Estradiol in old age, and after cancer: going against the official guidance

#1

This post is not about rapa, per se, but it is about the decision process each of us has had to go through to figure out whether this (or other) intervention is a good one for them personally.

I am considering restarting estradiol (patch). I am now 76 and had a very tiny, very indolent hormone driven breast cancer six years ago.

I used estradiol for about 16 years starting early forties, early menopause, and osteoporosis. When my obgyn cut me off a few years after I had started taking, about 1998, I started sourcing it myself from Canada. (also took prometrium)

Stayed on it until diagnosed in 2020 at age 70. Glad now, very glad, to have taken it for so long.

I feel I have aged since I stoppped the estradiol. Energy, strength, and body composition.

The cancer was only 2 mm, and the Ki67 was 1%. Anything below 14% is considered not growing. (Cells, just before they divide, manifest this Ki67 protein on their membranes. I had virtually none.)

I think this was an iatrogenic breast cancer, caused by many, many biopsy needle pricks. None of the biopsies found any cancer but a few cells were found in the pathology post lumpectomy. Clear margins. I believe the needles punctured the ducts and released or pushed some of the in-situ cells out of the basement membrane. DCIS is not cancer, we now believe, but a “risk” for the development of cancer. I have now seen research that points to biopsies as a risk in just the way things happened to me. Cannot tell for certain, but “that’s my story. . . .” as they say.

I believe my greatest risk now and going forward, is frailty and sarcopenia, a hip fracture, a loss of muscle strength.

So, I have come to question whether I should look past the “guidance” and restart a low dose of estradiol (and prometrium).

This is either folly, and risky, or – it is a considered balancing of potential risks and rewards.

Interestingly, since the pendulum has now swung from totally abjuring estrogen after breast cancer, to a willingness to prescribe local vaginal estradiol (and I am on that now.)

Risks and rewards are inherent in most interventions, and doctors know it, but I do not think I could find any official providor who would let me have systemic estrogen, eg a patch. And yet, I keep thinking that it might be a good thing for me given the osteoporosis and my overall, catabolic make-up.

Long ago I read “Eat Right For Your Type,” (meaning blood type) which impressed upon me the importance of making decisions (in this case food, but why not medicines too?) based on your personal makeup. (The book described how the proteins that defined your blood type - A, B, O, AB, interacted with the proteins in foods.)

So, for example, I reluctantly decided not to take rapa because I felt it was not a good match with my “type” (older, “catabolic” and leery of infections like UTI’s). But estradiol just seems like it would be good for me, for the greatest threats I personally face.

Argue with me, please ----

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#2

I can’t argue with you because knowing what I know about estradiol I’d be as tempted as you are. But I’d go and argue with better informed people than members of this forum, whose demographics alone, setting aside medical qualifications, make them less likely to know their way around the weeds of esterogen related tradeoffs. Perhaps look into the women featured here:

They’re available for a paid consult. From my limited understanding of the issue, the biggest risk factor in your case would be that you’ve been off it for 6 years. Is that too long? Would oral be the only way to go back, if at all? Does it carry extra risks vs. cancer?

I’d say it’s worth a consultation given how life changing estrogen can be.

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#3

I wish I had something to offer other than moral support and a genuine hope that you are able to come to the best informed decision possible. I LOVE my estradiol patch.

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#4

ER+ breast cancers grow on response to estrogen. Was yours estrogen dependent? If so I would stay away from estrogen in any form. A friend of mine has BC in her early 50ies. It was considered completely cured when in her late 60ies she started some light hormone therapy - it returned, she died at 76. Not saying that it’s because of estrogen.

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#5

Great video.

#6

Deborah_Hall,

I understand your dilemma and don’t have helpful advice about restarting estradiol. However, having had a hip (femur) fracture, I’ve focused strongly on regaining bone density and muscle strength. For muscle strength, I assume you’re already doing a variety of exercises, so I’ll concentrate only on osteoporosis.

I specifically recommend The Dr. Doug Show on YouTube because it helped me focus on targeted exercises to improve my osteoporosis. Dr. Doug Lucas also discusses various medications (SERMs, SARMs, hormones, etc.) for different situations. It’s possible he may have covered your situation in one of his videos, although that would likely require watching a large number of them. It’s just one idea.

Jay

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#7

Thank you all for your thoughtful responses. I will check out the information you pointed to.

Sometimes it is more difficult to back away from something that seems to hold so much promise. The fine line between prudence and risk aversion. I said no to radiation and further surgery, and so far so good, but it may be time to “fold em” as they say. So much great information, but still not enough and at the end of the day it’s all a bit of a crap shoot.
Thank you all for your suggestions and support.

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#8

I asked ChatGPT to research Dr. Doug Lucas for information he may have discussed related to your question. The link is below. I will probably delete it from my account a week from today, but if you find it useful you could copy my question and ask ChatGPT yourself.

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#9

Thank you for sharing your saga and thought process. I shared some of my wife’s struggles with the specialist community earlier, the relevant portion that she eventually prevailed. For what it is worth, even though she is now on the patch, plus 100-200 mg progesterone daily (I assume you are taking that as well), she reports that she felt better on the creams provided by the compound pharmacy. It was also easier to adjust the progesterone levels on the creams. The capsules are either 100 or 200 mg. and her optimal dose appears fo be 150 mg. She converted to the patch because it was difficult to find a physician who was comfortable managing them and the one who was had moved to another state.

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#10

Hi I am 65 and not against the estrogen but I am wary of synthetic progestins as was associated with meningioma on our Australian news > I have a treated acoustic neuroma and have read that one line research of reducing growth was anti progesterone therapy. I use Ovestin currently. Use of progestogens and the risk of intracranial meningioma: national case-control study - PubMed

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#11

I recently read Oestrogen Matters: Why Taking Hormones in Menopause Can Improve and Lengthen Women’s Lives - Without Raising the Risk of Breast Cancer by Dr Avrum Bluming and Carol Tavris, 2018, 2024.
It’s by far the best book I’ve read on the topic of hormone replacement therapy. In a nutshell, to decrease the risk of dementia, cardiovascular disease, osteoporosis and diabetes, and enhance health and longevity, we’re better off using HRT, even women who’ve had breast cancer.

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