Susan's Place Transgender Resources

Community Conversation => Transitioning => Hormone replacement therapy => Topic started by: Amy1988 on December 07, 2013, 12:51:55 PM

Title: Half life of estrogen
Post by: Amy1988 on December 07, 2013, 12:51:55 PM
I've read the half life of estrogen is like 30 or 35 hours.  If this is true then wouldn't taking estrogen every day build up to a very high level?  I use Oestrogel gel daily but after a few weeks I start getting leg aches in my right leg and a feeling like I've been running.  Like a bit out of breath.  I take plavix which helps for a while but eventually the estrogen levels get too high and I have to lay off for a while.  I don't think I'm getting clots but think the estrogen make my blood more viscous.  Any thoughts?
Title: Re: Half life of estrogen
Post by: Devlyn on December 07, 2013, 12:55:51 PM
Standard advice: See your doctor and have it checked. Hugs, Devlyn
Title: Re: Half life of estrogen
Post by: Jamie D on December 07, 2013, 01:07:27 PM
Quote from: Amy1988 on December 07, 2013, 12:51:55 PM
I've read the half life of estrogen is like 30 or 35 hours.  If this is true then wouldn't taking estrogen every day build up to a very high level?  I use Oestrogel gel daily but after a few weeks I start getting leg aches in my right leg and a feeling like I've been running.  Like a bit out of breath.  I take plavix which helps for a while but eventually the estrogen levels get too high and I have to lay off for a while.  I don't think I'm getting clots but think the estrogen make my blood more viscous.  Any thoughts?

I have read that the half-life of 17-beta estradiol is about 15 hours.  That may have been the information from my Climara patches - can't remember.  The patches provide constant dosing, so I never thought much about the half-life.

The clotting studies were largely based on experience with ethinyl estradiol.  Few people are prescribed that anymore.
Title: Re: Half life of estrogen
Post by: Ltl89 on December 07, 2013, 01:28:19 PM
Quote from: Amy1988 on December 07, 2013, 12:51:55 PM
I've read the half life of estrogen is like 30 or 35 hours.  If this is true then wouldn't taking estrogen every day build up to a very high level?  I use Oestrogel gel daily but after a few weeks I start getting leg aches in my right leg and a feeling like I've been running.  Like a bit out of breath.  I take plavix which helps for a while but eventually the estrogen levels get too high and I have to lay off for a while.  I don't think I'm getting clots but think the estrogen make my blood more viscous.  Any thoughts?

I started to get leg pains after my a week or two on estrogen.  That stopped after a while.  At the time, I was doing leg exercises and running on a treadmill frequently, but the aches felt different than muscle pain.  I didn't have any issues after the first month and everything is fine with me.  Still, I think you should always be cautious and make sure you are aware of any potential issues.  Blood clots should be detected as soon as possible.  The last thing you want is to find out that you have a clot when it's too late.  Good luck with everything and hope that it's nothing serious.   
Title: Re: Half life of estrogen
Post by: Amy1988 on December 07, 2013, 02:26:53 PM
Quote from: Joules on December 07, 2013, 01:39:10 PM
Keep in mind that any item with a slow decay, such as Estrogen, will eventually reach a steady state where incoming equals outgoing.  The effect of a slow decay simply cause a bit of "residence time" in Chemistry terms.  A better known example is that of Prozac(Fluoxetine), it has a very long decay time (half life) of 16 days.  Estrogen dosage regimens are designed to mimic the output of typical cis female ovaries.

So can you tell me what the half life is for estrogen? 
Title: Re: Half life of estrogen
Post by: Amy1988 on December 07, 2013, 03:30:10 PM
Quote from: Joules on December 07, 2013, 02:36:13 PM
A quick Google turned up results ranging from 13 to 72 hours, depending on the form, the administration method and individual metabolic factors as well as liver status.  Probably most typical is 16 to 36 hours.

Wow! That's a pretty wide range 16-36 hours.  I wish I knew what it was for me but it seems like its on the longer end of the range.
Title: Re: Half life of estrogen
Post by: Jamie D on December 07, 2013, 04:18:13 PM
Quote from: learningtolive on December 07, 2013, 01:28:19 PM
I started to get leg pains after my a week or two on estrogen.  That stopped after a while.  At the time, I was doing leg exercises and running on a treadmill frequently, but the aches felt different than muscle pain.  I didn't have any issues after the first month and everything is fine with me.  Still, I think you should always be cautious and make sure you are aware of any potential issues.  Blood clots should be detected as soon as possible.  The last thing you want is to find out that you have a clot when it's too late.  Good luck with everything and hope that it's nothing serious.

One thing to consider is if you are on spirolactone at the same tome, as it is a potassium-sparing diuretic, you might be depleting sodium in your body, which also can cause muscle cramps.
Title: Re: Half life of estrogen
Post by: JLT1 on December 07, 2013, 07:23:09 PM
See your doctor and get your levels measured.  Also, in general, the longer you take something, the better your body is at both dealing with the active (in this case estrogen) and the better your body is at metabolizing it.

Please, see your doctor.

Hugs,

Jen
Title: Re: Half life of estrogen
Post by: Thylacin on December 07, 2013, 07:55:51 PM
So if you take injections of E every week or two, is it possible to ever have relatively steady and high enough levels of estrogen?
Title: Re: Half life of estrogen
Post by: Shantel on December 07, 2013, 08:14:27 PM
Quote from: Amy1988 on December 07, 2013, 12:51:55 PM
I've read the half life of estrogen is like 30 or 35 hours.  If this is true then wouldn't taking estrogen every day build up to a very high level?  I use Oestrogel gel daily but after a few weeks I start getting leg aches in my right leg and a feeling like I've been running.  Like a bit out of breath.  I take plavix which helps for a while but eventually the estrogen levels get too high and I have to lay off for a while.  I don't think I'm getting clots but think the estrogen make my blood more viscous.  Any thoughts?

As a lot of folks here know I had been self medicating at an earlier time which is not a wise thing to do, we need to have our kidney, liver functions and hormone levels checked periodically. I had a nasty case of DVT and wound up in the ER and was put on blood thinners for some time. I was having leg aches and woke up one morning with my left leg twice the size of the right one. It turned out that there was a big clot at the top of my thigh close to my crotch, but the leg problems had initially been in the lower extremity along with swelling of the ankle. Best to be under a doctor's care and direction and if you're not it's time to make that appointment and do it the right way.
Title: Re: Half life of estrogen
Post by: Thylacin on December 08, 2013, 06:35:41 AM
Quote from: Joules on December 07, 2013, 08:02:13 PM
Injection is only one form of E administration, perhaps one of the lesser common at that.  As I understand it, the injectable form is oil-based and has a time release factor, so that it is actually a continuous delivery over the course of the time between injections.

Oh ok! Thanks!
I will be starting injections in a few weeks (ahh :D), so I was curious.
Title: Re: Half life of estrogen
Post by: Amy1988 on December 08, 2013, 07:33:37 AM
Quote from: Shantel on December 07, 2013, 08:14:27 PM
As a lot of folks here know I had been self medicating at an earlier time which is not a wise thing to do, we need to have our kidney, liver functions and hormone levels checked periodically. I had a nasty case of DVT and wound up in the ER and was put on blood thinners for some time. I was having leg aches and woke up one morning with my left leg twice the size of the right one. It turned out that there was a big clot at the top of my thigh close to my crotch, but the leg problems had initially been in the lower extremity along with swelling of the ankle. Best to be under a doctor's care and direction and if you're not it's time to make that appointment and do it the right way.

May I ask what estrogen you were using?
Title: Re: Half life of estrogen
Post by: Shantel on December 08, 2013, 09:24:19 AM
Quote from: Amy1988 on December 08, 2013, 07:33:37 AM
May I ask what estrogen you were using?

There are a lot of restrictions about discussing hormones here but I will admit to have been using ethinyl estradiol at the time knowing full well that it was risky and especially for someone my age, but since I'm so GD intelligent I did it anyway. It is not generally recommended by trans savvy doctors for HRT because of the known clotting risks which are greater than other estrogen types. Once again though, self medicating with anything is risky business because there is no way of knowing what your hormone levels are and if in fact you are compromising your liver. Anything taken in pill form has to be first processed by the liver which when it is becoming overtaxed is where the clot begins to take life, then the hormones take a second pass through the liver one the way back out of the body. I'm under the care of an endocrinologist now and am on a patch which is just as effective with limited risks.
Title: Re: Half life of estrogen
Post by: Oriah on December 08, 2013, 01:09:38 PM
the half life of estrogen depends on the type and route of administration
Title: Re: Half life of estrogen
Post by: Amy1988 on December 08, 2013, 02:57:57 PM
Quote from: Shantel on December 08, 2013, 09:24:19 AM
There are a lot of restrictions about discussing hormones here but I will admit to have been using ethinyl estradiol at the time knowing full well that it was risky and especially for someone my age, but since I'm so GD intelligent I did it anyway. It is not generally recommended by trans savvy doctors for HRT because of the known clotting risks which are greater than other estrogen types. Once again though, self medicating with anything is risky business because there is no way of knowing what your hormone levels are and if in fact you are compromising your liver. Anything taken in pill form has to be first processed by the liver which when it is becoming overtaxed is where the clot begins to take life, then the hormones take a second pass through the liver one the way back out of the body. I'm under the care of an endocrinologist now and am on a patch which is just as effective with limited risks.

Thanks for sharing that.  I using Oestrogel which is applied to the skin.  Thing is I'm taking less than half the dose. 
Title: Re: Half life of estrogen
Post by: Shantel on December 08, 2013, 03:11:23 PM
Quote from: Amy1988 on December 08, 2013, 02:57:57 PM
Thanks for sharing that.  I using Oestrogel which is applied to the skin.  Thing is I'm taking less than half the dose.

Topical applications are usually pretty safe, still you should see a doc and get a baseline on your levels.
Title: Re: Half life of estrogen
Post by: Doctorwho? on December 08, 2013, 03:21:03 PM
1. Shantel is correct.

2. Self medicating is a bad idea.

3. Half life will vary depending on the formulation. For example conjugated estrogens like premarin have a much longer half life...

4. I don't want to worry you, but the symptoms you describe DO need to be checked out, and relatively soon. They may be nothing, but if accompanied by any calor (heat) dolor (pain) or tumor (swelling) in the area they could be an early indication of thrombosis... which in fact is exactly caused by higher viscosity of blood.

5. Please don't ignore symptoms. I know its sometimes tricky to find a sympathetic doctor but actually its better than ending up with a serious problem. Go find someone and be safe please.
Title: Re: Half life of estrogen
Post by: Amy1988 on December 08, 2013, 04:29:44 PM
Quote from: Doctorwho? on December 08, 2013, 03:21:03 PM
1. Shantel is correct.

2. Self medicating is a bad idea.

3. Half life will vary depending on the formulation. For example conjugated estrogens like premarin have a much longer half life...

4. I don't want to worry you, but the symptoms you describe DO need to be checked out, and relatively soon. They may be nothing, but if accompanied by any calor (heat) dolor (pain) or tumor (swelling) in the area they could be an early indication of thrombosis... which in fact is exactly caused by higher viscosity of blood.

5. Please don't ignore symptoms. I know its sometimes tricky to find a sympathetic doctor but actually its better than ending up with a serious problem. Go find someone and be safe please.

I know it's a bad idea but I am also taking plavix to prevent clots.   I think the estrogen and plavix kind of nullify each other but the estrogen seems to sort of win out.  I did see my doctor a week ago but she is a PA and couldn't help me much.  She refered me to one of the doctors and I will see him in the next week hopefully. 
Title: Re: Half life of estrogen
Post by: Doctorwho? on December 09, 2013, 02:36:48 AM
NO!  :o :o :o

You just can't do things like that. That is EVEN MORE dangerous. Unless you have been properly diagnosed as needing an anti-coagulant, taking one is quite likely to give you all sorts of serious problems up to and including internal bleeding, hemorrhage, liver failure, stroke and sudden death.

Taking a powerful anti-coagulant is not something to do lightly and without regard to your blood chemistry, and indeed liver function. My foster son is currently struggling with liver failure. Trust me you don't want to go there.

Please go to a sympathetic doctor as soon as possible tell them what you have been doing, and why, and get proper blood tests done. Even if they don't want to prescribe, at very least they should be prepared to do the bloodwork for you to make sure you don't kill yourself.

If you can't do this properly then please stop now, because you are potentially putting your life in jeopardy.
Title: Re: Half life of estrogen
Post by: kelly_aus on December 09, 2013, 04:11:04 AM
Quote from: Doctorwho? on December 09, 2013, 02:36:48 AM
NO!  :o :o :o

You just can't do things like that. That is EVEN MORE dangerous. Unless you have been properly diagnosed as needing an anti-coagulant, taking one is quite likely to give you all sorts of serious problems up to and including internal bleeding, hemorrhage, liver failure, stroke and sudden death.

Taking a powerful anti-coagulant is not something to do lightly and without regard to your blood chemistry, and indeed liver function. My foster son is currently struggling with liver failure. Trust me you don't want to go there.

Please go to a sympathetic doctor as soon as possible tell them what you have been doing, and why, and get proper blood tests done. Even if they don't want to prescribe, at very least they should be prepared to do the bloodwork for you to make sure you don't kill yourself.

If you can't do this properly then please stop now, because you are potentially putting your life in jeopardy.

Having watched the woman I love die of liver failure, I'll second the comment about not going there. It was painful and far from pleasant..

EDIT: Just checked Plavix in my MIMS.. Crap.. I'd be giving that up, like yesterday.. Like Doctorwho? suggested, get some medical help before you do yourself some damage..
Title: Re: Half life of estrogen
Post by: Cindy on December 09, 2013, 04:25:41 AM
If you are having these symptoms get to an ED ASAP.

Tell them what you have been doing and get help.

I was close to death on monitored therapy, it was the fast reaction of my endo that saved me and I had no symptoms.

Get help and never self medicate.
Title: Re: Half life of estrogen
Post by: Amy1988 on December 09, 2013, 05:41:07 AM
Quote from: Doctorwho? on December 09, 2013, 02:36:48 AM
NO!  :o :o :o

You just can't do things like that. That is EVEN MORE dangerous. Unless you have been properly diagnosed as needing an anti-coagulant, taking one is quite likely to give you all sorts of serious problems up to and including internal bleeding, hemorrhage, liver failure, stroke and sudden death.

Taking a powerful anti-coagulant is not something to do lightly and without regard to your blood chemistry, and indeed liver function. My foster son is currently struggling with liver failure. Trust me you don't want to go there.

Please go to a sympathetic doctor as soon as possible tell them what you have been doing, and why, and get proper blood tests done. Even if they don't want to prescribe, at very least they should be prepared to do the bloodwork for you to make sure you don't kill yourself.

If you can't do this properly then please stop now, because you are potentially putting your life in jeopardy.

I won't stop.  I'll see a doctor but I won't stop.  And please don't play doctor and try to scare the hell out of people.  It has some risk but it's not that bad.
Title: Re: Half life of estrogen
Post by: Amy1988 on December 09, 2013, 05:44:14 AM
Quote from: Cindy on December 09, 2013, 04:25:41 AM
If you are having these symptoms get to an ED ASAP.

Tell them what you have been doing and get help.

I was close to death on monitored therapy, it was the fast reaction of my endo that saved me and I had no symptoms.

Get help and never self medicate.

People take plavix everyday and most never have a problem.
Title: Re: Half life of estrogen
Post by: Cindy on December 09, 2013, 05:45:57 AM
Go to a doctor now. Please.
Title: Re: Half life of estrogen
Post by: Amy1988 on December 09, 2013, 06:02:04 AM
Quote from: Cindy on December 09, 2013, 05:45:57 AM
Go to a doctor now. Please.

I will this week. 
Title: Re: Half life of estrogen
Post by: Doctorwho? on December 09, 2013, 06:40:31 AM
Quote from: Amy1988 on December 09, 2013, 05:41:07 AM
I won't stop.  I'll see a doctor but I won't stop.  And please don't play doctor and try to scare the hell out of people.  It has some risk but it's not that bad.
Amy - I'm not PLAYING doctor I AM a genuine medical student! Therefore in a very short while I WILL be a fully qualified doctor for real, I'm already at the stage in my training where I see some patients under supervision, and I don't want to end up treating you in end stage liver failure!!!

Trust me I know the risks and I am absolutely NOT overstating anything! You are playing Russian roulette here, and if you don't believe me believe my very good friend Professor Cindy - who is a full professor in a medical school in Australia. We Know, please trust us, we're trying to save your life!
Title: Re: Half life of estrogen
Post by: Amy1988 on December 09, 2013, 08:00:46 AM
Quote from: Doctorwho? on December 09, 2013, 06:40:31 AM
Amy - I'm not PLAYING doctor I AM a genuine medical student! Therefore in a very short while I WILL be a fully qualified doctor for real, I'm already at the stage in my training where I see some patients under supervision, and I don't want to end up treating you in end stage liver failure!!!

Trust me I know the risks and I am absolutely NOT overstating anything! You are playing Russian roulette here, and if you don't believe me believe my very good friend Professor Cindy - who is a full professor in a medical school in Australia. We Know, please trust us, we're trying to save your life!

Well thanks for your concern but I think you are exaggerating the danger to make a point.  You make it sound as though liver failure is eminent rather than a rare side effect. 
Title: Re: Half life of estrogen
Post by: Amy1988 on December 09, 2013, 08:08:29 AM
Quote from: Joules on December 09, 2013, 06:42:43 AM
Amy, you are obviously very keen on the idea of transition.  I am too.  I have some health issues (high blood pressure, high cholesterol, mild liver damage) that cause doctors to hesitate in treating me at all.  I had to go on a crash course to bring my stats in line before a doc would even start me on low level HRT.  One thing I was told was that a history of clots could prevent me from ever receiving HRT.

That is one of the additional hazards of the path you are on.  If your actions result in some of the more severe possible results, you may be reducing your access to proper treatment in the future.  I'm guessing you are young and in reasonable health now, treatment is wide open for you, but if you damage your health, your options will grow dimmer in the future.  I was nearly devastated and suicidal when I faced the prospect of being disallowed from ever receiving HRT.  I am old and have done a lot of stupid things in my life, please learn from me, don't repeat my mistakes by wrecking your health and your ability to be treated properly.

Well I don't think I've been taking it long enough to have caused any damage.  When I see my doctor I will see if she will Put me on Eliquis which is much safer.
Title: Re: Half life of estrogen
Post by: Doctorwho? on December 09, 2013, 08:12:51 AM
Quote from: Amy1988 on December 09, 2013, 08:00:46 AM
Well thanks for your concern but I think you are exaggerating the danger to make a point.  You make it sound as though liver failure is eminent rather than a rare side effect.
No - I'm not saying that, and indeed no one can tell you that. Like all biological processes there is a high degree of random chance involved. Point is given that the consequences are potentially serious and irreversible do you really want to take the risk however small it might appear to be?

A risk of say 1 in 1000 may sound small until you become the unlucky ONE - (and someone will) -  whereupon the risk is absolute. So all I am saying is that taking that risk, where the consequences, if things go badly, are reversible (curable), may be a reasonable gamble. However with things like liver failure they aren't reversible at our current level of medical skill, and so it is better not to take the chance. Particularly when the risk is easily avoidable.

Anyway I hear that you have got the point so I'll leave you to it.
Title: Re: Half life of estrogen
Post by: Jamie D on December 09, 2013, 10:17:49 AM
Quote from: Amy1988 on December 09, 2013, 05:44:14 AM
People take plavix everyday and most never have a problem.

I was on Plavix for several years and developed bleeding in the brain.  I can tell you from personal experience that hemorrhagic strokes are unpleasant.  Try an enteric coated 81 mg aspirin each day until you see your doctor.

From a recent study:

    6.5% of Plavix-aspirin users experienced a serious bleeding event, compared with 3.3% of aspirin-only users.
    5.8% of Plavix users died, compared to only 4.1% of aspirin-only users.


Title: Re: Half life of estrogen
Post by: Amy1988 on December 09, 2013, 10:44:06 AM
Quote from: Jamie D on December 09, 2013, 10:17:49 AM
I was on Plavix for several years and developed bleeding in the brain.  I can tell you from personal experience that hemorrhagic strokes are unpleasant.  Try an enteric coated 81 mg aspirin each day until you see your doctor.

From a recent study:

    6.5% of Plavix-aspirin users experienced a serious bleeding event, compared with 3.3% of aspirin-only users.
    5.8% of Plavix users died, compared to only 4.1% of aspirin-only users.


Those are very low rates.  Not much worse than plain aspirin.
Title: Re: Half life of estrogen
Post by: Ashey on December 09, 2013, 04:32:39 PM
Amy, your disregard for your own health and safety is very troubling, and nearly sickening. Unless you are a qualified medical professional, you should assume you know nothing about any of this stuff, and can't reasonably expect to know what interactions and what dosages of this or that are appropriate for you. You may have underlying medical conditions that you are not aware of, which could only be exacerbated by what you are doing to yourself. Screwing around with your blood and your body chemistry is dangerous if you don't know what you're doing. You can't just guess, you can't just hope for the best. And nobody is ragging on you here or trying to be mean. We want to help you but you aren't taking that help, and that's not just frustrating for us, it's also sad and troubling. None of us want anything bad to happen to you.
Title: Re: Half life of estrogen
Post by: JLT1 on December 09, 2013, 05:08:03 PM
Quote from: Amy1988 on December 09, 2013, 10:44:06 AM
Those are very low rates.  Not much worse than plain aspirin.

Amy,

I know what it is like to need to transition.  I know what it is like to hurt.  I also know what it is like to go off estrogen for a while.  Quite simply, it all sucks.  If you won't quit, let's be as safe as we can until you get to a doctor.  If money is a big problem and is delaying you from seeing a doctor, PM me.

Are you taking any other pharmaceuticals for any reason?   I ask because they can interfere with your ability to metabolize estrogen and/or plavix.  With estrogen, your body is getting rid of it and with plavix, first pass metabolism converts what you take into the active drug.  Other drugs may interfere with metabolism and it may be easier to quit one of those...

Second, short term thing, I would recommend you drop the estrogen to ¼ normal dose.  It will hold you for a while.  Stopping suddenly and starting suddenly is hard on your body.  Also, start tapering off Plavix.  Do nothing suddenly.

Please let me know, I will be online most of the night.  I'm not an MD.  I am a scientist who works in this area.  I am also going to get in a lot of trouble for this but I want you alive.  If you would like to know more about plavix, go to rxlist.com and search plavix.

Hugs,

Jen
Title: Re: Half life of estrogen
Post by: Amy1988 on December 09, 2013, 07:21:29 PM
Quote from: JLT1 on December 09, 2013, 05:08:03 PM
Amy,

I know what it is like to need to transition.  I know what it is like to hurt.  I also know what it is like to go off estrogen for a while.  Quite simply, it all sucks.  If you won't quit, let's be as safe as we can until you get to a doctor.  If money is a big problem and is delaying you from seeing a doctor, PM me.

Are you taking any other pharmaceuticals for any reason?   I ask because they can interfere with your ability to metabolize estrogen and/or plavix.  With estrogen, your body is getting rid of it and with plavix, first pass metabolism converts what you take into the active drug.  Other drugs may interfere with metabolism and it may be easier to quit one of those...

Second, short term thing, I would recommend you drop the estrogen to ¼ normal dose.  It will hold you for a while.  Stopping suddenly and starting suddenly is hard on your body.  Also, start tapering off Plavix.  Do nothing suddenly.

Please let me know, I will be online most of the night.  I'm not an MD.  I am a scientist who works in this area.  I am also going to get in a lot of trouble for this but I want you alive.  If you would like to know more about plavix, go to rxlist.com and search plavix.

Hugs,

Jen

Jen thank you for offering to help me but I am currently employed with medical insurance so that's not a problem.  The tough part is finding a doctor willing to fool with someone like me.  My current provider is is great for regular stuff.  I adore her but she can't help me with this stuff.  She is actually a PA but she refered me to an MD on staff.  I'll see what he is willing to do. 
Title: Re: Half life of estrogen
Post by: Ltl89 on December 09, 2013, 07:40:18 PM
Amy,

People are giving you advice not to scare you, but to warn you.  Some here had the very same negative health reactions that you are brushing off.  It's not that the medications itself are problematic or that you are in imminent danger.  The issue is that the meds could potentially cause problems if they aren't monitored properly and the negative look out signs aren't be addressed.  You talked about potential issues with clots.  That can be life threatening.  Everyone here just wants to make sure that you will be okay.  At the very least, please talk to a doctor asap about the meds you are taking and the side effects you are experiencing.   
Title: Re: Half life of estrogen
Post by: Jenna Marie on December 12, 2013, 07:51:35 PM
I'll just chime in to say that I'm another who had a bad reaction - and without talking numbers, my dose was low enough that it's within the range often brought up as an example of "too little to do any good." I was on HRT for three months when the follow-up blood tests showed I was in beginning liver failure; it took weeks of waiting before I could restart HRT, plus more tests (including a panicky ultrasound) and another year of close monitoring before I was out of the woods. I had absolutely zero symptoms, and my endo said that without the regular testing, I could easily have died.

(I'm now on only half that original tiny dose; for me personally, even the super low starting point was *too much.*)