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[Wilks]

Erika28- There is a huge amount of evidence supporting that some types of breast cancer are driven by oestrogen/ progesterone and several effective, approved anti cancer treatments are based on blocking oestrogen. Supported by randomised, controlled Phase 3 trials.

I agree that the understanding of the causes of breast cancer are complex; not all types are hormone-driven, and that the best available evidence sUpports that HRT likely poses only a very small risk. I know the amount of oestradiol absorbed from gels and patches differs among women so we require different doses.

I use HRT myself, and it's literally been a lifesaver for me. I totally get it that the benefits for many of us outweigh the risks. I just disagree with some of the assertions you're presenting to this forum.

[Alicess]

Erica,. don't have much time to go in to details at the moment but I agree with your views. Please continue to share your thoughts and experiences.

Alicess 🌷

[Wilks]

What? Even when she's making false and irresponsible statements?
How are we going to be able to collect reliable safety data on the long term real-world use data of HRT when people are encouraging others to apply high doses of the most potent form of oestrogen to their vaginas? Against recommendations, and justifying it with incorrect assertions?

I left this forum for a year or so because someone with an “agenda” was spreading incorrect information to put people off HRT, denying that low oestrogen levels can adversely affect your bone and heart health. I returned a few months ago, but I see that most of you prefer fake information, so it's not a place I want to be associated with.

[Erika28]

Erika28- There is a huge amount of evidence supporting that some types of breast cancer are driven by oestrogen/ progesterone and several effective, approved anti cancer treatments are based on blocking oestrogen. Supported by randomised, controlled Phase 3 trials.

I agree that the understanding of the causes of breast cancer are complex; not all types are hormone-driven, and that the best available evidence sUpports that HRT likely poses only a very small risk. I know the amount of oestradiol absorbed from gels and patches differs among women so we require different doses.

I use HRT myself, and it's literally been a lifesaver for me. I totally get it that the benefits for many of us outweigh the risks. I just disagree with some of the assertions you're presenting to this forum.

My assertions are based off research I've read in the last 10-15 years. To be able to assert with certainty that estradiol CAUSES breast cancer, you need large randomized trials, repeated over and over again, showing estradiol alone increases significantly the risk of breast cancer. We actually have the opposite of that: 2 large randomized trials which showed estradiol alone REDUCED the risk, one only significantly after cessation of the study. The media rarely mentions these, if ever! As mentioned earlier, high dose estrogen has been used for decades in the treatment of advanced breast cancer and found to be AS EFFECTIVE as anti-estrogens. Lastly, pregnancy, a period when hormone levels are VERY HIGH, has shown to be associated with a LOWER risk of cancer, over time. And we have much more...I have a whole document with a multitude of studies.

I would be happy to go over the research with you and you would likely agree with me, at the end of it. When you dig deeper, you see the truth of the matter. Then, you realize how MONEY drives treatments.

[Erika28]

What? Even when she's making false and irresponsible statements?
How are we going to be able to collect reliable safety data on the long term real-world use data of HRT when people are encouraging others to apply high doses of the most potent form of oestrogen to their vaginas? Against recommendations, and justifying it with incorrect assertions?

I left this forum for a year or so because someone with an “agenda” was spreading incorrect information to put people off HRT, denying that low oestrogen levels can adversely affect your bone and heart health. I returned a few months ago, but I see that most of you prefer fake information, so it's not a place I want to be associated with.

If needed, I can provide the research supporting my assertions. I have absolutely no problem with this. I have no agenda except the truth, which when we start to dig deeper, we realize we really don't know much anyways and there is so much more to learn. I truly care about others and only want them to be as informed as possible so they can make the best possible decision. I present data and let others draw their own intelligent conclusions.

I'm not encouraging anyone to do anything. I'm only sharing my personal experience with hormones. People should ALWAYS consult their doctors before doing anything. A forum is a place of exchange and this is what I do: I exchange information.

[Hurdity]

Oh heavens not this thread again....

FWIW my well-informed gyno (in US) suggested I use the testosterone gel she prescribed this way, and the compounding pharmacy said yes that is one of the ways it can be applied. I rotate with other areas, seems fine.

No! Absolutely not! I am sure no reputable gynae (endorsed by British Menopause Society) will advocate putting testosterone gel - a preparation produced for men - onto female genitalia - if that's what you mean by " that is one of the ways it can be applied."  Also since compounding pharmacies ie BHRT are also not recommended by the BMS (nor N American one for that matter as far as I recall) - then whatever they say cannot be taken as any sort of endorsement. You can do what you like - but it is not recommended for anyone else to even think about it!

Here is the BMS info about T replacement in women:

"10 How should testosterone gel/cream be used?

The testosterone gel/cream should be to applied to clean dry skin (lower abdomen/upper thighs) and allowed to dry before dressing. Skin contact with partners or children should be avoided until dry and hands should be washed immediately after application. The area of application should not be washed for 2-3 hours after application."

https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/

Hurdity

[Hurdity]

What? Even when she's making false and irresponsible statements?
How are we going to be able to collect reliable safety data on the long term real-world use data of HRT when people are encouraging others to apply high doses of the most potent form of oestrogen to their vaginas? Against recommendations, and justifying it with incorrect assertions?

I left this forum for a year or so because someone with an “agenda” was spreading incorrect information to put people off HRT, denying that low oestrogen levels can adversely affect your bone and heart health. I returned a few months ago, but I see that most of you prefer fake information, so it's not a place I want to be associated with.

Hi Wilks - it's good to see you back on the forum and I can assure you that "most of" us DO NOT "prefer fake information". The big C word has been happening so many of us are otherwise occupied but please continue to post as this forum is endorsed by a renowned gynaecologist and is underpinned by science. False information or stuff not back up be evidence is usally challenged - but as always we only come on here when we have time in between busy lives 

I am followed by a private doctor in Canada who is a specialist in female hormones, she even wrote a book on the subject. She thinks outside the box, like me. I am very lucky to have her! I will share studies I come across, with her and she will share her own findings with me, based on the 1,000 patients she treats. I very much enjoy our discussions.

I have already responded to the use of the oft quoted cliche "thinking outside the box" which tends to be used to advocate any unconventional treatment that anyone wants to justify! It's not done to requote your own posts except probably in a very long thread but what I said about this is on the first page.... this (thinking outside the box) does not justify applying oestrogel to your vagina for the reasons given earlier - however much you appear to be trying to sell the idea to us!

Compounding pharmacies - like I said - are used by a minority, unregulated and not recommended, as we have perfectly good cheap tested, efficacious products available on NHS.

The issue about breast cancer is another matter entirely.

Yes sharing of information can be helpful and interesting but not if it appears to encourage a minority regime that is untested, totally off-piste, potentially unsafe, and the regime together with the  monitoring needed only available privately at great expense.

The licensed HRT products should only be used in or on parts of the body that they have either been licensed for and/or research has shown are effective and safe at the doses used or can be easly extrapolated from the doses used for that preparation.

Hurdity

[dangermouse]

I never used it (anywhere) but I was told by the endocrinologist prescribing testosterone that it worked better for libido if applied to the vaginal area. I assumed that's where everyone who used it applied it!

[Hurdity]

See my other post on pepperminty's thread. I am sure no reputable gynae would advocate applying any form of T to genitals and if they have please post here who they are and the info! I've quoted an extract from the Androfeme (T cream for women licensed in Oz) product info on the other thread. T gel would be variably absorbed and give erratic serum T levels so totally inappropriate on labia or vagina. Any sort of compounded creams will not have been tested re T levels in body and won't be standardised so defo not recommended (to apply to genitals or anywhere). Just because your endocrinologist suggested this dangermouse does not mean it's OK! If you can link me to trials showing what product was used and applied to labia, and the outcomes re T levels etc together with recommended dosage, or the name of the doc so that we can look at their website maybe, then I'll take notice! With respect, we have to go on what advice is published rather than hearsay.

Hurdity x

[Sgtvhilts]

Erica- you are a grown adult. You can do what you like, with what you like- regardless of what is proven and what is not.
It is about informed consent and knowing full well that you accept the consequences of your actions.
I do what I like- safe in the knowledge if it goes ti*s up then I knew what I chose to do and accept the consequences of my actions. Sure, I won't be very happy if I get some hideous ‘disease', but I chose to take the risk.
Do what works for you.
I smoke like a trooper- I love it.  Will it kill me- probably/maybe/maybe not;but as my old nan used to say “smoking prevents dementia “ how nan?= they are all dead before they get that old! LOL
People will then day ... oh , you shouldn't ‘burden' the NHS....... er , no.. I have paid my national insurance as well as medical insurance for the last 30 + years so have every right to use it.  Dementia is also a ‘burden' on the NHS is it not.
Life really is for living- for the time that is given to us

[Mary G]

Sgtvhilts, I agree, sometimes conventional forms of HRT don't work and you have no option other than to find your own solutions.  I used Angeliq topped up with a patch for a long time.

I can't take any of the standard forms of progesterone so I now use bespoke 50mg progesterone alongside Oestrogel and testosterone and it's working extremely well.

The only other option was a hysterectomy so in as last ditch effort, I decided to take responsibility for it myself and find something that worked.   What was I supposed to do?   

I wish I could use a standard HRT regime but it's just not possible.

[dangermouse]

See my other post on pepperminty's thread. I am sure no reputable gynae would advocate applying any form of T to genitals and if they have please post here who they are and the info! I've quoted an extract from the Androfeme (T cream for women licensed in Oz) product info on the other thread. T gel would be variably absorbed and give erratic serum T levels so totally inappropriate on labia or vagina. Any sort of compounded creams will not have been tested re T levels in body and won't be standardised so defo not recommended (to apply to genitals or anywhere). Just because your endocrinologist suggested this dangermouse does not mean it's OK! If you can link me to trials showing what product was used and applied to labia, and the outcomes re T levels etc together with recommended dosage, or the name of the doc so that we can look at their website maybe, then I'll take notice! With respect, we have to go on what advice is published rather than hearsay.

Hurdity x

I suspect all hormones are more effective if applied to mucous membranes, the dose needed is probably less than if taken orally if that's how testosterone is normally taken.

This could be what you're looking for: https://www.ncbi.nlm.nih.gov/m/pubmed/16681480/

[jaycee]

When i was given Estrogel by mistake from a Dr other than my own, instead of Ovestin, my own Dr was horrified ,and i suspect the other Dr,a new young one had a good telling off

[Erika28]

Here is a study detailing estrogen application intravaginally.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354766/

Rigg and colleagues measured the levels of estradiol, estrone, LH, and FSH after application of 2 g of vaginal cream containing either 0.2 mg estradiol (E2), 2.0 mg estradiol (E2), or 1.25 mg conjugated equine estrogen (CEE) in six postmenopausal women.23 Each participant rotated treatment with each type of cream. With the low dose estradiol (0.2 mg), an increase in serum estradiol was seen in 30 minutes with a peak of 80 ± 19 pg/ml reached at 4 hours. In comparison, the high dose estradiol cream (2.0 mg) led to an increase in serum estradiol that occurred in 15 minutes with its peak occurring in 4 hours at 527 ± 45 pg/ml. CEE cream showed a much slower rise of estradiol level, with a significant increase occurring after 3 hours and a peak reached at 6 hours of 33 ± 6.6 pg/ml.

What's interesting is when you look at the graph, you notice how levels remain quite stable over 24 hours. I have the entire study of this (N Engl J Med 1978; 298:195-197, DOI: 10.1056/NEJM197801262980406)

Also,

Intravaginal estradiol is also utilized in women undergoing embryo transfer. Tourgeman et al. studied oral versus vaginal estrogen administered to women preparing for embryo transfer.27 The women were given leuprolide, inducing a temporary menopausal state, and then administered either oral micronized estradiol (2mg bid orally or vaginally) during days 15-21 of their cycle. Two hours after the final dose of oral estradiol, mean serum levels were 279 pg/ml compared to mean serum levels following vaginal estradiol (2344 pg/ml).

And,

In a study by Martin et al.28 postmenopausal women were given 0.5 mg vaginal micronized estradiol as a one time dose. Another group was given 0.5 mg vaginally with alternate day dosing for 14 days. The levels of estradiol, estrone, and gonadotropins were analyzed at 2, 4, 6, 8,10 and 24-hours post application. With the one time dose, estradiol reached a mean peak level of 1105 ± 160 pg/ml at 4 hours. At 10 hours, the estradiol level was 24 times baseline levels. In contrast, estrone reached 11 times baseline after 8 hours (exact values not given, approximately 400 pg/ml vs 0). There was a significant decrease in both FSH and LH during the first 10 hours (FSH approximately 90 to 70 mIU/ml, and LH 40 to 25 mIU/ml).28 These data were compared to an earlier study in which 2 mg oral estradiol was used. Use of vaginal estradiol 0.5 mg resulted in a peak serum estradiol 10 times higher than 2 mg oral estradiol (0.5mg of vaginal estradiol resulted in mean peak levels of 1105 pg/ml at 4 hours as noted above vs 2.0 mg oral estradiol esulted in peak level of 110 pg/ml at 2 hours ). Estrone levels were 25% higher with the vaginal application. Oral delivery of estradiol yielded serum levels of estrone which significantly exceeded levels of serum estradiol secondary to hepatic “first pass” metabolism. However, vaginal administration of estradiol results in higher serum levels of estradiol compared to estrone because the vaginally administered estradiol is not subject to “first pass” metabolism. 28, 29

With estradiol tablets taken vaginally, levels fluctuate more. There is quite a rapid peak and then drop so that by 24 hours, levels are back to where they were before taking the tablet. Cream results in much steadier levels.


I have all 3 studies as pdfs. I work at a university, this is why.

[Hurdity]

I suspect all hormones are more effective if applied to mucous membranes, the dose needed is probably less than if taken orally if that's how testosterone is normally taken.

This could be what you're looking for: https://www.ncbi.nlm.nih.gov/m/pubmed/16681480/

Hi dangermouse - thanks for the link - I'd seen that paper but it was just a study looking at one application of a synthetic testosterone product (not used for T replacement in women)  to see at how it was absorbed in the body - so not relevant to our situation. Testosterone is never taken orally anyway for HRT - always transdermally (and occasionally subcutaneously via pellet) - for the reason you give - that it is better absorbed as well as not leading to metabolic by-products from going through liver etc.

There is no product available which can be applied vaginally or onto labia (I posted the Androfeme info on the other thread about T).

Hurdity x