The WHI study >20 years ago certainly did way more harm than good. They applied their flawed results to all women, all types of hormone formulations, etc. Turns out conjugated equine estrogens and medroxyprogesterone (Premarin and Provera) are not the same as estradiol and progesterone and can increase risk of breast cancer and thromboembolism.
Newer research is showing that natural estradiol and progesterone when given at the onset of menopause may actually have a long term benefit on cardiovascular risk. Recent studies have even shown a lower risk of breast cancer development, but these breast cancer studies are very new and underpowered to make that generalization yet.
The semiweekly estradiol patch reaches peak serum levels after about 2 weeks of use. It comes in 5 doses, but the lowest dose (0.025 mg/24hr) has not been shown to have any bone density benefit. Transdermal estradiol is much safer from a thromboembolism (stroke, DVT/PE, heart attack) than oral due to the bypassing the “first pass” effect. When any of these types of hormones are taken orally, they are absorbed through the GI tract and go to the liver. When the liver metabolizes these estrogens (coming in as 1 larger dose), it increases its output of clotting factors all at once. With the patch, we avoid this first pass effect from the GI tract. A very dilute amount in the blood stream reaches the liver and there is minimal clotting factor output. This is far safer from a blood clot standpoint. Also, the patch provides a nice steady state of hormone in your blood stream vs a larger peak & trough with the oral form. I have noticed that the Dotti generic patch has fewer glue allergies and stays on better than other generics.
For those of us that have a uterus it is important to take progesterone as well. This counteracts the thickening effect of estradiol on the uterine lining to avoid precancers or overt uterine cancer. FYI, If you take the estradiol without progesterone even for a couple weeks and then start the progesterone, you can get some bleeding but it should subside.
Progesterone is sedating and can help with sleep. It is oral and comes in two general doses (100 and 200 mg). Higher estradiol doses will need the higher progesterone dose.
Women have certainly have different menopause symptoms and journeys! Absolutely menopause can lead to generalized joint pain and body aches for some. Brain fog, mood, hot flashes/night sweats, insomnia, vaginal atrophy, decreased skin elasticity, weight gain, and bone loss are all common issues. Some women with a history of menstrual migraines may notice more headaches in the perimenopause and early menopause years.
For bone density, the most beneficial thing we can do is weight bearing exercise and strength training. This will make a much larger difference than the hormones or other pharmaceutical treatments. Even taking regular walks with a weighted vest can make a dramatic difference.
Short term, i.e 2-3 years at a use of pharmaceuticals can provide improvements in bone density even after therapy is stopped. There are many classes of drugs out there with very different side effects and durations of treatment. I certainly do recommend treatment breaks and not taking these continuously forever (there can be deleterious effects if taken long term).
For me, menopause has been a much easier journey than what my mom went through (she was batpoop crazy during my teenage years!) I would have to say, I prefer menopause over going through puberty, but all of our experiences are so different!
