oral or transdermal) for me in this case or is there not enough evidence yet on either method? Thank you.
I had extensive papillary cancer with my thyroid removed and about 40 lymph nodes with about 20 lymph nodes positive. This was back about 10 years ago. I am 50 years old and started transdermal estradiol and progesterone about 8 months ago and all is well. No issues as it relates to the thyroid cancer so far.
I just read that estradiol can cause hair loss. Makes no sense if this is a bio (body) identical hormone. Makes me afraid of estradiol. "Progesterone levels drop as women approach menopause, which can lead to an abundance of estrogen that triggers excessive hair shedding and ultimately hair loss." Does this mean if I don't have a uterus and only take estradiol without progesterone, that I may suffer hair thinning?
When you mention oral estradiol, you’re talking about taking the bio identical one, right?
@radiantcauliflower5235 YES. Oral estradiol always refers to the bioidentical hormone estradiol, exactly the same as the estradiol made in the ovaries.
Please discuss the theory that oral Estradiol converts too readily to Estrone. I believe oral E2 helped significantly in lowering my cholesterol so I want to take it and I’ve never had Estrone tested so I don’t know where that is at. What would I look for as a symptom of Estrone being too high?
@pammackenzie8629 Great questions.
Estradiol DOES convert to estrone.
There's a complicated metabolic pathway for estradiol that I've chosen, so far, not to try and explain.
My channel is called "Simple Hormones."
Whenever I make videos or blog posts, I ask myself 2 questions:
1) Is it SIMPLE? (If not . . . can I SIMPLIFY it?)
2) Is it about HORMONES?
In the case of estradiol metabolism it IS about HORMONES.
But it's pretty difficult to simplify. So I've chosen to avoid putting out content that's too complicated.
It's not so much that "estradiol converts too readily to estrone." Rather there's some evidence (but not a lot) that estradiol is metabolized into various forms of estrone, including 16-hydroxy-estrone and 2-hydroxy-estrone.
The idea is that the ratio of 2 hydroxy estrone to 16 hydroxy estrone predicts breast cancer risk.
That MIGHT be true.
But a fairly robust review article goes into some great detail that seems to call that conclusion into question. Instead, the paper has this conclusion:
"All of nine properly designed epidemiological studies (six prospective case-control studies and three retrospective studies) failed to show a significant relationship between urinary or circulating EMR (2OHE1/16αOHE1) and breast cancer risk."
Here's a link to that study:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3039007/
I really enjoy your videos. Why is it that hormone providers never discuss the simplest and best delivery methods- injections for menopause. I inject both estradiol valarate and testosterone cypionate and I feel amazing. There are better options out there than the patch and pill. Why is no one speaking on injections?
@blondebeautylush That's an interesting perspective. I would guess that the obvious answer is most patients are afraid of needles and won't be interested in daily or weekly injections. I like to say there are advantages and disadvantages to EVERY dosage form. You just pick your problems. Injectable estradiol has some advantages. But it can cause dramatic peaks and troughs in blood levels, very high right after the injection and very low right before.
This is so confusing now to me. I have always heard the E patches are better for less risk of blood clots. I have tried taking baby aspirin and I would find bruising from nowhere. So, I got off that. I try to do the best I can for my body, but at 67 I have to realized, no matter what you do there😒 are side effects to everything.
I've been on the pill for 21 years because of super painful periods, and I always remember those bruises that came out of nowhere...It happened to me when I was 28, so I don't think it's a matter of age, I think...Right now, I no longer take the pill and those bruises are gone... I suppose there is a certain association between hormones and those bruises, but it is not linked to age, I believe.
@kathystclair9485 As I say in the video, the risk for blood clots is mainly for women who have had them before or who have genetic clotting risk factors. The key is to have a hormone provider who knows how to evaluate ALL your risks.
Steve - is there anyone qualified to evaluate “all risks” in the Kansas City metro ? And I’m frisky certain most don’t accept health insurance 😕
@@nc2764 The best way to request a referral is through my referral request form here simplehormones.com/referral If I take them other ways - like in comments or chat or email, they always fall through the cracks
What about Absorption rate? I'm told oral less effective because it gets lost in the gut?
@debbiecalderon5376 Great question - Oral estradiol does get metabolized to a greater extent when it goes through the gut, then the liver. The solution is pretty simple . . . you just take a higher dose. The doses of estradiol patches are substantially lower than in oral tablets. There's some evidence that the metabolism of estradiol in the liver is the reason oral estradiol has a greater impact on heart risk.
Thank you
@@SimpleHormones
What would you recommend for a woman over 10 years post whose only symptoms are vaginal dryness and libido?
@joannepigliavento7930 If you watch very many of my videos, you'll begin to see that I recommend hormone optimization. That means that all your hormones aren't too high and they're not too low but they're just right. That helps in 2 ways: 1. It reduces or eliminates all your symptoms (even if you only have a few) and 2. it reduces your long-term health risks. Risks are actually MUCH more important than symptoms, in my view.
In a case like yours, it's important to have someone who knows what they're doing assess all your risks to help guide you to the dosage form and dose that's best for your situation.
@@SimpleHormones Thank you!
What about the liver?
@andreapicardi9682 I’m guessing you’re referring to “liver first pass metabolism” of estradiol? That is a factor in estradiol. All estradiol is metabolized by the liver from puberty, when your ovaries start making estradiol. It is true that oral estradiol is metabolized by the liver sooner and to a greater extent than transdermal estradiol. But that’s not a bad thing. The liver can handle estradiol metabolism no problem. And it appears estradiol liver metabolism may be the reason estradiol helps reduce the risk for heart disease.
Do the symptoms of menopause ever end?
@nellie... Looks like you've seen my "Breakthrough HRT Study" video that explains how many menopause symptoms DO NOT go away. Some of them, particularly vaginal and urinary symptoms, get MUCH WORSE over time. What also does not go away are the increased health risks that come from having inadequate hormone levels. Osteoporosis and heart disease are the biggest and first to show up.
Is it possible to schedule a phone consultation with you?
I offer a 30-minute hormone coaching call for patients here: simplehormones.com/coaching
@@SimpleHormones thank you appointment booked!
Do you know if oral estradiol has better success with bleeding issues? I switched from Estradot patch to Climara patch due to shortages of Estradot, and I bleed every 10 days :( I increased progesterone to 200mg and still no end in sight. I believe it’s the brand I’m having an issue with. Would like to try either gel or oral, but I’m curious if oral has better success with bleeds?
I'm in the UK and we have an oral HRT called Bijuve here. Oestradiol and micronized progesterone together. But I'm a long time migraine sufferer, so I don't know if it's suitable for me. I'm presently on E patches and separate micronized P.
There's a new HRT product in the pipeline, using estetrol instead of oestradiol, called Donesta. I think that's oral as well 😊xx
Stay away from horse urine estrogens, for the horses 🐴 sake