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.
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.
This is the 3rd video by Dr. Gersh that I've watched and I feel I'm beginning to understand her approach. Thank you Dr. Gersh for this discussion of the difference between your approach and what other BHRT practitioners do=the static dosing approach.
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!!!
I would also very much appreciate knowing a ballpark level. Here in Minnesota, my menopause practitioner isn't willing to prescribe the estradiol patch to me over .075. I'm wondering if that's high enough to achieve the health benefits I'm so eager to achieve at age 53.
@@brookebrightweather1519 Starting low is good cuz you could get breast tenderness. I’m 73 & haven’t had hormones in years…..my dr prescribed .1 mg. of estradiol……I have breast tenderness but trying to put up with it cuz I know I need it…..& it’s protecting my brain, bones, heart etc…..my blood work in mid October showed my level as 54.7……when in January of 2024 it was 19.8. Normal range is 25.8 to 134.8 Post menopause
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 agree, more research is needed! The physiologic dosing Dr Gersch talks about sounds logical, but there's no long term randomised control trial data to support that's its safe and effective. We shouldn't have to just try it and see without the proper research behind decision making. Dr Louuse Newsom in the UK just got into alot of trouble for prescribing high dose oestrogen, outside the guidelines because a woman suffered serious uterine thickening. Research would help wonderful Drs like Felice to back up her clinical recommendations 😊
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
Thank you for your always honest information! Cyclic progesterone is something new I’m trying and so far, I can already see some positive changes! Thinking about how progesterone down regulates estrogen - what do you think about using DIM? It would seem that it does the same thing - so possibly I’m missing out on the physiologic dosing benefits. Thoughts?
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.
Oh they shut down everything in the early 20th century up to the 50s. Especially in America. The Rockefellers frontmen criminals took over traditional/homepath etc and started pushing petrol chemical derivatives.
I hope the studies are done soon, I’m 61 already with osteoporosis I don’t have time to wait, would be willing to have a cycle again but need it spelled out😁
I found it helpful to print a graph of the rise & fall of estradiol & progesterone in a natural cycle (thank you Google!) to use as a guide. One pump of Estradiol gel is 0.75mg, not 1 mg. (here in Canada, maybe different in. Denmark?) The amount of gel in one pump is 1.25mg but the amount of Estradiol within that gel is 0.75mg. Good to read label carefully because it can be a bit confusing!
Thanks for your input🙏🏻 I also have a graph beside the dose schedule, but very good point to always be sure about the amount in the gels. Best regards 🌸
Please do a talk for us who have had a radical hysterectomy covering P and E .. so many of us ask if we still need to cycle P. I’ve had 4 different doctors who prescribe hormones and none cycle P
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.
@annab5090 Yes, they do prescribe hrt but are prone to use synthetic monodose hormones. And when you ask for natural compounded ones or cycling, they not agree with different protocols. I hope this change in the near future.
I am from Brazil also. You right about it if you go to the doctors from the traditional medicine but if go to the doctors from integrative medicine they all prescribe hrt and even suggest the best compound pharmacy. What most of them don’t do is to use the cycling protocol . But few ones use this protocol. Look up for the integrative medicine doctors .
Thank you so much for this informative video, it really helped me to understand the difference between dosing both hormones. Giving women the choice to begin with should be the way to start in every doctor's office.
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)?
All the research I have done these past few months gives me the impression that 8mg a day of estradiol is too high of a daily dose. 3mg is too high for daily. I do 1mg daily, then 3mg on peak, and take dose down to .05 on low e days.
@@bluejean-1968 hi, so you do cycling or rhythmic dosing. Wow 👌. I am on 1 mg estradiol pill ( only option available here) and 100 mg micronized progesterone daily. So no periods. I am thinking to switch to cycling progesterone to see how it impacts my body, but honestly 2 years periods free has been so good in our hot climate where summers lasts 8,9 months a year. I am still debating.
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
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!
@@lyndah8359 Good question, I had same dilemma! I don't think basal temperature would work because there's no ovulation taking place. What I did was make "Day 1" the first day of my new prescription refill of Estrogel & only took Progesterone on Day 14-28 It took a couple of months but then I got some spotting & light bleed & then I made that day my new "Day 1" and it has worked out Hope that helps!
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
If you see my comment above, I was prescribed higher dose oestradiol (British spelling) in early menopause with micronised progesterone. I developed a pre-cancerous condition: atypical endometrial hyperplasia and am now facing a hysterectomy.
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.
@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.
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?
Thank you for sharing your knowledge with us. It would be very useful Dr Gersh if you could cover HRT methods, dosage, etc in women with Fibroids. I have terrible premenopausal symptoms and a big fibroids close to my bladder causing pelvic pain/pressure whilst on HRT. I am not sure if I can take HRT at all?! I am 51 and still have my periods.
The only meno symptom I had since stopped the periods at age 48, 16 years ago, was low libido(no problems there). But now, at the age of 64, I only need to take hormones for healthy longevity, with no malignant tumors chasing me around in my reproductive system, etc…
Can anyone share dosing for cyclic HRT if Dr Gersh cannot? I am on a cyclic program from another Dr but am not getting a bleed. The doctor is stumped! My lining has built up and I now have to have a hysteroscopy. I believe in what Dr. gersh speaks about and my Dr is a proponent but the creams are not working on me.I wonder if I could do this with patches. I did switch to oral progesterone and when I did, I got one small bleed. But subsequent months produced no bleed. I would love to hear ANYONE'S comments on how to make this system work! What dosages are you using?? And do you use a patch. Thank you!!
Would be interested in hearing if you still recommend cyclic HRT to someone in menopause with stage 4 endometriosis. Wouldn't they benefit from static dosing? This is such an important condition to consider.
I went to visit a Obgyn after many years looking for hormone therapy. He did a hysteroscopy to remove some polips and after that, he prescribed estradiol.25 plus micronized progesteron 100mg to take every day. I'm 63 and haven't started yet. Should I take 200mg progesterone for 14 days instead of every day? I don't want to annoy my doctor, I think his focus is on younger woman, I had only seen pregnant women in the waiting room but I feel lucky that he agreed to start me on HRT.
I don’t have a uterus and I’m in surgical menopause I do estradiol injections my e2 runs 400 and I cycle progesterone without bleeding because no uterus and I both look and feel freaking fantastic with my 21 year old levels of estradiol
H Dr Felic Your medical recommendation for pulsed HRT or only 14 days of progesterone and stop for bleeding even for post menopausal women .Does this regime increases significantly the risk of breast cancer? You are the only Doctor advocating that. Other doctors recommendation is to take continuous for post menopausal women. Please explain. Thank you
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.
@@mrgondini if you still have bleedings, 1st day is the firts day of bleeding. If you don't have bleedings, is the 14th day after you started oestrogen.
🙏❤️ I ❤️bleeding, it makes me sacred, close to my daughter, one with earth, one with life. 🌺 Two questions: what would be the lowest /highest dose? I cycle between 0.025 - 0.05 patch, dancing with my body’s rhythm ( my hormones still fluctuate like they used to, only faster . I don’t tolerate progesterone pills, so I use transdermal/ intraoral oil pretty much every hour just like my body would do, leaving two days off, then gradually increase up to 100 mg. In the course of a year I did not bleed . 2. It actually seems, that my years of working with herbs & homeopathy , trying to restore my ovaries, may be showing something. On min dose HRT for a year but recently felt a lot of activity in my breasts and bled couple times on the full moon. My hormone levels measured by inito are much higher that my HRT can deliver. I’m not ready to get ofHRT, because I don’t know whether my own hormones are sufficient, and reliable in longer term ( each time I tried to take the patch of I had horrible symptoms, so I’m leaving the lowest dose on as a baseline. It’s full moon and I’m currently bleeding. 🩸
Hello Dr. Gersh. Thank you for sharing your knowledge & expertise. Does the med TIBOLONE which is a combo of synthetic estrogen, progesterone & androgen does the same job as HRT treatment with separate estrogen and progesterone tablets in terms of longevity & anti-aging during meno?
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).
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.
I am 10 years into menopause,my estrogen levels when tested over the years were close to zero , as was my testosterone and progesterone. I never supplemented estrogen and only briefly ( 6 years ago ) supplemented with bio identical progesterone and testosterone. At my last doctors visit , my estrogen levels are surprisingly 30 , without supplementation or herbs etc . What could be causing this , I am overweight and pre diabetic but not obese ? My cholesterol levels are quite high .
Its because you are overweight. You are producing Estrone= E1. In the fat cells. The fact you are overweight and diabetic speaks volumes. It means you are very deficient in Estradiol =E2 and Progesterone. The Testosterone shrinks as one ages. Remember Estrone is not Estradiol. Even though they convert into each other. You now don't have Estradiol to counterbalance Estrone. And 30 is low. Dr. Gersh said 50 is scraping the barrel.
There’s a test for DHEA/DHEAS. There is a lab you can get done that might be beneficial. From everything I’ve looked at low doses are totally fine. I would not go above 10 mg.
Dr Gersh, would love your thoughts on using TRT to indirectly optimize estrogen. I had my estrogen checked 3 days after 10mg of testosterone SQ. My E was 514.
But what dose do I take if I have fibroids going into menopause that are starting to shrink. I feel like I have no options except major surgery. Please help women (80% of us) with fibroids.
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.ymcbray3123 Hi, how do you now natural cycle your estrogen and progesterone? Do you still modify the estrogen doses according to the graph? Are you taking 200mg P only 2 weeks end cycle?
@@lilydesjardins5063 Hi Yes 200mg P last 2 weeks and yes, with my Estradiol gel, I use less/ none Day 1-4 & 25-28 & more, like 3-4 pumps/day mid-month to try & mimic when it would normally peak in cycle. I'm prescribed 2 pumps/daily (public Doc), so this works out well because still end up using up the same amount prescribed. It's actually also written on the manufacturer's box of my Estradiol gel not to use 5-7 days/mo. When I asked Doc about this, reply was that's only for women with a cycle lol!
@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.
What would the dosages be for this kind of regimen? Is 2 mg of estradiol enough to be considered high dosing? How do you find a doctor in your area that does this kind of dosing?
Round and round in circles! 🙏please tell us what the "optimal blood work levels for longevity are" estradiol, progesterone, testosterone, DHEAS. Once we know these levels, then we can work with our health care providers to achieve these levels, and tweaking the doses. You say dose matters, adequate amount of estrodial matters, dose matters .... what's that dose. Otherwise, I don't know the goal. Thank you.
As I listened to your amazing lecture on how the goal is not to grow the uterus but since it’s there we can’t help it, I had a thought. What if we got procedures to embolization the arteries which feed the uterus? Just like in the procedure to shrink uterine fibroids? Could that help with not ha I g the uterus grow the uterine lining, hence no bleeding if we take physiologic amounts of estradiol?
If a woman had an endometrial ablation and no longer bleed, how could they confirm if they are taking the "optimal dose"? Is the optimal dose only recommended for those who have a uterine lining?
This makes logical sense to me however, would it also cause PMS/PMDD in women, like me, who had suffered miserably during the reproductive years with this?
I started cyclical HRT a few days ago for the first time ever, and after two doses of estradiol (no P) I woke up feeling woozy and hungover. I couldn't function all day. I wonder what could have caused it? Isn't estradiol supposed to give you energy?
Just got both estradiol and progesterone. Do I just start estradiol for 14 days and then progesterone on days 15 and until the 1st ? My doc gave me everything I asked for but I am not sure how to cycle it exactly… plz advise, ladies, how you do it. Wiley protocol talks about moon cycle- it sounds a bit too much for me.
No Estradiol is static.. so its every day. You pick between 12-14 days where you up the Estradiol dose. Then go back to the normal dose. Then you use the Progesterone 12-14 days. Remember no Progesterone is taken orally. Its vaginal or transdermal Progesterone.
@@jessicahitchens6926Please tell me how much estriol/estradiol (with a pick from 12 to 14th day) and then lower again until the 26th day ?? and how much progssteron from 14th day for next 12 to 14 day? 2x 100 mg? I stop both from 26 day for next 5 days?? Thank you very much 10:22
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?
So, post menopause at 55yo I want to try cyclic hrt...assuming a 28 day cycle I use estradiol gel in a higher dose daily...then 2 weeks in I use progesterone (capsules vaginally as it makes me nauseous when taken orally) this will mean a bleed that is necessary to shed the uterus lining (a fake period)...have I got that right?
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
Would it be beneficial to take progesterone in this way....Take at least 200mg by mouth for 14....but instead of just straight 200mg for all 14 nights Take it like this first 5 nights 200mg and then for 4 nights 300mg and then the last 5 night back to the 200mg ? Would this be beneficial to mimic a "rise" ? Or would this be harmful? Just curious. I am also using estradiol patch my rotation is Monday and Thursday however I do not wear a patch on Sundays and so far it seems to be working well for me.
She never says what is a high dose. I’m 65 and take 0.075mg patch with 100 oral progesterone. But I don’t feel that‘s high enough. So what dose is high? Or after blood test, about around what would the numbers look like for a high blood level?
Anything over 2mg a day is high. Every woman is so different. And then age comes into it. So a woman in her early 40s is completely different to a woman at 60.
@@jessicahitchens6926 it depends on how much you absorb transdermally…my blood test for e came in at 130…so if one disregards symptoms, does she think that number alone is in her preferred high range or not. I guess that’s what I’m trying to find out.
Do I understand you correct? - if I want HRT to follow my cycle, I should only do estrogen the først 2 weeks of my cycle and progesteron the last 14 days of my cycle?
I thought the estrogen patch .05 x wk eg. is continuous, progesterone 200mgs starting 14th day of the month? Blood work is important for opt. levels, then readjust as you go along .... ? I'm so confused, this is so ambitious ... women need answers.
So frustrating because she never says what the optimum dose of estradiol is. I mean, give me the info to take to my GYN to see if she will consider prescribing. I just started a regimen of the lose dose estradiol combined with progesterone and I question even starting this at all. Now I’m feeling like this will never do enough and could even cause issues in a few years. I’m 70 and looking for healthy longevity. Never took HRT during my pre-during menopause. But I’m not excited to have periods again. Been comando since I was 57. The thought of wearing underware, Kotex, tampons….no way.
It's not for you then. 57 was late for menopause. Most don't even get into the early 50s nowadays. She can't give you a level because everyone is unique. Your receptors would be weak as well.
I am taking physiologic levels (for me) of estrogen and now am bloating after everything I eat and my digestion has nearly come to a halt. This has gotten worse over the year I’ve been taking HRT as my estrogen doses have increased. I run, lift weights, don’t drink, eat plenty of veggies…and have a near-constant bloated stomach. At least my hot flashes and bad mood are gone so yay, I guess. lol
I’m just curious… if estrogen is such a vital hormone for life, did nature/ God make a mistake with designing the function of menopause? Is there a benefit to having a natural end to periods and estrogen?
Can anyone confirm, per Dr. Gersh, the healthy way of hrt is 2 weeks of progesterone in the second half of the cycle and estrogen all 28 days. NOT alternating estrogen and progesterone 2 weeks each.
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.
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
Hi, fyi I am on. 05 estradiol weekly patch also but 100 mg bioidentical progesterone and that doesn't cause bleeding for me. However I recently tried cycling, continuous patch but 200 mg progesterone for 14 days and that initiated a monthly bleed. I'm wondering then maybe 200 mg progesterone continuous is too high for you and you should try 100 mg. Just my 2 cents ❤
@@zorinaganpaul1598 Thank you, I appreciate your input. I started on the 100 mg Progesterone along with the .05 patch but that was also causing bleeding. That’s why the Progesterone was increased to 200 mg but still didn’t stop the monthly bleed (more like every 3 weeks). I really feel like I may be one of those women who just need a much higher amount to balance out the estrogen. But if I can’t get a doctor to prescribe it I don’t have many options. My doctor has scheduled a biopsy in a couple weeks just to rule anything out… I dread it. If it comes out normal I think I’m gonna switch to the true cyclic method and just live with a monthly period.
I noticed when I was on hrt for 8 yrs usingvthe 0.1mg patch and 15 days of progest I never had breakthru bleeding - only a light period the last 3-4 days of month at end of progesterone for 15 days. However when a previous dr reduced my estradiol patch to 0.75, I started having pink urine then bladder infection - things seemed out of whack.
As a biomedical scientist I find the idea of replicating a natural menstrual cycle physiologically fascinating. But what I will say is that in early menopause I was prescribed oestradiol implants along with micronised progesterone. This led to atypical endometrial hyperplasia. I am now facing a hysterectomy. I don’t have any risk factors for endometrial hyperplasia in that I am slim, non diabetic, physically active and don’t have PCOS.
On another YT video I believe Dr. Gersh stated 0.1 estradiol patch (taken twice a week) and 200mg of progesterone, if you still have your uterus and take one pill a day for the first 14 or 15 days out of the month.
Listen at the six minute mark I think you might understand a little little bit better. But always find a menopause specialist to prescribe in your area.
Wait, WHAT?! Low doses of estradiol are more inflammatory than no estradiol at all??!? Please PROVIDE THIS STUDY!! As you note, most doctors prescribe the lowest effective dose - are they harming women's health?
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?
They decline every decade ... and the estrogen is Estrone low grade garbage. Do you ever see really healthy gorgeous elderly women that aren't frail with orsteopenia or oesteporis. I don't ever. Even women in their late 60s look a wreck. Or obese with no shape. Or dumpy.. The hormones are vitality.
@@jessicahitchens6926 I don’t think you read the question properly. It wasn’t to do with hormone levels declining after menopause as of course they do, we all know that. My question was to do with Dr Gersh statement about static levels of hormones. Are they statically low or cyclically low after menopause.
Thank you for explaining it in a way that everyone can understand!
You are a great teacher!
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.
What’s the optimal dose for us who don’t mind bleeding?
Love Dr Gersh. I wish she would occasionally respond to some of her comments like Dr Berg and others do. Even if it’s only 5 comments per video.
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 the 3rd video by Dr. Gersh that I've watched and I feel I'm beginning to understand her approach. Thank you Dr. Gersh for this discussion of the difference between your approach and what other BHRT practitioners do=the static dosing approach.
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!!!
I would also very much appreciate knowing a ballpark level. Here in Minnesota, my menopause practitioner isn't willing to prescribe the estradiol patch to me over .075. I'm wondering if that's high enough to achieve the health benefits I'm so eager to achieve at age 53.
I’ve heard on other drs channels it’s some where around 80-100 pg/ml
@@brookebrightweather1519 Starting low is good cuz you could get breast tenderness. I’m 73 & haven’t had hormones in years…..my dr prescribed .1 mg. of estradiol……I have breast tenderness but trying to put up with it cuz I know I need it…..& it’s protecting my brain, bones, heart etc…..my blood work in mid October showed my level as 54.7……when in January of 2024 it was 19.8. Normal range is 25.8 to 134.8 Post menopause
Above 60 is for bones…….
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
💪♀️💕
You do know billions are made off women. The bandaid treatments are extreme lucrative. They're not giving that up.
I agree, more research is needed! The physiologic dosing Dr Gersch talks about sounds logical, but there's no long term randomised control trial data to support that's its safe and effective. We shouldn't have to just try it and see without the proper research behind decision making. Dr Louuse Newsom in the UK just got into alot of trouble for prescribing high dose oestrogen, outside the guidelines because a woman suffered serious uterine thickening. Research would help wonderful Drs like Felice to back up her clinical recommendations 😊
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
Thank you Dr. Gersh. You explain things so clearly and in ways I can understand!
For a while I will melt all this fantastic information. It makes me fee so
good and hopefull! Thank You Felice Gersh for who You are and give! ❤️🙏 ☀️
This is information that is not mainstream like many of the bandwagon jumpers are using. Fantastic!
Thank you for your always honest information! Cyclic progesterone is something new I’m trying and so far, I can already see some positive changes! Thinking about how progesterone down regulates estrogen - what do you think about using DIM? It would seem that it does the same thing - so possibly I’m missing out on the physiologic dosing benefits. Thoughts?
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.
Oh they shut down everything in the early 20th century up to the 50s. Especially in America. The Rockefellers frontmen criminals took over traditional/homepath etc and started pushing petrol chemical derivatives.
This is extremely helpful and informative!! Many thanks!! 💐🙏😊
I hope the studies are done soon, I’m 61 already with osteoporosis I don’t have time to wait, would be willing to have a cycle again but need it spelled out😁
Thank you for all your great videos - I am learning so much
I found it helpful to print a graph of the rise & fall of estradiol & progesterone in a natural cycle (thank you Google!) to use as a guide.
One pump of Estradiol gel is 0.75mg, not 1 mg. (here in Canada, maybe different in. Denmark?)
The amount of gel in one pump is 1.25mg but the amount of Estradiol within that gel is 0.75mg. Good to read label carefully because it can be a bit confusing!
Thanks for your input🙏🏻 I also have a graph beside the dose schedule, but very good point to always be sure about the amount in the gels.
Best regards 🌸
@@c.ymcbray3123Almost always it is 1 mg of Estriol and 0.25 mg of Estradiol in 1 pump.
Please do a talk for us who have had a radical hysterectomy covering P and E .. so many of us ask if we still need to cycle P. I’ve had 4 different doctors who prescribe hormones and none cycle P
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.
Doctors in Brazil do not prescribe HRT for women?
@annab5090 Yes, they do prescribe hrt but are prone to use synthetic monodose hormones. And when you ask for natural compounded ones or cycling, they not agree with different protocols. I hope this change in the near future.
I am from Brazil also. You right about it if you go to the doctors from the traditional medicine but if go to the doctors from integrative medicine they all prescribe hrt and even suggest the best compound pharmacy. What most of them don’t do is to use the cycling protocol . But few ones use this protocol. Look up for the integrative medicine doctors .
Thank you so much for this informative video, it really helped me to understand the difference between dosing both hormones. Giving women the choice to begin with should be the way to start in every doctor's office.
Thank you very much for this invaluable information. Please, share your thoughts about tibolon
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...
Dr Gersh has said that the WP doses of Estradiol are too high.
@@bluejean-1968 has she? They work pretty great for me and also can be adjusted as needed...
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.
All the research I have done these past few months gives me the impression that 8mg a day of estradiol is too high of a daily dose. 3mg is too high for daily. I do 1mg daily, then 3mg on peak, and take dose down to
.05 on low e days.
@@bluejean-1968 hi, so you do cycling or rhythmic dosing. Wow 👌.
I am on 1 mg estradiol pill ( only option available here) and 100 mg micronized progesterone daily.
So no periods. I am thinking to switch to cycling progesterone to see how it impacts my body, but honestly 2 years periods free has been so good in our hot climate where summers lasts 8,9 months a year. I am still debating.
@@bluejean-1968yeesh to complicated.
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 🙏🏻
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!
Dr. Gersh said on another video that usually she prescribes a 100mch/day patch, but sometimes less.
what is the right dose of estradiol?
Hi Doctor Gersh. Thank you for educational information. is there anyway I can schedule an appointment with you?
Are you saying that Progesterone should only be taken the last two weeks of the cycle, versus static dosing for 30 days?
Yes!
How do you calculate the last 2 weeks of your cycle if you're not bleeding anymore? By taking basal temperature?
@@lyndah8359 Good question, I had same dilemma!
I don't think basal temperature would work because there's no ovulation taking place.
What I did was make "Day 1" the first day of my new prescription refill of Estrogel & only took Progesterone on Day 14-28
It took a couple of months but then I got some spotting & light bleed & then I made that day my new "Day 1"
and it has worked out
Hope that helps!
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
If you see my comment above, I was prescribed higher dose oestradiol (British spelling) in early menopause with micronised progesterone. I developed a pre-cancerous condition: atypical endometrial hyperplasia and am now facing a hysterectomy.
Thank you so much, this is exactly the information I was looking for!
Please can we have links to any studies that show benefits of cycling over continuous?
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.
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.
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?
Thank you for sharing your knowledge with us. It would be very useful Dr Gersh if you could cover HRT methods, dosage, etc in women with Fibroids. I have terrible premenopausal symptoms and a big fibroids close to my bladder causing pelvic pain/pressure whilst on HRT. I am not sure if I can take HRT at all?! I am 51 and still have my periods.
The only meno symptom I had since stopped the periods at age 48, 16 years ago, was low libido(no problems there). But now, at the age of 64, I only need to take hormones for healthy longevity, with no malignant tumors chasing me around in my reproductive system, etc…
Can anyone share dosing for cyclic HRT if Dr Gersh cannot? I am on a cyclic program from another Dr but am not getting a bleed. The doctor is stumped! My lining has built up and I now have to have a hysteroscopy. I believe in what Dr. gersh speaks about and my Dr is a proponent but the creams are not working on me.I wonder if I could do this with patches. I did switch to oral progesterone and when I did, I got one small bleed. But subsequent months produced no bleed. I would love to hear ANYONE'S comments on how to make this system work! What dosages are you using?? And do you use a patch. Thank you!!
Hi and thank you! How can I access that course of yours? ❤
i feel so confused.iam 64.first time to take hormones for good longetivity...what to start with?
Would be interested in hearing if you still recommend cyclic HRT to someone in menopause with stage 4 endometriosis. Wouldn't they benefit from static dosing? This is such an important condition to consider.
I went to visit a Obgyn after many years looking for hormone therapy. He did a hysteroscopy to remove some polips and after that, he prescribed estradiol.25 plus micronized progesteron 100mg to take every day. I'm 63 and haven't started yet. Should I take 200mg progesterone for 14 days instead of every day? I don't want to annoy my doctor, I think his focus is on younger woman, I had only seen pregnant women in the waiting room but I feel lucky that he agreed to start me on HRT.
I don’t have a uterus and I’m in surgical menopause I do estradiol injections my e2 runs 400 and I cycle progesterone without bleeding because no uterus and I both look and feel freaking fantastic with my 21 year old levels of estradiol
How do you know when to cycle your progesterone?
H Dr Felic
Your medical recommendation for pulsed HRT or only 14 days of progesterone and stop for bleeding even for post menopausal women .Does this regime increases significantly the risk of breast cancer?
You are the only Doctor advocating that.
Other doctors recommendation is to take continuous for post menopausal women.
Please explain. Thank you
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
How do I figure out when to do the 14 day dose of the progesterone?
@@mrgondini if you still have bleedings, 1st day is the firts day of bleeding. If you don't have bleedings, is the 14th day after you started oestrogen.
Love your videos - THANK YOU ❤
🙏❤️
I ❤️bleeding, it makes me sacred, close to my daughter, one with earth, one with life. 🌺
Two questions: what would be the lowest /highest dose?
I cycle between 0.025 - 0.05 patch, dancing with my body’s rhythm ( my hormones still fluctuate like they used to, only faster .
I don’t tolerate progesterone pills, so I use transdermal/ intraoral oil pretty much every hour just like my body would do, leaving two days off, then gradually increase up to 100 mg. In the course of a year I did not bleed .
2. It actually seems, that my years of working with herbs & homeopathy , trying to restore my ovaries, may be showing something.
On min dose HRT for a year but recently felt a lot of activity in my breasts and bled couple times on the full moon. My hormone levels measured by inito are much higher that my HRT can deliver.
I’m not ready to get ofHRT, because I don’t know whether my own hormones are sufficient, and reliable in longer term ( each time I tried to take the patch of I had horrible symptoms, so I’m leaving the lowest dose on as a baseline. It’s full moon and I’m currently bleeding. 🩸
Hello Dr. Gersh. Thank you for sharing your knowledge & expertise. Does the med TIBOLONE which is a combo of synthetic estrogen, progesterone & androgen does the same job as HRT treatment with separate estrogen and progesterone tablets in terms of longevity & anti-aging during meno?
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!
@@olderandwiser127can you link to the scientific studies that show insulin resistance is the root of all cancer? I would like to read them.
Thats not true
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.
I am 10 years into menopause,my estrogen levels when tested over the years were close to zero , as was my testosterone and progesterone. I never supplemented estrogen and only briefly ( 6 years ago ) supplemented with bio identical progesterone and testosterone. At my last doctors visit , my estrogen levels are surprisingly 30 , without supplementation or herbs etc . What could be causing this , I am overweight and pre diabetic but not obese ? My cholesterol levels are quite high .
Its because you are overweight. You are producing Estrone= E1. In the fat cells. The fact you are overweight and diabetic speaks volumes. It means you are very deficient in Estradiol =E2 and Progesterone. The Testosterone shrinks as one ages. Remember Estrone is not Estradiol. Even though they convert into each other. You now don't have Estradiol to counterbalance Estrone. And 30 is low. Dr. Gersh said 50 is scraping the barrel.
At what point in the cycle do you introduce testosterone or DHEA?
There’s a test for DHEA/DHEAS. There is a lab you can get done that might be beneficial.
From everything I’ve looked at low doses are totally fine. I would not go above 10 mg.
So when should I take progesterone and when to stop. I prefer to cycle.
Dr Gersh, would love your thoughts on using TRT to indirectly optimize estrogen. I had my estrogen checked 3 days after 10mg of testosterone SQ. My E was 514.
What about if you have had a full, radical hysterectomy? Should I still cycle the progesterone?
Absolutely
@@bluejean-1968how do you know when to cycle without a bleed?
But what dose do I take if I have fibroids going into menopause that are starting to shrink. I feel like I have no options except major surgery. Please help women (80% of us) with fibroids.
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!
@@c.ymcbray3123 Hi, how do you now natural cycle your estrogen and progesterone? Do you still modify the estrogen doses according to the graph? Are you taking 200mg P only 2 weeks end cycle?
@@lilydesjardins5063 Hi
Yes 200mg P last 2 weeks and yes, with my Estradiol gel, I use less/ none Day 1-4 & 25-28 & more, like 3-4 pumps/day mid-month to try & mimic when it would normally peak in cycle.
I'm prescribed 2 pumps/daily (public Doc), so this works out well because still end up using up the same amount prescribed.
It's actually also written on the manufacturer's box of my Estradiol gel not to use 5-7 days/mo.
When I asked Doc about this, reply was that's only for women with a cycle lol!
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.
@@SPower-yl9ww80 mg of estradiol?!?
What would the dosages be for this kind of regimen? Is 2 mg of estradiol enough to be considered high dosing? How do you find a doctor in your area that does this kind of dosing?
I feel even 1mg is a good daily dose.
What about postmenopausal women should we not take progesteron every night?
Why won't you suggest dosages???????
Round and round in circles!
🙏please tell us what the "optimal blood work levels for longevity are" estradiol, progesterone, testosterone, DHEAS. Once we know these levels, then we can work with our health care providers to achieve these levels, and tweaking the doses. You say dose matters, adequate amount of estrodial matters, dose matters .... what's that dose. Otherwise, I don't know the goal. Thank you.
As I listened to your amazing lecture on how the goal is not to grow the uterus but since it’s there we can’t help it, I had a thought. What if we got procedures to embolization the arteries which feed the uterus? Just like in the procedure to shrink uterine fibroids? Could that help with not ha I g the uterus grow the uterine lining, hence no bleeding if we take physiologic amounts of estradiol?
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
What is the dosage of progesterone you use for cyclic?
If a woman had an endometrial ablation and no longer bleed, how could they confirm if they are taking the "optimal dose"? Is the optimal dose only recommended for those who have a uterine lining?
This makes logical sense to me however, would it also cause PMS/PMDD in women, like me, who had suffered miserably during the reproductive years with this?
I started cyclical HRT a few days ago for the first time ever, and after two doses of estradiol (no P) I woke up feeling woozy and hungover. I couldn't function all day. I wonder what could have caused it? Isn't estradiol supposed to give you energy?
So the only way to know if your dose is high enough for optimal health is to have your uterine lining measured?
Just got both estradiol and progesterone. Do I just start estradiol for 14 days and then progesterone on days 15 and until the 1st ? My doc gave me everything I asked for but I am not sure how to cycle it exactly… plz advise, ladies, how you do it. Wiley protocol talks about moon cycle- it sounds a bit too much for me.
No Estradiol is static.. so its every day. You pick between 12-14 days where you up the Estradiol dose. Then go back to the normal dose. Then you use the Progesterone 12-14 days. Remember no Progesterone is taken orally. Its vaginal or transdermal Progesterone.
@@jessicahitchens6926Please tell me how much estriol/estradiol (with a pick from 12 to 14th day) and then lower again until the 26th day ?? and how much progssteron from 14th day for next 12 to 14 day? 2x 100 mg? I stop both from 26 day for next 5 days?? Thank you very much 10:22
I wasn’t even aware of vaginal progesterone existing. Why is oral progesterone bad?
@@jessicahitchens6926 why not orally?
@@Joanna1111-gj2bdthis is what I want to know.
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?
So, post menopause at 55yo I want to try cyclic hrt...assuming a 28 day cycle I use estradiol gel in a higher dose daily...then 2 weeks in I use progesterone (capsules vaginally as it makes me nauseous when taken orally) this will mean a bleed that is necessary to shed the uterus lining (a fake period)...have I got that right?
I am 40. When should i start hormone replacing theraphy?
What according to you should minimum level be?
So is 50 a small dose ? 100? No guideline on Estradiol amount...of did I miss that bit!?? Please advise. Im on 50 patch
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
4 pumps daily Estrogel is actually much higher than what is typically prescribed, and is a dose that Dr. Gersh often prescribes.
Can you reccommend someone in the Milwaukee areas that would have a similar philosophy.
Would it be beneficial to take progesterone in this way....Take at least 200mg by mouth for 14....but instead of just straight 200mg for all 14 nights Take it like this first 5 nights 200mg and then for 4 nights 300mg and then the last 5 night back to the 200mg ? Would this be beneficial to mimic a "rise" ? Or would this be harmful? Just curious.
I am also using estradiol patch my rotation is Monday and Thursday however I do not wear a patch on Sundays and so far it seems to be working well for me.
My dr prescribed me Premarin vaginal cream, can I use it on other parts of my body?
Im willing to be a "test dummy" lol. Lets get some published data Doc!
Amen - ME TOO!!!
Me three!!
She never says what is a high dose. I’m 65 and take 0.075mg patch with 100 oral progesterone. But I don’t feel that‘s high enough. So what dose is high? Or after blood test, about around what would the numbers look like for a high blood level?
Anything over 2mg a day is high. Every woman is so different. And then age comes into it. So a woman in her early 40s is completely different to a woman at 60.
@@jessicahitchens6926 it depends on how much you absorb transdermally…my blood test for e came in at 130…so if one disregards symptoms, does she think that number alone is in her preferred high range or not. I guess that’s what I’m trying to find out.
For my age group of course.
Great question!
Dr, are you using HRT and are cycling?
What if you have fibroids? Is it safe, does it increase cancer risk cyclic ?
One youtube doctor answered that question saying you can still do cyclic, but need close supervision of a doctor. God help us find one!
What if you’ve had a stroke during menopause? I’m 60 …had a stroke last year. My doc says no HRT. I have bad symptoms…
So WHAT dose do you recommend ?
Start listening at the six minute mark, but I would absolutely recommend finding a menopause specialist in your area.
Do I understand you correct? - if I want HRT to follow my cycle, I should only do estrogen the først 2 weeks of my cycle and progesteron the last 14 days of my cycle?
I thought the estrogen patch .05 x wk eg. is continuous, progesterone 200mgs starting 14th day of the month? Blood work is important for opt. levels, then readjust as you go along .... ? I'm so confused, this is so ambitious ... women need answers.
What if the physiologic dose?
So frustrating because she never says what the optimum dose of estradiol is. I mean, give me the info to take to my GYN to see if she will consider prescribing. I just started a regimen of the lose dose estradiol combined with progesterone and I question even starting this at all. Now I’m feeling like this will never do enough and could even cause issues in a few years. I’m 70 and looking for healthy longevity. Never took HRT during my pre-during menopause. But I’m not excited to have periods again. Been comando since I was 57. The thought of wearing underware, Kotex, tampons….no way.
It's not for you then. 57 was late for menopause. Most don't even get into the early 50s nowadays. She can't give you a level because everyone is unique. Your receptors would be weak as well.
I tried to buy your course and my credit card company said you are not accepting payments?
I am taking physiologic levels (for me) of estrogen and now am bloating after everything I eat and my digestion has nearly come to a halt. This has gotten worse over the year I’ve been taking HRT as my estrogen doses have increased. I run, lift weights, don’t drink, eat plenty of veggies…and have a near-constant bloated stomach. At least my hot flashes and bad mood are gone so yay, I guess. lol
Tried probiotics and prebiotics for digestion? Lots of vegetables and some fruit daily?The fiber content feeds our innate probiotics = our microbiome.
I’m just curious… if estrogen is such a vital hormone for life, did nature/ God make a mistake with designing the function of menopause? Is there a benefit to having a natural end to periods and estrogen?
We live much longer now...way past fertility I guess nature didn't take this any account!
Can anyone confirm, per Dr. Gersh, the healthy way of hrt is 2 weeks of progesterone in the second half of the cycle and estrogen all 28 days. NOT alternating estrogen and progesterone 2 weeks each.
You are correct in that its estradiol all month long and only progesterone on cycle day 14-28.
@@opheliazen❤
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.
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.
Hi, fyi I am on. 05 estradiol weekly patch also but 100 mg bioidentical progesterone and that doesn't cause bleeding for me. However I recently tried cycling, continuous patch but 200 mg progesterone for 14 days and that initiated a monthly bleed. I'm wondering then maybe 200 mg progesterone continuous is too high for you and you should try 100 mg. Just my 2 cents ❤
@@zorinaganpaul1598 Thank you, I appreciate your input. I started on the 100 mg Progesterone along with the .05 patch but that was also causing bleeding. That’s why the Progesterone was increased to 200 mg but still didn’t stop the monthly bleed (more like every 3 weeks). I really feel like I may be one of those women who just need a much higher amount to balance out the estrogen. But if I can’t get a doctor to prescribe it I don’t have many options. My doctor has scheduled a biopsy in a couple weeks just to rule anything out… I dread it. If it comes out normal I think I’m gonna switch to the true cyclic method and just live with a monthly period.
I noticed when I was on hrt for 8 yrs usingvthe 0.1mg patch and 15 days of progest I never had breakthru bleeding - only a light period the last 3-4 days of month at end of progesterone for 15 days. However when a previous dr reduced my estradiol patch to 0.75, I started having pink urine then bladder infection - things seemed out of whack.
As a biomedical scientist I find the idea of replicating a natural menstrual cycle physiologically fascinating. But what I will say is that in early menopause I was prescribed oestradiol implants along with micronised progesterone. This led to atypical endometrial hyperplasia. I am now facing a hysterectomy. I don’t have any risk factors for endometrial hyperplasia in that I am slim, non diabetic, physically active and don’t have PCOS.
@Tabitha_K Ideally an annual transvaginal scan of your endometrium would have been arranged.
Because you were taking cyclic estradiol , 14 days only than alternate with progesterone 10 and & 4 days complete rest for the hormonal receptors
Implants.... so no transdermal Estradiol. Just saying.....
And I’m taking daily estrogen and progesterone and bleed!
So what is the optimal dose? It didn’t answer that
exactly. I'm guessing it's different for everyone
On another YT video I believe Dr. Gersh stated 0.1 estradiol patch (taken twice a week) and 200mg of progesterone, if you still have your uterus and take one pill a day for the first 14 or 15 days out of the month.
Listen at the six minute mark I think you might understand a little little bit better. But always find a menopause specialist to prescribe in your area.
Wait, WHAT?! Low doses of estradiol are more inflammatory than no estradiol at all??!? Please PROVIDE THIS STUDY!! As you note, most doctors prescribe the lowest effective dose - are they harming women's health?
What is you've had vaginal ablation 15 years ago? Im on 200mg nightly progesterone,.05 twice a week estrogen patch, & compounded testosterone.
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?
@@BelBelin great question 👍
They decline every decade ... and the estrogen is Estrone low grade garbage. Do you ever see really healthy gorgeous elderly women that aren't frail with orsteopenia or oesteporis. I don't ever. Even women in their late 60s look a wreck. Or obese with no shape. Or dumpy.. The hormones are vitality.
@@jessicahitchens6926 I don’t think you read the question properly.
It wasn’t to do with hormone levels declining after menopause as of course they do, we all know that.
My question was to do with Dr Gersh statement about static levels of hormones. Are they statically low or cyclically low after menopause.