On the compound pharmacies, I live in Brazil and this country has top tier quality in compounding pharma. So having hormones compounded wouldn't be a problem except for the need of a medical recipe. And no doctor will prescribe them. Is har enough for them to accept to prescribe hrt in the first place. So that is another barrier: educating active professionals to help their patients.
So grateful you offer you’re patients choices!! That is SO rare , especially when dealing with hormones. Most physicians are a my way or the highway mentality or there is no talking about hormones at all and you are shut down.
This info seems good but if you have a uterus, it is going to be like finding a needle in a haystack in terms of locating any doctor that will prescribe estradiol without progesterone because of their fears of the uterus growing into cancer territory without the progesterone to balance the estradiol . So how would your course or book help women who cannot get a prescription for estradiol and progesterone separately??? Seems like a lost cause for women with uterus to try the physiological protocol you teach about when most of us can barely get prescriptions for 1mg Estradiol/0.5 norethindrone (progesterone) because all they really want to do is prescribe the lowest dose. I had to go through hell and high water just to get the aforementioned higher dose.
Our “healthcare” system is broken and has failed us women, yes. For now, the only way is to go outside the system. I love this doctor. Saw her PA via telehealth, who set me on the optimization path right away. Followed up with Gersh just recently. Got my insurance to pay for the labs.
@@allisonhuber1771 I'm in NorCal (they are in SoCal); however, you can still do telehealth from out of state as long as you make an in-person visit twice a year. It's worth it, imo. I'll be moving to CO and am totally willing to travel twice a year to see someone who actually cares about my health and who is not bound by our broken system. Btw, it was a PA (Physician's Assistant) who I saw first (better than an NP!).
@@j.j.l. I have booked an appointment with their office for late October. Trying to decide if I should go with the PA or the doctor herself. How was your experience with them? Would you mind sharing? Thank you
Dr Gersh, i can't thank you enough for sharing information and knowledge for free on SM platforms. I am from Pakistan and as most women in developing countries, we don't have many resources and facilities regarding women's health, let alone menopausal care. You and wonderful doctors who selflessly share knowledge are our only source to learn about what feels like a havoc in mid life. Here in Pakistan, ONLY oral estradiol pill is available, that too 2 mg , pharmaceutical grade. So, it remains our only option for estrogen intake. Hopefully, some day transdermal will be made locally and we could benefit from it too, till then i shall take my chances with oral estradiol pill and pray to God, everything remains good .
I had no luck even finding a doctor in Pakistan who knew anything about hormonal care. Luckily there are private clinics in Dubai that do and also compounding pharmacies. If you can come to Dubai, see Dr. Hani, American qualified Lebanese doc at Enfield Clinic in Jumeirah. There are others too, you can search.
@@SPower-yl9ww thank you for replying. I know right. Not a single doctor who has proper knowledge or training. They look terrified when you ask them about hrt. And then no transdermal form of estradiol available whatsoever. Only oral pill is our only option.
@PrototypeM You are lucky you found Estradiol pill. When I was there in January, didn't even find that. I was educating the Endricronologist in Karachi, gave him a book to read and told him to get up to speed! Gynecologists/ Endos in Dubai are not any better. Gyny was 3 years older than me and didn't have a clue. I asked, what did you do in perimenopause? She said nothing. 😝 The clinic I recommended to you has the lowest consulting fee I could find and the compounding pharmacy they work with have lower prices than others I checked with. Take a trip out, will be worth your while.
Thank you Dr Gersh 🤗 If you've seen the Panorama programme, you'll know it starts out with, 'The lowest dose for the shortest time.' The dogma all medics are trained in, drummed into them, so it's familiar, it sounds safe, and we like to go back to the familiar in times of uncertainty. Which is pretty useless for menopause care and treatment, and therefore pretty useless for women, but it's a soothing message for the doctors. And the other message, 'there's no research to show this is safe...', isn't the same as saying there is research to show that it's unsafe, it just means no-one has done the research. And in women's health, there are huge gaps where research should be. Why is that? Keep going Dr Gersh, don't let them get you down 💛xx
I love your content and approach to menopause treatment. Can you please share the optimal estradiol levels you aim for with your patients? Since Drs don't run hormonal labs for us when we are in our 20s we don't have a baseline to calculate our average. Even a ballpark level would be so incredibly helpful. THANK YOU!!!
Taking low dose estrogen and continual progesterone never felt right to me. My body feels much happier on a cycle. The bleeding is really of no consequence - a couple of heavier days then just a few more days spotting. Well worth it for all the benefits. I have stopped talking to anyone about it though - I got fed up with all the raised eyebrows!
I know what you mean- most drs are just not educated enough in this area. The Wiley Protocol has this compounded monthly plan. Curious what your drs have told you. I am looking for a local physician that I don’t have to educate and fight to be healthy. 😱
@Spunkylbs I'm in the UK so it's 2 pumps of estradiol gel (1.5 mg) daily with 200mgs micronised progesterone (which I use vaginally) for 12 days per month. This is a pretty standard option on the NHS.
@@essanjay8604 Do you happen to know whether existing uterine fibroids continue to grow if progesterone is not given continuously and the continuous estradiol dosage is optimal/higher (as opposed to minimal)?
@@SpunkylbsI only had a public GP (no private plan) & finally got prescription for transdermal E gel and daily P. after over-emphasizing debilitating symptoms ($25/mo.) Even tho the P is 100mg /daily, I take 2x 100 for only the 2nd half of month without needing to explain this to GP, not have their consent! ead@Spunkylbs
in the 20's, 30's and into mid 40's, estradiol was considered a cosmetic ingredient. Helena Rubenstein, and other cosmetic designers, sold facial creams with estradiol. In 1945 the FDA began controlling this widely available hormone, making it illegal to sell w/o a doctors orders.
Thank you for clarifying these points. So many women are confused about this. I feel like we are in the Wild West status of hormone replacement progress for women in the US. It’s crazy. I believe most docs and definitely women want to do the right thing but there’s so much misinformation and misunderstanding and it’s difficult to wade through all of it.
I do the cyclical way that you mention that mimics the way hormones rise and fall during a pre-menopausal woman's cycle ... Basically, I do what is called The Wiley Protocol... I am sure you have heard of it... Just want to say that it's awesome and I don't find it at all complicated to do - at least once I had done my research and done a few cycles of it.... Thank you for your great videos and the amazing knowledge that you so freely share Dr Gersh..
Yes- where do you live? I am looking for a dr to Rx me Wiley Protocol. I found a pharmacy and they will mail it me. I was surprised that the price is actually cheaper than static compounded hormones.
Some places are expensive with the Wiley protocol I tried it for a couple months but I could not get my levels up switched over to other compounded estrogen and progesterone @@Spunkylbs
Thanks for backing common sense, doc. The only source I know for cycling hrt is the Wiley protocol. Because it lacks the proper scientific support (especially on how she developed the dosage that are apparently very high) is not something I'll take blindly. I got my first hrt prescription last month and it was this low monodose all month round estradiol progestin garbage (sorry, but it's that for me). So I decided to use over the counter bioidentical hormones and cycle, imitating a natural cycle. I'm using the lowest dosage I can for the minimum and using the Wiley protocol's ratios to de peaks. But its hard not knowing how little is too low and how high is too much. Another thing is that as women we never get a record of our normal hormone levels when we are stil fertile, so the reference is always a population reference and not our own healthy levels reference.
Right . I wish I knew I had to know my baseline hormonal levels while in my 20s, would have been easy for my doctor and me to tweak hrt. Also I never knew about cycling progesterone, nor did my telehealth company told me about it. Just on 1mg oral estradiol pill and 100mg micronized progesterone every night
@@cwednesday thanks. I'll look into it. My estradiol level is 107 after being on 1 mg oral estradiol pill and 100 mg progesterone daily, started 6 months ago. Should I be cycling progesterone
@@cwednesday my E2 level is 107 with 1mg oral Estradiol pill and 100 mg micronized progesterone pill, daily. It's been 6 months I started with this. Should I be cycling progesterone?
Dr Gersh- have you reviewed the Wiley Protocol? Cyclic dosing for optimization with a bleed. I am all About volunteering for any study for cyclic dosing with a bleed to optimize health and longevity.
Thank you for the thorough explanation. I find your videos incredibly helpful. I have a question regarding the specific dosage ranges you consider to be low, that addresses only symptoms , and the higher dose of estradiol recommended if you want to address the symptoms and longevity. While I understand that it varies on each individual, could you clarify what range you typically classify as "low" and what you see as an "optimal" dose for longevity? For instance, would 0.025 mg to 0.075 mg generally speaking be considered in the lower range? And would anything starting at 0.1 mg typically fall within the higher range when recommended for longevity (in addition of symptoms improvement)?
Dr Gersh, I would appreciate your thoughts on whether putting breasts through more cycling with this approach increases the risk of breast cancer. The number of menstrual cycles a woman has had factors into her risk calculation for developing breast cancer, the more cycles, the higher the risk.
the root cause of all cancers is insulin resistance. Fasting insulin is the best marker for health and longevity. You can test w/o a doctor and it only costs about 14 bucks. Your goal must be for a level of under 5; if you are over 5 then work on lowering carbohydrates in your diet. I'm 66 and mine is always around 3. While at it check eGFR, HS-CRP, AST and ALT, homocysteine. Be sure to be minimum of 12 hours fasted, but not more than 15. I use ownyourlabs (which uses LabCorp) and/or UltaLabs (which uses Quest labs).
Does this mean that I could have a 03875 patch that I'm wearing daily changing twice a week and then instead of taking 100 mg of oral progesterone every night I would just take it during those 14 days in order to mimic the physiological dosing effect?
@StayGold_Michele with the patch and the equal dose of progesterone you are mimicking the monodose prescription. You are allowing the bleeding because you stop the progesterone but that's it. Cycling implies having the peaking of the hormones. The changes in the amount of hormone levels is like a switch for some physiological processes. If the hormone dose doesn't change you have a monodose protocol.
What dose range for oestrogen patch to be therapeutic? And what dose of progesterone every two weeks? Also, would a person get PMS again like they did in earlier years when they do this?
I switched over to the cyclical regime a few months back (from "continuous") 2 pumps transdermal Estradiol (one pump = 0.75mg) daily and 200mg micronized Progesterone last 2 weeks of month. No standard PMS bc there's no ovulation but maybe a bit of fatigue for a couple of days.
@@jetwestland4546 In 1 month, it'll be "official" meno (12 mos. w/o reg. cycle) & started HRT about 6 mos. ago First 2 mos. with daily P (continuous) then switched to cyclical Hope that helps!
Dr Gersh, you state that never in a women’s life does she have a static dose of estrogen and progesterone every day. I’ve read that after natural menopause, the adrenal glands, brain and other organs still produce estrogen and progesterone even though they are produced in much lower amounts. My question is, do the naturally produced estrogen and progesterone levels still go up and down cyclically post menopause? Or are they on more of an even keel?
Hello Dr Felice, Love listening and learning from u / I have a Questions I am 66 yrs young is it to late for me to start hormones . I had aHysterectomy
It is never too late. I am 67, and at age 54 my GP encouraged me to get off HRT because of the Women’s Health Initiative. I have lost 15 years of benefit, but I am going back on HRT and I can’t wait.
Thank you for this explanation. What are your thoughts about a woman who has no uterus, cervix, fallopian tubes etc. from hysterectomy - but who takes estradiol? Would you still recommend progesterone?
@juliecord5409 there is an approach that understands that progesterone has receptors all over the body, so yes it would be beneficial to take it even with a total hysterectomy. Moreover if you listen to Dr. Gersch when she explains that progesterone regulate oestrogen receptors.
Dr. Gersh, what about those of us who are sensitive to progesterone? I can only tolerate 75mg daily, continuous. If I increase dose & abruptly stop it triggers bad migraines. Any way to use a smaller amount of progesterone ie 25mg in the first 2 weeks so there’s not an abrupt start & stop?
@Katepwe trial and error. If you have exams prior to your surgery (and with normal reading) you could use those as a parameter. If not, you take the lower dose and after a blood test you adjust the dosage. This should be done by a physician, of course.
@@laleilha there is a lot of conflicting/confusing information not only amongst women but also the medical professionals. Some say hormone testing should be done others say it should be based individually on symptoms.
@Katepwe yes. That's why what Dr. Gersch proposes is so important. As long as we don't have a consensus, all we can do is to try and adjust. The goal can be to be just ok and focus narrowly only on symptoms or to look for long-term well-being and search for our individual optimal. As long as we have clarity in the goal, we'll be on the right path. The problem is when doctors keep you in a subclinical state when your labs look good, but you still feel like crap and don't understand why and think that you're overreacting or psychologically unstable. I've been dealing with endocrinologists for over 25 years and started to be healthy only when I educated myself enough to understand my body and to know how to use my medication safely.
At 49 I’m doing the UK cyclic method, 2 pumps transdermal oestrogen every day and 200mg progesterone 2 weeks out of 4. However for the last 2 months I haven’t had a breakthrough period in the 2 weeks off P. In the UK I would prob be put into P every day at 100mg but this contradicts the cycling method. So confusing
Hi I had the same issue also bc I was trying to switch over to cyclical from continuous It took at least 3 mos. for anything to happen, esp that I had no idea what my Day 1 was (normally first day of period)! I tried taking less pumps towards the end of the cycle (1 pump for last 3 days, none on the last 4-5 if no sweats & then using my extra pumps, (so 3 pumps) on days 10-14 I printed a graph of the estradiol/ progesterone in a natural cycle (Google graph hormone levels in a menstrual cycle) and on this you can see when the two are high and low) This helps understand when the body would normally have more and less in a natural cycle which is what we're trying to mimic. If you're in the UK, there's a really good forum thru Menopause Matters (it's available to anyone but there's a lot of British ladies on it and lots of info exchange) Hope this helps & try to give it time. The loads of benefits from cyclical are worth it!
Hi, 45yo and post menopausal. My understanding and experience is that no bleeding indicates no (or not enough) growth of the uterine lining which means you're not getting enough Estradiol. I would get your E and FSH levels checked. FSH also helps you know if your body is getting enough E. Hope this helps!
Jacqueline, your estrogen patch dose is high. You can do bloodwork to check your level. When i was on the .1 mg dose, my estrogen level was 232 which is high so my doctor put me on .075 now.
@@essanjay8604I did, however some people choose not to bleed. I asked because she’s inquiring about her dose but that’s dependent on her goals. It’s subjective whether her dose is too high or low depending on her motives.
@abbycroft0 I was in that position. What I did was start cycling, because "unteaching" my beated up receptor the monodosing was a no for me. But I started in day 14, so took oestrogen and progesterone right away to get them running in my system. Had a short 3 days normal period bleeding and then I started with the proper cycle. The symptoms are going away. The only ones that disappeared right away were the hot flashes. I'm still having some trouble with sleep and hairloss but is getting better. I believe it would be normal after the first six months. Hormones takes time.
I did continuous for first 2 months and was putting weight on rapidly so switched to cyclical month 3, with an increase in Estradiol dose to 80mg transdermal and reduced progesterone to 50mg (from 100mg). I feel much better. Glad to see Dr. Felice's timely video on this to validate. I just followed my instincts, my doc wasn't the one to recommend this. On my own I thought.. hmm maybe I should follow what a natural cycle should look like.
I’m on 0.05 Estradiol weekly patch and 200mg Micronized Progesterone taken continuously everyday. However I’ve continued to have a breakthrough bleed once a month for several days… been going on for over a year. My doctor did an ultrasound and my uterine lining was fine. She wanted me to switch to Norethindrone 5mg to try to stop the bleeding but I don’t want to go on a synthetic Progestin… I prefer the bio-identical Progesterone. Also I asked for my Progesterone to be increased to 300mg to see if that made a difference but she won’t prescribe higher than 200mg. So, if I’m taking the hormones continuously every day yet my body is still behaving like I’m doing the cycling method, what does this mean? Should I have a uterine biopsy for some underlying issue?
I’m having the same bleeding issue for on e year. Booked an telecare appointment with Gersh for later this month. She charges $695/ hour $$$. Very expensive but I will give it a try and see if it’s beneficial
Will I get hot flashes for the 14 days that I wouldn't take progesterone if I try cyclic? I am worried about trouble sleeping and hot flashes during those two weeks.
@c.ymcbray3123 I agree. I didn't get any symptoms back switching to cyclical. In fact progesterone gives me body ache so am glad I only have to deal with it the last week of cycle.. I'm only taking progesterone for 7 days, hopefully it's enough.
@@SPower-yl9ww If 7 days works & no side effects, then I'd think it'd be fine (as long as you're getting a "shed") I printed a graph of hormone levels in "idealized meno cycle" (thank you google) & progesterone starts to spike up at Day 17 thru 24 which does equal 7 days
The breast cancer as consequence is largely talked but shortly it was a bad interpretation in a flawed study. The thing with oestrogen is if you have a oestrogen dependent tumor because it will be feed/estimulated by the hormone. But the oestrogen causing cancer has been refuted.
@@SPower-yl9wwI think you’ll find the data says that transdermal estrogen is safer regarding blood clots not cancer. It’s believed cancer risk is related to the use of synthetic progestins though apparently the risk is still small.
Can you please advise on a ballpark of dosage range for lets say estrogel ?to acheive physiological levels or close? 😊im on 4 tpumps but feel i could use more
![[Full Episode] The Restaurant War Thailand ศึกพ่อค้าซ่าแม่ค้าแซ่บ Episode 3 | 6 ต.ค. 67](http://i.ytimg.com/vi/fTfIMFVjt_8/mqdefault.jpg)
On the compound pharmacies, I live in Brazil and this country has top tier quality in compounding pharma. So having hormones compounded wouldn't be a problem except for the need of a medical recipe. And no doctor will prescribe them. Is har enough for them to accept to prescribe hrt in the first place. So that is another barrier: educating active professionals to help their patients.
So grateful you offer you’re patients choices!! That is SO rare , especially when dealing with hormones. Most physicians are a my way or the highway mentality or there is no talking about hormones at all and you are shut down.
Thank you for explaining it in a way that everyone can understand!
You are a great teacher!
This info seems good but if you have a uterus, it is going to be like finding a needle in a haystack in terms of locating any doctor that will prescribe estradiol without progesterone because of their fears of the uterus growing into cancer territory without the progesterone to balance the estradiol . So how would your course or book help women who cannot get a prescription for estradiol and progesterone separately??? Seems like a lost cause for women with uterus to try the physiological protocol you teach about when most of us can barely get prescriptions for 1mg Estradiol/0.5 norethindrone (progesterone) because all they really want to do is prescribe the lowest dose. I had to go through hell and high water just to get the aforementioned higher dose.
Our “healthcare” system is broken and has failed us women, yes. For now, the only way is to go outside the system. I love this doctor. Saw her PA via telehealth, who set me on the optimization path right away. Followed up with Gersh just recently. Got my insurance to pay for the labs.
@@j.j.l. What state are you in? I would love to do telehealth with her NP too. Thank you!
@@allisonhuber1771 I'm in NorCal (they are in SoCal); however, you can still do telehealth from out of state as long as you make an in-person visit twice a year. It's worth it, imo. I'll be moving to CO and am totally willing to travel twice a year to see someone who actually cares about my health and who is not bound by our broken system. Btw, it was a PA (Physician's Assistant) who I saw first (better than an NP!).
@@j.j.l. I have booked an appointment with their office for late October. Trying to decide if I should go with the PA or the doctor herself. How was your experience with them? Would you mind sharing? Thank you
Dr Gersh, i can't thank you enough for sharing information and knowledge for free on SM platforms.
I am from Pakistan and as most women in developing countries, we don't have many resources and facilities regarding women's health, let alone menopausal care.
You and wonderful doctors who selflessly share knowledge are our only source to learn about what feels like a havoc in mid life.
Here in Pakistan, ONLY oral estradiol pill is available, that too 2 mg , pharmaceutical grade. So, it remains our only option for estrogen intake.
Hopefully, some day transdermal will be made locally and we could benefit from it too, till then i shall take my chances with oral estradiol pill and pray to God, everything remains good .
💕🙏
I had no luck even finding a doctor in Pakistan who knew anything about hormonal care.
Luckily there are private clinics in Dubai that do and also compounding pharmacies.
If you can come to Dubai, see Dr. Hani, American qualified Lebanese doc at Enfield Clinic in Jumeirah.
There are others too, you can search.
@@SPower-yl9ww thank you for replying. I know right. Not a single doctor who has proper knowledge or training. They look terrified when you ask them about hrt. And then no transdermal form of estradiol available whatsoever. Only oral pill is our only option.
@PrototypeM You are lucky you found Estradiol pill. When I was there in January, didn't even find that. I was educating the Endricronologist in Karachi, gave him a book to read and told him to get up to speed!
Gynecologists/ Endos in Dubai are not any better. Gyny was 3 years older than me and didn't have a clue. I asked, what did you do in perimenopause? She said nothing. 😝
The clinic I recommended to you has the lowest consulting fee I could find and the compounding pharmacy they work with have lower prices than others I checked with.
Take a trip out, will be worth your while.
@@SPower-yl9ww So sad to hear that women are left in the lurch. ♀️
Keep on spreading the word! And thank you for sharing the info! 🙏
This is information that is not mainstream like many of the bandwagon jumpers are using. Fantastic!
Thank you Dr Gersh 🤗
If you've seen the Panorama programme, you'll know it starts out with, 'The lowest dose for the shortest time.'
The dogma all medics are trained in, drummed into them, so it's familiar, it sounds safe, and we like to go back to the familiar in times of uncertainty.
Which is pretty useless for menopause care and treatment, and therefore pretty useless for women, but it's a soothing message for the doctors.
And the other message, 'there's no research to show this is safe...', isn't the same as saying there is research to show that it's unsafe, it just means no-one has done the research. And in women's health, there are huge gaps where research should be. Why is that?
Keep going Dr Gersh, don't let them get you down 💛xx
💪♀️💕
Thank you Dr. Gersh. You explain things so clearly and in ways I can understand!
I love your content and approach to menopause treatment. Can you please share the optimal estradiol levels you aim for with your patients? Since Drs don't run hormonal labs for us when we are in our 20s we don't have a baseline to calculate our average. Even a ballpark level would be so incredibly helpful. THANK YOU!!!
Taking low dose estrogen and continual progesterone never felt right to me. My body feels much happier on a cycle. The bleeding is really of no consequence - a couple of heavier days then just a few more days spotting. Well worth it for all the benefits. I have stopped talking to anyone about it though - I got fed up with all the raised eyebrows!
I know what you mean- most drs are just not educated enough in this area. The Wiley Protocol has this compounded monthly plan. Curious what your drs have told you. I am looking for a local physician that I don’t have to educate and fight to be healthy. 😱
@Spunkylbs I'm in the UK so it's 2 pumps of estradiol gel (1.5 mg) daily with 200mgs micronised progesterone (which I use vaginally) for 12 days per month. This is a pretty standard option on the NHS.
@@essanjay8604 Do you happen to know whether existing uterine fibroids continue to grow if progesterone is not given continuously and the continuous estradiol dosage is optimal/higher (as opposed to minimal)?
@@cm1906 I believe it's called the 'bone sparing' dose. I know nothing about fibroid. You would need medical advice on that.
@@SpunkylbsI only had a public GP (no private plan) & finally got prescription for transdermal E gel and daily P. after over-emphasizing debilitating symptoms ($25/mo.)
Even tho the P is 100mg /daily, I take 2x 100 for only the 2nd half of month without needing to explain this to GP, not have their consent! ead@Spunkylbs
This is extremely helpful and informative!! Many thanks!! 💐🙏😊
in the 20's, 30's and into mid 40's, estradiol was considered a cosmetic ingredient. Helena Rubenstein, and other cosmetic designers, sold facial creams with estradiol. In 1945 the FDA began controlling this widely available hormone, making it illegal to sell w/o a doctors orders.
Thank you for clarifying these points. So many women are confused about this. I feel like we are in the Wild West status of hormone replacement progress for women in the US. It’s crazy. I believe most docs and definitely women want to do the right thing but there’s so much misinformation and misunderstanding and it’s difficult to wade through all of it.
I do the cyclical way that you mention that mimics the way hormones rise and fall during a pre-menopausal woman's cycle ... Basically, I do what is called The Wiley Protocol... I am sure you have heard of it... Just want to say that it's awesome and I don't find it at all complicated to do - at least once I had done my research and done a few cycles of it.... Thank you for your great videos and the amazing knowledge that you so freely share Dr Gersh..
Yes- where do you live? I am looking for a dr to Rx me Wiley Protocol. I found a pharmacy and they will mail it me. I was surprised that the price is actually cheaper than static compounded hormones.
Some places are expensive with the Wiley protocol I tried it for a couple months but I could not get my levels up switched over to other compounded estrogen and progesterone @@Spunkylbs
Can you tell me more about that ?
@@Spunkylbs- Could you please let us know about the pharmacy?
@XeniaAiden can you tell how you do it and the amount 🙏🏻
Thanks for backing common sense, doc. The only source I know for cycling hrt is the Wiley protocol. Because it lacks the proper scientific support (especially on how she developed the dosage that are apparently very high) is not something I'll take blindly. I got my first hrt prescription last month and it was this low monodose all month round estradiol progestin garbage (sorry, but it's that for me). So I decided to use over the counter bioidentical hormones and cycle, imitating a natural cycle. I'm using the lowest dosage I can for the minimum and using the Wiley protocol's ratios to de peaks. But its hard not knowing how little is too low and how high is too much. Another thing is that as women we never get a record of our normal hormone levels when we are stil fertile, so the reference is always a population reference and not our own healthy levels reference.
Right . I wish I knew I had to know my baseline hormonal levels while in my 20s, would have been easy for my doctor and me to tweak hrt.
Also I never knew about cycling progesterone, nor did my telehealth company told me about it.
Just on 1mg oral estradiol pill and 100mg micronized progesterone every night
The Wiley protocol levels are based on the levels you would have had pre-menopause.
@@cwednesday thanks. I'll look into it. My estradiol level is 107 after being on 1 mg oral estradiol pill and 100 mg progesterone daily, started 6 months ago.
Should I be cycling progesterone
@@cwednesday and progesterone is 1.8
@@cwednesday my E2 level is 107 with 1mg oral Estradiol pill and 100 mg micronized progesterone pill, daily.
It's been 6 months I started with this. Should I be cycling progesterone?
Thank you so much, this is exactly the information I was looking for!
Dr Gersh- have you reviewed the Wiley Protocol? Cyclic dosing for optimization with a bleed. I am all
About volunteering for any study for cyclic dosing with a bleed to optimize health and longevity.
yes, The WIley Protocol is awesome...
Please can we have links to any studies that show benefits of cycling over continuous?
Love your videos - THANK YOU ❤
Thank you for the thorough explanation. I find your videos incredibly helpful. I have a question regarding the specific dosage ranges you consider to be low, that addresses only symptoms , and the higher dose of estradiol recommended if you want to address the symptoms and longevity. While I understand that it varies on each individual, could you clarify what range you typically classify as "low" and what you see as an "optimal" dose for longevity? For instance, would 0.025 mg to 0.075 mg generally speaking be considered in the lower range? And would anything starting at 0.1 mg typically fall within the higher range when recommended for longevity (in addition of symptoms improvement)?
@@sf4792 no doctor answers this on social media sadly. I guess you have to their patient to find out.
Thank you very much for this invaluable information. Please, share your thoughts about tibolon
Dr Gersh, I would appreciate your thoughts on whether putting breasts through more cycling with this approach increases the risk of breast cancer. The number of menstrual cycles a woman has had factors into her risk calculation for developing breast cancer, the more cycles, the higher the risk.
It’s interesting how this risk dramatically increases as soon as she hits menopause, when the hormones are at their lowest.
the root cause of all cancers is insulin resistance. Fasting insulin is the best marker for health and longevity. You can test w/o a doctor and it only costs about 14 bucks. Your goal must be for a level of under 5; if you are over 5 then work on lowering carbohydrates in your diet. I'm 66 and mine is always around 3. While at it check eGFR, HS-CRP, AST and ALT, homocysteine. Be sure to be minimum of 12 hours fasted, but not more than 15. I use ownyourlabs (which uses LabCorp) and/or UltaLabs (which uses Quest labs).
@@olderandwiser127Love this info - super helpful! Thank you!
@@olderandwiser127 can you link the scientific studies that show the root of all cancers is insulin resistance? I would like to read them
@@olderandwiser127can you link to the scientific studies that show insulin resistance is the root of all cancer? I would like to read them.
Im willing to be a "test dummy" lol. Lets get some published data Doc!
Amen - ME TOO!!!
Me three!!
Does this mean that I could have a 03875 patch that I'm wearing daily changing twice a week and then instead of taking 100 mg of oral progesterone every night I would just take it during those 14 days in order to mimic the physiological dosing effect?
Ditto! I have the same question. I’m on the same dosage of estradiol patch and oral progesterone.
@StayGold_Michele with the patch and the equal dose of progesterone you are mimicking the monodose prescription. You are allowing the bleeding because you stop the progesterone but that's it. Cycling implies having the peaking of the hormones. The changes in the amount of hormone levels is like a switch for some physiological processes. If the hormone dose doesn't change you have a monodose protocol.
That's what I did, except taking 2x100mg P for those 14 days
What dose range for oestrogen patch to be therapeutic? And what dose of progesterone every two weeks?
Also, would a person get PMS again like they did in earlier years when they do this?
I switched over to the cyclical regime a few months back (from "continuous")
2 pumps transdermal Estradiol (one pump = 0.75mg) daily and 200mg micronized Progesterone last 2 weeks of month. No standard PMS bc there's no ovulation but maybe a bit of fatigue for a couple of days.
@@c.ymcbray3123 nice to hear, are you in menopause or peri
@@jetwestland4546 In 1 month, it'll be "official" meno (12 mos. w/o reg. cycle) & started HRT about 6 mos. ago
First 2 mos. with daily P (continuous) then switched to cyclical
Hope that helps!
Are you saying that Progesterone should only be taken the last two weeks of the cycle, versus static dosing for 30 days?
Yes!
Dr Gersh, you state that never in a women’s life does she have a static dose of estrogen and progesterone every day.
I’ve read that after natural menopause, the adrenal glands, brain and other organs still produce estrogen and progesterone even though they are produced in much lower amounts.
My question is, do the naturally produced estrogen and progesterone levels still go up and down cyclically post menopause? Or are they on more of an even keel?
@@Belhel5533 great question 👍
So WHAT dose do you recommend ?
At what point in the cycle do you introduce testosterone or DHEA?
Hello Dr Felice, Love listening and learning from u / I have a Questions I am 66 yrs young is it to late for me to start hormones . I had aHysterectomy
It is never too late. I am 67, and at age 54 my GP encouraged me to get off HRT because of the Women’s Health Initiative. I have lost 15 years of benefit, but I am going back on HRT and I can’t wait.
Thank you for this explanation. What are your thoughts about a woman who has no uterus, cervix, fallopian tubes etc. from hysterectomy - but who takes estradiol? Would you still recommend progesterone?
@juliecord5409 there is an approach that understands that progesterone has receptors all over the body, so yes it would be beneficial to take it even with a total hysterectomy. Moreover if you listen to Dr. Gersch when she explains that progesterone regulate oestrogen receptors.
Would you please comment whether, in your experience, uterine fibroids grow larger with the optimal/higher dose estradiol and cyclical progesterone?
I would like the answer to this to
Can you reccommend someone in the Milwaukee areas that would have a similar philosophy.
Dr. Gersh, what about those of us who are sensitive to progesterone? I can only tolerate 75mg daily, continuous. If I increase dose & abruptly stop it triggers bad migraines. Any way to use a smaller amount of progesterone ie 25mg in the first 2 weeks so there’s not an abrupt start & stop?
I’m confused……how do I know if I have an adequate dose of estradiol? What is considered a high dose? I don’t have ovaries or a uterus.
@Katepwe trial and error.
If you have exams prior to your surgery (and with normal reading) you could use those as a parameter. If not, you take the lower dose and after a blood test you adjust the dosage. This should be done by a physician, of course.
@@laleilha there is a lot of conflicting/confusing information not only amongst women but also the medical professionals. Some say hormone testing should be done others say it should be based individually on symptoms.
@Katepwe yes. That's why what Dr. Gersch proposes is so important. As long as we don't have a consensus, all we can do is to try and adjust. The goal can be to be just ok and focus narrowly only on symptoms or to look for long-term well-being and search for our individual optimal. As long as we have clarity in the goal, we'll be on the right path. The problem is when doctors keep you in a subclinical state when your labs look good, but you still feel like crap and don't understand why and think that you're overreacting or psychologically unstable. I've been dealing with endocrinologists for over 25 years and started to be healthy only when I educated myself enough to understand my body and to know how to use my medication safely.
What about if you have had a full, radical hysterectomy? Should I still cycle the progesterone?
At 49 I’m doing the UK cyclic method, 2 pumps transdermal oestrogen every day and 200mg progesterone 2 weeks out of 4. However for the last 2 months I haven’t had a breakthrough period in the 2 weeks off P. In the UK I would prob be put into P every day at 100mg but this contradicts the cycling method. So confusing
Hi
I had the same issue also bc I was trying to switch over to cyclical from continuous
It took at least 3 mos. for anything to happen, esp that I had no idea what my Day 1 was (normally first day of period)!
I tried taking less pumps towards the end of the cycle (1 pump for last 3 days, none on the last 4-5 if no sweats & then using my extra pumps, (so 3 pumps) on days 10-14
I printed a graph of the estradiol/ progesterone in a natural cycle
(Google graph hormone levels in a menstrual cycle) and on this you can see when the two are high and low)
This helps understand when the body would normally have more and less in a natural cycle which is what we're trying to mimic.
If you're in the UK, there's a really good forum thru Menopause Matters
(it's available to anyone but there's a lot of British ladies on it and lots of info exchange)
Hope this helps & try to give it time. The loads of benefits from cyclical are worth it!
Hi, 45yo and post menopausal. My understanding and experience is that no bleeding indicates no (or not enough) growth of the uterine lining which means you're not getting enough Estradiol. I would get your E and FSH levels checked. FSH also helps you know if your body is getting enough E. Hope this helps!
@@c.ymcbray3123Thanks for the Menopause Matters rec - I'm going to check this out!
And I’m taking daily estrogen and progesterone and bleed!
Many thanks for the great information. I’m 57 taking estradiol 0.1mg patch twice a week and progesterone 100mg. Started cyclic . Is that a low dose?
Question: if your’re not having periods anymore, why are you taking it cyclically?
@bohemianrealty8284 Did you watch the video???
Jacqueline, your estrogen patch dose is high. You can do bloodwork to check your level. When i was on the .1 mg dose, my estrogen level was 232 which is high so my doctor put me on .075 now.
@@essanjay8604I did, however some people choose not to bleed. I asked because she’s inquiring about her dose but that’s dependent on her goals. It’s subjective whether her dose is too high or low depending on her motives.
@@HangPham-ig8xtThat’s completely subjective. I like my estrogen in the 200’s. Anything below is suboptimal for me. It really depends on her goals.
So what is the optimal dose? It didn’t answer that
exactly. I'm guessing it's different for everyone
Do you start cycling as soon as you start hrt.or do you get the progesterone in your system to get your symptoms under control first?
@abbycroft0 I was in that position. What I did was start cycling, because "unteaching" my beated up receptor the monodosing was a no for me.
But I started in day 14, so took oestrogen and progesterone right away to get them running in my system. Had a short 3 days normal period bleeding and then I started with the proper cycle. The symptoms are going away. The only ones that disappeared right away were the hot flashes. I'm still having some trouble with sleep and hairloss but is getting better. I believe it would be normal after the first six months. Hormones takes time.
I did continuous for first 2 months and was putting weight on rapidly so switched to cyclical month 3, with an increase in Estradiol dose to 80mg transdermal and reduced progesterone to 50mg (from 100mg).
I feel much better.
Glad to see Dr. Felice's timely video on this to validate. I just followed my instincts, my doc wasn't the one to recommend this.
On my own I thought.. hmm maybe I should follow what a natural cycle should look like.
I’m on 0.05 Estradiol weekly patch and 200mg Micronized Progesterone taken continuously everyday. However I’ve continued to have a breakthrough bleed once a month for several days… been going on for over a year. My doctor did an ultrasound and my uterine lining was fine. She wanted me to switch to Norethindrone 5mg to try to stop the bleeding but I don’t want to go on a synthetic Progestin… I prefer the bio-identical Progesterone. Also I asked for my Progesterone to be increased to 300mg to see if that made a difference but she won’t prescribe higher than 200mg. So, if I’m taking the hormones continuously every day yet my body is still behaving like I’m doing the cycling method, what does this mean? Should I have a uterine biopsy for some underlying issue?
I’m having the same bleeding issue for on e year. Booked an telecare appointment with Gersh for later this month. She charges $695/ hour $$$. Very expensive but I will give it a try and see if it’s beneficial
@@shproperties9974Wow that’s pricey…but may be the only way to get questions answered since she doesn’t seem to reply to her listeners’ comments.
Will I get hot flashes for the 14 days that I wouldn't take progesterone if I try cyclic? I am worried about trouble sleeping and hot flashes during those two weeks.
I didn't. Pretty sure it's the Estradiol that helps the most with hot flashes
@c.ymcbray3123 I agree. I didn't get any symptoms back switching to cyclical.
In fact progesterone gives me body ache so am glad I only have to deal with it the last week of cycle.. I'm only taking progesterone for 7 days, hopefully it's enough.
@@SPower-yl9ww If 7 days works & no side effects, then I'd think it'd be fine (as long as you're getting a "shed")
I printed a graph of hormone levels in "idealized meno cycle" (thank you google) & progesterone starts to spike up at Day 17 thru 24 which does equal 7 days
I wonder how about risk of breast cancer when taking oestrogen?
Read Menopause Matters. Cancer can feed off Estrogen same as it feeds of carbs and sugars, Estrogen does not Cause cancer.
The breast cancer as consequence is largely talked but shortly it was a bad interpretation in a flawed study. The thing with oestrogen is if you have a oestrogen dependent tumor because it will be feed/estimulated by the hormone. But the oestrogen causing cancer has been refuted.
If you take it transdermal there's no cancer risk.
Oral is processed by liver, the cream/gel just absorbs through skin.
@@SPower-yl9wwI think you’ll find the data says that transdermal estrogen is safer regarding blood clots not cancer. It’s believed cancer risk is related to the use of synthetic progestins though apparently the risk is still small.
@@Belhel5533 Thanks for the clarification. So we can conclude transdermal Estrogen and micronized natural pregesterone is a safe bet.
Can you please advise on a ballpark of dosage range for lets say estrogel ?to acheive physiological levels or close? 😊im on 4 tpumps but feel i could use more