Hi Everyone
Since coming back to Susan's and helping others find peace I have reflected on my own path. At times the following sense comes over me. I feel at peace, contentment and serenity with a soft melancholy that endures within me. I will never relent, let go or give up on, who I am. I guess this forms the background to the stories I tell about myself.
Just recently I heard someone was concerned about lipid levels regarding their hormones. That started me thinking about my own situation and the following story relates to my experience with taking hormones. So here is my HRT story, what I had, what I want and why.
My HRT Story: What I Had, What I Want and Why.
I have been on HRT for nearly thirty six years. I have tolerated it well with no side effects that I am aware of except for a clear episode of lactation that followed surgery. Before surgery I was taking Premarin at 2 mg tablets two at a time twice a day which is 8 mg daily. I was also receiving an injection of Depo Provera once a fortnight to suppress testosterone. Depo Provera is a progestin that suppresses luteinising hormone which lowers testosterone production, basically chemical castration which I only learned recently and I cannot help grinning about it now. It was a practical way to keep levels low before surgery.
In February 1989 I changed my life around, hormones started late February 1989 (close) and two years later in February 1991 I had surgery. I remember it clearly which makes me smile because I was born in February 1959. So many of my significant mileposts land in February. So why is that? Coincidence, destiny, the universe showing off, a running gag, or the calendar having a quiet laugh at me. I guess I will never know. After surgery I began to lactate. When Depo Provera was stopped the lactation ceased. There were no further breast discharge issues once the progestin stopped.
At some point I was moved from Premarin to Progynova which is estradiol valerate. I do not recall the exact year. My best estimate is about fifteen years ago. The reason for the shift was simple. I was moved from conjugated equine estrogens to estradiol because estradiol matches the hormone a woman's body makes and much safer for my body. Pills were easy to take and they fitted daily life smoothly. Swallow. Done.
My current doctor who knows my medical condition later advised me to use estradiol gel. I tried it. It was messy. It took time to apply. It did not fit me as well as a pill does. I considered patches because they also avoid first pass liver effects. I swim a lot which makes patches less attractive. Patches can leave marks and can lift at the edges which is not a good match for frequent swimming. I also considered sublingual estradiol. Holding tablets under the tongue is simple and it avoids most first pass liver metabolism. I was aware that sublingual levels can peak high then fall quickly which can make levels feel variable through the day.
Given all that I chose an estradiol implant. An implant avoids the liver pass. It is swimmer friendly. It is set and forget for months which suits my routine. I understand implants can be slow to adjust if the dose is a little high or low. I accept that trade off. In may 2025 I had an implant and I plan to do blood work to see where my level sits as the pellet dissolves over time.
For the last couple of years since coming back to Susan's I have been acutely aware that should be more aware of my hormone levels and have been trying to be more proactive in this area. I do not want levels that mimic menopause because osteoporosis risk rises and HRT may offer possible benefits for the heart. So an average or mid range level of hormones that females have. I have virtually no testosterone since I have had surgery which means I do not need high estradiol doses for suppression.
So my target is clear. I want a premenopausal female estradiol level around 400 pmol per litre, not too high and not too low, I want physiological replacement that sits comfortably in the normal range. I guess there is a psychological aspect to this, a feeling that I want that level, so that my femaleness is not taken away from me. This is one aspect that I'm not going to relent on, let go or give up on. Regardless of how ridiculous that sounds.
In the beginning I was diligent about attending my doctors' appointments and taking my hormones during the first 16 years after I changed my life around. I was still in Sydney at that stage and in 2005 I moved away from Sydney and began my teaching career and the taking of my hormones became sporadic since I lived in a country town and access to doctors was minimal at best. It was not until late 2011 that I began to take my hormone tablets regularly again. That was when I went home to family to look after my mother.
Even then I was still ignorant of my levels and in the following years life continued as normal. I believe not long after my mum's death in 2022 that I began seeing my mum's doctor and I became aware of and actively engaged with my hormone levels. That is not to say I did not have one or two blood tests that measured my levels but as far as I know nothing really came out of those tests before that time.
Since then, coming back to Susan's Forums, the inevitable discussion of hormones surfaced in the forums and as a result I tried to be more active in tracking what my hormone levels are and that is where I was able to ascertain the level of 400 pmol from my mum's doctor who thought it was a bit high but was not worried about it. My current implant is 100 mg inserted in May 2025. I did not have blood tests immediately before the implant or in the weeks after it since I live remotely.
So at this stage where do I stand? This morning I rang my two previous medical practices about my records and I also made a phone call to arrange a consultation with my current doctor and one aim is to determine if those previous records have been sent to her and if not to obtain them. In addition I will be seeking current blood tests. So what I am trying to achieve is to get the records of my hormone blood tests and with that information I will be able to plot them on a chart and actively monitor my levels.
I had a conversation with my doctor today and it was revealed I had a level of 1000 pmol in a previous blood test, why such a figure I do not know, but here I am and I never noticed any side effects that I can tell. In addition she was only concerned about the current levels not past and I did get a referral for blood works.
I have thought about breast cancer risk in relation to long term HRT use. I considered my genetics and the fact that women spend roughly forty years with normal ovarian hormones before menopause. I judged that my personal risk from physiologic estradiol replacement was very small, given studies of HRT replacement have linked it to a higher risk of breast cancer. That judgement has been supported by my lived experience across decades with no red flags. I still support routine screening and common sense monitoring with my doctor.
Why this path makes sense for me is simple. I want the ease and consistency of a long acting method that suits a swimmer. I want to avoid unnecessary liver problems. I want levels in the normal female range not at a menopausal level. I have decades of experience with my own body on HRT. I listen to that experience. The implant with sensible monitoring best matches my goals today and should I consider anything wrong I will be taking myself to the "doctors".
So yes, this is what I had, what I want and why.
Take care of yourselves and listen to your body.
Best Wishes Always
Sarah B
Global Moderator
