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Osteoporosis Message Board

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I debated on replying to this post since my situation is a bit different but decided to anyway since I have heard some info on this topic. I am nearly 36 and had a hysterectomy with removal of both ovaries three years ago. I was placed on hrt right away but went through several kinds (Estratest, sublingual compounded bioidentical troches, drops, creams in the forms of estrogen and progesterone and testosterone in cream and troche form) and had numerous problems with them. At one point in 2006 I had my estradiol levels checked as well as other hormone levels and my estradiol came back at something like 17 pg/ml, waaay post menopausal even with hrt. I was not absorbing the hrt I was on. My testosterone and progesterone levels were extremely low also. Two months later (one year after my surgery) I had my first dexa scan which showed a t score in spine of -3.2 and right hip -1.8. I was also down to 102 lbs at 5'6" at the time (digestive problems, strict diet, eating disorder, and smoking all contributed). This prompted me to change some things in my life. I quit smoking (still quit), gained weight (now at 120 lbs but was up to 130 lbs for some time), upped my vitamin D intake along with calcium, and started the Vivelle Dot patch. After some initial adjustments I settled at .075mg patch. I also was already exercising but saw a physical therapist and trainer and began a more intensive weight bearing regiman at the gym and at home. One year later in 2007 my dexa scores were as follows: Spine -3.0, right hip -1.4, left hip -1.2, wrists normal. So there was an improvement (.2 in spine and .4 in right hip over the year). I might also add that around the same time as my second dexa scan I had my estradiol levels checked again and they were at 130 pg/ml. Whether it was quitting smoking, gaining weight and better diet, upping the vitamin D and calcium, or the hormone patch at a higher dose that contributed I cant say for sure. Maybe all of them. But I am certain adding the higher dose patch and finally absorbing some estrogen had a lot to do with it. There are studies that confirm that enough estrogen is needed for the proper absorption and utilization of calcium (even in men testosterone converts to estrogen and provides that needed estrogen). How much estrogen to achieve this I dont know, but since women in natural menopause still continue to secrete small amounts of estrogen from the ovaries and yet still commonly lose bone density it makes you wonder.
In her book "Screaming To Be Heard: Hormonal Connections Women Suspect and Doctors Still Ignore", Dr. Elizabeth Vliet, M.D. claims that women need at least estradiol levels of 70-80 pg/ml to maintain healthy bone density and protect what you have. She claims that her clinical experience has shown this to be true, and mentions recent studies but does not cite exactly which studies which is frustrating. I have also seen studies regarding some of the hormone patches such as Menostar, Vivelle Dot etc. and claiming that there was an improvement in bmd compared to placebo in post menopausal women even at doses as low as .014. Of course the studies do not take into account how well the patches are absorbed by each individual woman, what kind of diet was followed and if diet included estrogenic substances. And what bmd was at baseline. All the studies I have seen also tend to be short term as opposed to ten years or longer.

I still dont feel great even with my estradiol levels where they are and still have symptoms of low estrogen but again I am younger and in surgical menopause and my estrogen needs are probably way different than someone older. I did try the .1 mg patch but bloated up and felt horrible. I just recently added compounded bioidentical testosterone back into my hrt regiman due to very low levels tested and symptoms of low testosterone. This time I am trying sublingual drops for testosterone which I have not tried before. I didnt do well with troches or creams. I am hoping this too will make a big difference for my bones. Testosterone is one hormone that is often overlooked for women in menopause. Not all women will need it but some benefit greatly from it, and women without ovaries especially benefit. As far as progesterone, I have a terrible time with even natural progesterone of any delivery method (cream, pills, troches, etc.). I simply can not tolerate it. For me though it is not life or death as it might be for a woman with a uterus using unopposed estrogen. I have heard good things about natural progesterone also helping with bmd though. Somewhere I read that human bone has receptors for progesterone as well as for estrogen. I will have to dig up that info.
Anyway, not sure if I helped any but just wanted to share what I have heard. I plan to stay with the Vivelle Dot for a long time. I do not have a family history of estrogen dependant cancers and without hrt I am a complete physical and mental basket case. I am hoping to avoid the bisphosphonates as long as possible. It will be interesting to see what my next dexa scan shows. I will certainly post about it here one way or another.

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