Cyclic HRT: benefits of cycling estradiol & progesterone for women in menopause | Felice Gersh, MD
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- Опубліковано 28 тра 2024
- Most doctors prescribe low static doses of estradiol and progesterone because that is the easiest way to treat hot flashes without period bleeding. And this approach is much, much better than nothing.
But! Low-dose static HRT does not give you enough hormones to optimize healthy longevity. Instead, I prefer to prescribe estradiol and progesterone in a cyclic manner at levels similar to those found in reproductive-aged women.
Likely benefits of this approach include:
* building healthy bone
* building healthy neurons
* repairing and rejuvenating the cardiovascular system
* lowering inflammation
* suppressing cancer tumor growth
* lowering the risk of cancer metastasis
To learn more about my approach to Cyclic HRT, including detailed information on dosing, check out my HRT Course:
felice-gersh-md-courses.teach...
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I am a full time practicing doctor. I see patients in my office in Irvine, CA and worldwide via telemedicine. If you need more healthcare assistance than I can provide in a video series, please contact my office:
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---- Contents of this video --------------------------
00:00 - traditional HRT
04:32 - Cyclic HRT for healthy longevity
05:50 - Estradiol helps the body grow
09:23 - Progesterone is the opposite
10:57 - The beauty of the period
14:34 - You want a pretend period
UA-cam can be one of the most beneficial resources at no cost. Thank you, Dr. Gersh! You're helping countless women.
Glad you think so!
i love this woman! too many ladies get misinformed during this time of their life!
What are the proper blood levels for estrogen and progesterone?
Thank you!
You just confirmed my thoughts on HRT. My Doc doesn't get it. I'm being under dosed for my doctors' piece of mind at the expense of my health.
may I ask, what dose did the doctor give you?
I think I am too . I was told start with 0.05 mg day estradiol and no progesterone necessary post hysterectomy. I’m going back to debate this and found this info very empowering , thank you Dr Gersch
I’m 67. You don’t believe in daily progesterone when taking estradiol? My hormone doctor has me on those creams for 6 days a week for the last 12 years.
You just described the experience i jad with my doctor. So freaking frustrating. I starete doiig my own research and seekinf out doctoes that have kept with studies on HRT and menopause and keep themselves up-to-date on a regular basis!!
Please train these social media menopause “experts” there’s so much misinformation and poor protocol sharing by MDs in social media. ❤
I'm post menopause and too much HRT aggravated my fibroids, caused polyps to grow in the cervix and uterine lining and caused the lining to get so thick that I had to have a D&C. While I believe in HRT in theory, it doesn't seem to like me.
Dr Hersh provides a very convicing and detailed explanation of the necessity in cycle the progesterone. Unfortunately she is not providing the simple way to do this. The people posting comments are trying to help and are also asking the same questions. Not sure why Dr Gersh can't answer. Maybe its in a book she sells. Does anyone know this?
The Wiley Protocol. Be sure to use a progesterone cream that your body can absorb. I don't use the standard 20% cream. 5% works.
UA-cam will take down her video if she actually gives health advice, e.g. dosages.
Heard so much of the brnefits of cyclic HRT but most OBGYN'S provide it durin perimenopuse and shift to continuous once you are post menopause. Thankyou for your insights.
Im 47 and post menopausal for 2 years. I believe its yway too soon and nobody is listening to me. Having this info i may believe i can go in and speak to my dr more educated to be able to get my point across better. Drs not listening seems to be a growing issue especially with women in my opinion. Only education can fix this. Ive watched a few of ur videos and I appreciate the knowledge ur offering
Thank you very much!! Please speak in details how to mimic the cycle. And for the “period time” you recommended to stop all hormones and restart after with a small dose ?
Yes. That is my question too. I want to understand exactly how the cyclic theory works out in day to day so I can have the conversation with a local doctor.
As much as having periods sucks, all the evidence shows better health outcomes, breast cardiovascular etc with cyclical than continous progesterone. I will take that.
please cite that evidence.
@@lisao3041
Progesterone goes up 2 weeks after period. She doesn’t need to cite anything.
It’s a fact. The other 2 weeks is low so don’t take progesterone.
Your response doesn’t substantiate her claim.
@@lisao3041 if you're seriously looking for substantiation in youtube comments then I don't know what to tell you.
@@lostgirlproductions It's easy to cite a link to a study, even on UA-cam. But I think any rather substantial claim should be able to be justified or it's just wild speculation.
Thank you making this video. I was just started on Estradiol patch and Progesterone. I am post menopausal. Have a womb and recently diagnosed osteoporosis.
Thank you, Dr Gersh. I wonder if you could do a follow up video on the potential impact of long-term cyclical HRT on breast cancer risk. It’s my understanding that the number of menstrual cycles a woman has experienced has been identified as a risk factor for developing breast cancer - the more cycles, the higher the risk. Would cyclical HRT produce the same changes in breast tissues as “cycling” during a woman’s fertile years? Would love to know! 😊
I will!!
@@FeliceGershMD Thank you, Dr Gersh. Looking forward to it!
There would need to be a long-term study in order to prove the benefits of any HRT after menopause. No one is going to fund that unfortunately. Anyone who makes a claim without studies is speculating.
Fantastic explanation! Thank you so much!
Thank you so Much Doctor 💝💝New to your Channel
Dr Gersh…you are such a gift to this world. THANK YOU ❤
Very informative and enlightening. Thank you for this great resource.
Thank you for explaining hormones so i can finally understand!
What should estradiol blood tests measure to know you have enough?
I am wondering about this too
I think she had said above 50 -150
@auaticamazon thank you!
I love this woman, Tracy, Marshall Bell
Ok so I've watched quite a number of your videos and Dr. Havers (thanks both!!)...but...WHAT amounts of estradial and progesterone should we be taking? Im utterly confused, and have no idea what to ask/tell my doctor! Thanks.
Is this ok for cancer survivors?
Thank you - great video, Dr Gersh!
What is yr opinion of WILEY PROTOCOL?
Your talks are so incredibly informative! Much appreciated Can you give any feedback on your opinion of loestro fe in perimenopause?
Oral contraceptives are not a favorite but sometimes need to be used to control uncontrollable bleeding. Of course they also are contraceptives.
But as a general rule, I prefer human identical hormones over endocrine disruptors!
Dr Gersch, is it safe to say estradiol cream is the preferred dose? BIEST is out there w confusing information w the cream being 80% usually as estriol ? thoughts? thats not strong enough for cyclic method. right?
This is so fantastic, Dr. Gersh. I will definitely sign up for your course. I am about to start HRT in perimenopause and have a lot of questions around this. Hopefully your course will help answer these questions.
One question that I would really like to know as well is whether a woman in her 70ies could start HRT if she has never been on HRT before and went into menopause at 54. She has a lot of anxiety and trouble sleeping as well as vaginal dryness but otherwise very healthy, very physically active, healthy body weight, great insulin sensitivity, low APO-B, Coronary Calcium Score of 0, low blood pressure and no medication. Could she potentially benefit from HRT if the HRT is prescribed in the way you normally prescribe to patients?
Thank you so much in advance.
I can’t answer questions about any specific individuals … but as a general statement, I do not concur with the so-called timing hypothesis and strongly believe that even a late start on hormones is good. Early initiation of hormones is best … but if you don’t have any absolute contraindications, the present is the time to start on HRT!
Better late than never … as they say!
I tried cyclic HRT and the bleeding was very heavy, even heavier than it was when I had a period. I opted out. I'm currently on 0.05 estrogen patch and 100mg of progesterone daily. what you are saying makes a lot of sense.
So did I! I was on 200mg progesterone two weeks on and two weeks off. I bled like two weeks each month and it was terribly heavy like something was slaughtered inside of me. My iron levels became very low too. It was nothing like a normal period. Ever since I'm taking 100mg progesterone daily, the bleeding stopped. Unfortunately, the nightsweats are back though :-(
@@sabinehoehlmueller3190hello, what did you do to stop the heavy bleeding? I’m experiencing the same thing.
@@carlottataykowski143 some women are incredibly sensitive and will start bleeding without continuous progesterone. Some women need to take it 12 hours apart. In order to prevent bleeding. if you were experience is inconsistent progesterone causes bleeding, you might just have to take it continuously.
I hope you increase that patch dosage because it’s really low.
@@lisao3041 0.05 patch is low? I thought it was standard. I’m on my own because these doctors are clueless. Can you please tell me what’s a good dosage?
It seems estradiol therapy should be started along with progesterone prior to menopause. Does this affect ovarian production of these hormones, when they applied topically?
I love Dr Gersh!! I have learned so much! I took the course and followed the instructions exactly. I had the worst mood swings of my life. I was depressed, weepy, and irrational. The cramps were so intense and the "period" lasted two weeks. I powered through for three months. I almost ended up in divorce court. I had horrible PMDD when I was in my reproductive years. The treatment was birth control pills without taking the inert pills. That worked for me but I only did it for a few years. When I stopped the PMDD came roaring back. So my question is how does a woman who can not handle the hormone drop each month proceed? I am currently using a static regime with a very high dose of estrogen and I am joyful and energetic. Do I just stick with that? Or maybe try the cyclic regime less often?
What if you have had a hysterectomy? Does it still work to do it that way with the estradiol?
What about those of us who no longer have a uterus?
I have heard Dr. Gersh point out that progesterone does not only have the function of protecting the uterus. It has many other functions in the body (which makes sense evolutionarily speaking) so one would want to cycle progesterone as well if your goal is optimal health even if you do not have a uterus.
No problem! The uterus is a good marker of the hormonal effects … but is completely unnecessary for giving hormones and the regimen is the same with or without that organ.
Dr. Gersh...does your method follow the Wiley protocol or something similar? Thank you.
In that it’s cyclical, it does follow the Wiley protocol. The levels in the Wiley protocol can be a little too high, though.
My doctor told me to stop HRT bc my bleeding was causing my uterus lining to get too thick. It’s so confusing!!
Check levels of progesterone
did you stop your hrt as dr suggested? How is it going?
I understand cycling the progesterone, you only bring progesterone in on your second half of the cycling ..But the estrodial? Is that continuous? Same levels throughout the month? Or cycling the estrodial also? If yes, when do you bring estrodial in and for how long? How do i cycling an estrodial patch?
My guess is to follow what you would see on a graph over a month
The estrogen dosing is cycled and continuous.
Can you do a video on HRT with IUD
Is it important to take oral progesterone for health benefits if you have the IUD?
I have been prescribed an 0.1 estradiol patch and 100 mg of progesterone. Sooo I don’t have to take progesterone if I am post menopausal and have a uterus? I will have bleeding every month? I’m so confused and this is the first time I’ve heard of this approach. Do I not place the patch at certain times of the month or just use as prescribed? I’m actually excited about the possibilities. Thank you for sharing your knowledge.
Is 1 mg estradiol considered very low dose?
Is it ok to be on cyclic HRT if there is a small uterine fibroid? Isn’t the cycle going to stimulate the fibroid to grow?
How do I take the courses you offer?
Do you prefer bio identical hormones is there a difference?
Do you have any studies I can read that discuss the benefit of cyclical progesterone that I can show to my wife’s menopause doctor? Thanks
I am a good example of what you are describing Dr. Gersh. I started taking transdermal HRT since 57, I am now 60, my bone density has gone from-2.5 to -2.9 and my cognitive abilities have declined greatly. I was one of the strange women that always felt amazing during my period. I am not sure if my gynecologist will prescribe the hormones you describe. I wasn’t privileged to have kids and hopefully that does not matter and my questions is how can I get a doctor that prescribes it.
Fb group fixaflash is a good resource. Also, Womens Health Network
What type of cycling is recommended for a women in menopause with endometriosis? Is it still safe to take estrogen unopposed for 2 weeks each month?
What if you're doing this kind of rhythm if I've had an ablation does it really matter how great my hormones are as far as being at the right numbers will I not get a period I've heard you will not get a period if you've had an ablation done on the uterus
Can I ask, what happens if you have uterine fibroids? Will having an 'optimum' amount of estradiol and progesterone stimulate the growth of fibroids and the existing ones, (I have 17 small ones currently) grow larger?
What about for these people who are on cyclical HRT BUT no bleeding? Does this mean the progesterone is not enough?
Can someone please explain exactly how to cycle? Do you continue estrogen for the whole 28 days with 12 days of progesterone or do you totally stop both for a number of days?? 🙏😊
Look up a graph of a menstrual cycle. Use progesterone for last 2 weeks
Thank you 🙏
@@daniellebilson2612can you share the graph you found? Did you figure out how much estrogen to use each day?
What about estriol creams?
I'm cycling my progesterone and am having worse pms than I ever did before and I think I'd probably be better off w consistent progesterone. thoughts?
I don't have a uterus and am post menopause
I have 0 hormones of estrogen and progesterone according to my blood work. I have history of brest cancer in my family. Should I be on hormones?
So would you stop the estradiol patch when taking the progesterone pills (10 day period)?
No
What are the healthy levels of estadiol for a woman to have?
I use Estrogen one ruler a day… wonder if that’s enough
Between 75- 100 anywhere in between is how we used to make ir.
@@estelled389 does that mean taking BC which is 200-300mg is too much? Or am I thinking in different ref range it doesn’t convert like that?
@@Aki-wq6xhBC isn’t the same thing as HRT . It is actually opposite. BC are endocrine disrupters which prevents the body producing natural estrogen. This doctor had it explained very well I just cant find the post now. You are way better off BC if you can.
@@KC-kh5dv Anotehr youtube 'expert' insists I must be on BC dose HRT is too low for me.I am only 37 and I have been menopausal since 21
Thank you for your explanation of cycling. I do that… estradiol daily and progesterone every four months for 5 days/100 mg progesterone vaginally when I go to sleep. I have a vaginal bleed about 5-7 days later. I’ve been doing this for about 25 years. At 70 years of age I may cut back on estradiol due to aging changes at 70. But will continue but at a lower dose. I’ll seek out a doctor that will help me with this change. I’ve subscribed to your channel. Many thanks😊.
Hello I am glad to hear that I take progesterone 100 mg every other day for about 3 years now I am starting to believe now I have to go and get a biopsy I am very nervous
So you only have to take progesterone for five days out of four months? I’m on estrogen and progesterone, but I cannot and do not take the amount of progesterone that they give me because I cannot tolerate it, I would love to know I can only take it every four months!
Yes 100 mg insert into the vaginal before you go to sleep for 5 days in a row. About 5-7 days a period. For me it lasts about 4-5 days. No side effects from the progesterone. About 20 years ago I tried progesterone orally and I felt hot and sleepy. This is not acceptable because I work full time. I’m close to 70 years old and still work full time because I want to. Progesterone daily made me feel awful so this regimen I presently follow works with hardly any side effects. Just a menstrual bleed. Eat plenty of protein and veggies to balance your hormones and carbs with fiber. Mini meals works best for best. I learned all this from retired gynecologist Dr. Larrian Gillespie. She wrote books like the Goddess Diet and the Menopause Diet. Maybe it’s on Amazon. Take care.
How do you know what your physiologic levels are?
Test with a blood test
Estradiol goal - over 50
More info in my course!
Doctor does topical progesterone, estradiol, or estriol downregulate your, natural production?
Good question. I think it does. Consider, also, that healthy adrenal glands produce hormones in menopause; I wonder what hormone replacement does to this natural source. Watch Dr Elizabeth Bright's video "Menopause, What it is and What it is not".
Can you explain how to do this if the typical prescription dose does not? Doctors just don’t want to prescribe differently than the “normal” dose. Thank you. 😊
What’s an optimal amount??
So,is it a good sign that I never experienced any hot flashes, nor night sweat 15-20 years ago. I'm now 65 and went thru menopause around age 50-52 . But bizarrely ,a couple months ago, I suddenly was having hot flashes for a couple months. It really took me a couple weeks to figure out it was hot flashes,because of my age and never having them before.
I like this idea but 5 yrs ago I had fibroids.. what causes this and my doctor didn’t want me to go in HRT because she thought the estrogen would enhance this.. I am 61 and want to have HRT .. I don’t appear to have fibroids any longer but have all the other symptoms of menopause and over it.. please help thank you .
So Physiologic Restoration?
16:28 should estrogen be cycled as well?
Yes. Read Theresa Wiley's book.
I am on the highest dose patch 0.1 and 200mg P oral every night. Is that dose of patch enough?? What level of estradiol should I be looking for? If i wanted to cycle how many days would I stop taking progesterone? 7? Thank you for any advice.
No progesterone for the first 14 days of the month. Nightly progesterone for next 14 days the no progesterone for final two or three days of the month. The period/bleeding will start as soon as you stop the progesterone and last a few days. Restart cycle next month.
Where did you see this cycling protocol?
@@pennynichols various lectures and anecdotal information. A woman would adjust for what works for her. Generally 10 - 14 nights of progesterone each month. However some women take a progesterone for 14 days every 3 months.
@@bellaevidencias Thx for the info. When going off progesterone for those 2-3 days do you think it's a good idea to stop the estradiol too before cycle restart?
@@lostgirlproductions If you have the flexibility, it will better mimic a natural cycle if you reduce estradiol at the end of the cycle. But your low estrogen symptoms may come back. You can self-adjust your dosage if you take estradiol orally or transdermal. You can better adjust if you take estradiol sublingually.
I've had night sweats & hot flashes for at least 10 years 😢😢😢
But all that growth that the estrogen does also causes fibroids to grow and cysts in the uterus by feeding them.
Dr told my 70 year old my with hypertension that hrt is bad and could make her have a blood clot, is this true?
Anyone have more hot flashes when using the estrogen cream (even a very small dose)rather than the injection ?
Did she ever say how to cycle the 2 hormones??
I want the hormones but not a period again. Is that achievable?
What about weight gain?
Should you always start HRT even if you have no menopause symptoms?
Yes because you can’t see osteoporosis developing. It also has benefits of heart health protection and preventing dementia. I didn’t really have symptoms, but it’s best to start BHRT.
What’s you have no uterus ?
My dr. put me on a 200mg pill of progesterone at night…..& a 2mg. Estradiol pill in morning…..& a testosterone injection…..should I change any of these, oh I’m also on bio progesterone cream from compounding pharmacist…..should I switch to a patch for Estrodiol & testosterone cream?
Testosterone injections are superior to the cream.
If I were you, I would switch to the patch and not swallow my estrogen. Be sure to not take synthetic hormones.
I wonder, Do you recommend cycling progesterone for post menopausal women as well or just perimenopausal?
My understanding of what Dr. Gersh says regarding cycling refers to both perimenopausal and menopausal women.
I prefer cyclic hormones for every stage of menopause … if the patients agrees to it!
Dear Dr. Gersh, I am post-menopausal 52 years old my Dr wants me to take Progesterone 1st 12 days of the month only. Will my uterus/other be healthy and safe doing this? I use 0.50mg Estradiol patch and 200 mg Progesterone. ❤
For cyclic protocol: do you use oral progesterone or creams? I read that transdermal progesterone is not well absorbed. And what is the upper limit of Estrodiol that we are looking for on this protocol?
You can use either. Cream is better. Be sure to use a cream that isn't too concentrated or your body won't absorb it though.
I’m soooo confused! 64, Donnie want to bleed!
Four clicks of progesterone, 30 gm,
Four clicks Biest, .05
Nightly?!? I feel
Awful!!
I missed the whole point😭 so should i take progesterone or not😂 and what about us woman that break out like a teenager Everytime we take higher doses of estrogen...it drives me nuts
Are you saying Estradiol and Progesterone are bad ?
I been watching other Doctors on you tube say it’s good .
She didn’t say such a thing.
So, are the current maximum licensed doses of oestradiol ie 100mcg patch too small for physiological levels?
And also, in the UK, we take continuous micronized progesterone without any breaks. Would a break from day 25-28 be enough each month to provide any benefits?
Thank you 😊xx
Same question ❤
That patch delivers how much oestrodial. Is it 2mg ?
For many women the 100 mcg patch provides an adequate amount of estradiol.
The best break is 14 days off progesterone … and there is no data for a break of only 4 days … but I would prefer 4 days to no days.
So are you saying we should take progesterone for only 14 days out of 28? And what serum level of oestrogen is required for the longevity benefits please?
@@FeliceGershMD I don’t care for any current symptoms, only future disease - dementia- prevention. In that case do you think HRT dose is enough? Or would I need a birth control dose?
How can I become your patient?!
Easy! Just call my office: 949-753-7475
@@FeliceGershMD I live in Illinois so unlikely I’d be able too, unless teledoc visits are available and covered by insurance. I am starting estradiol .05 patch. How do we know if that dosage is adequate? I’m at a loss as to what questions I should ask my dr at my upcoming appointment. You are so informative!! Thank you for sharing the knowledge.
❤❤❤❤😊
But estrogen not a histamine liberator? That implies pro inflammation.
I wish I could afford to pay out of pocket for a doctor like you. My insurance only pays for the corporate dinosaur doctors in their network.
Hi! Lots of women pay to see me. It’s not astronomical!
Should you always start HRT even if you have no menopause symptoms?
Yes, I’m 49, still have a regular period but I’m on cyclical HRT for a year. Loving it!! Never had symptoms but taking it like the doctor said so your organs can do its things. It doesn’t know your age