AYYL · Health Intelligence

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Active Health Flags

🩸

Estradiol: Critical Drop

158 → 40.1 pmol/L in 12 months (−75%) on same HRT. Review patch absorption urgently.

☀️

Vitamin D: Insufficient

31.4 → 27.3 ng/mL despite 1,000 IU/day. Dose increase needed — target 40–60 ng/mL.

📈

LDL: Trend Upward (Improving in 2026)

133 → 144 → 146 mg/dL (2023–2025). Direct LDL 110 in 2026 after Red Yeast Rice.

🫀

Bradycardia Progressing

59 → 50 → 45 bpm across 3 years. Sinus bradycardia on ECG 2023. Cardiology review warranted.

🔴

Rheumatoid Factor: Elevated but Improving

22 → 22 → 16 → 16 IU/mL (ref <14). No symptoms. Declining trend reassuring.

🫁

New Uterine Fibroid (Jun 2026)

0.4×0.4×0.2 cm intramural. Probably new vs 2023. Repeat US in 12 months.

🧪

Ferritin Never Tested

Iron panel reassuring but ferritin (storage) untested in 4 years. Request now.

🦴

Bone Density: Exceptional Recovery

Hip neck −1.6 → −0.8 T-score (+13.3% BMD). Lumbar −0.5 → +0.1. Both now Normal.

✅

Metabolic Health Excellent

HbA1c 5.4%, fasting glucose 74, insulin 3.2 mU/L, HDL 85, TC/HDL 2.4.

Key Metrics · 2026

Total Chol

204

mg/dL · ref <200

HDL

mg/dL · ref ≥50(F)

LDL Direct

110

mg/dL · ref <130

TC/HDL Ratio

2.4

ref <4.6

HbA1c

5.4%

Normal ≤5.6%

eGFR

100

ml/min/1.73m²

Vitamin D

27.3

ng/mL · Insufficient

Estradiol

40.1

pmol/L ↓ from 158

TSH

2.45

mIU/L · Normal

hs-CRP

0.42

mg/L · Low CVD risk

Tap Edit to amend. Changes saved locally.

● Strong RCT ● Emerging ● Mechanistic ● Weak/Mixed ● Mixed/Prop.

💊 HRT Medications

Hormone Lab Results

⚠️

Estradiol: 75% drop in 12 months

158 pmol/L (Jun 2025) → 40.1 pmol/L (Jun 2026) on same HRT. Discuss urgently with prescriber. Low E2 accelerates bone loss and increases CVD risk.

Marker	2023	2024	2025	2026	Ref
Estradiol (pmol/L)	—	—	158	40.1 ↓↓	<505 (PM)
FSH (IU/L)	Not tested	—	—	—	>25 confirms PM
LH (IU/L)	Not tested	—	—	—	Post-M elevated
Progesterone (nmol/L)	Not tested	—	—	—	<2 (Post-M)
DHEA-S (µmol/L)	Not tested	—	—	—	0.8–8.9 (F 50s)
Total Testosterone (nmol/L)	Not tested	—	—	—	0.2–2.9 (F)
SHBG (nmol/L)	Not tested	—	—	—	18–114 (F 50s)
Insulin (mU/L)	—	—	—	3.2	2.6–24.9

⚠️ FSH, LH, progesterone, DHEA-S, testosterone and SHBG have never been tested. Request at next appointment.

Estradiol Trend (pmol/L)

2025: 158 2026: 40.1 Post-M upper limit: 505

Symptom Log

Track HRT-related symptoms. 1 = None / Mild, 5 = Severe. Log dates and notes over time.

Body Composition Trends

Metric	Nov 2023	Aug 2024	Jun 2026
Weight kg	56.3	58.6	58.2
BMI	18.4	19.0	19.2
Body Fat %	25.0	26.6	27.9
Waist cm	67.0	64.0	69.0
Visceral Fat	—	1.5	2.0
BMR kcal	1241	1267	1244

Body Fat % Trend

📊

Sarcopenic fat gain

Body fat 25 → 27.9% while weight held ~58 kg. Muscle replaced by fat — classic post-menopausal pattern. Creatine + resistance exercise directly address this.

📏

Waist rose 5 cm in 2026

64 → 69 cm. Well below female CVD risk threshold of 80 cm but rate of change warrants attention.

✅

BMI now healthy

Was underweight (18.4, 2023). Now 19.2 — healthy range.

🌟

Exceptional Bone Recovery

Hip neck −1.6 → −0.8 T-score (+13.3% BMD). Lumbar −0.5 → +0.1 (+7.2%). Both now Normal. Rare result in a post-menopausal woman over 3 years.

Lumbar Spine L1–L4

Nov 2023 · Age 51

−0.5

0.946 g/cm²

Normal

Jun 2026 · Age 53

+0.1

1.014 g/cm²

Normal ↑ +7.2%

Level	BMD 2023	T 2023	BMD 2026	T 2026	Z 2026
L1	0.801	−0.8	0.884	−0.1	0.7
L2	0.962	−0.2	1.007	0.2	1.1
L3	0.960	−0.6	1.017	−0.1	0.7
L4	1.033	−0.1	1.114	0.6	1.3
Total	0.946	−0.5	1.014	+0.1	0.9

Left Hip

Nov 2023 · Age 51

−1.6

0.643 g/cm² (Neck)

Osteopenic

Jun 2026 · Age 53

−0.8

0.729 g/cm² (Neck)

Normal ↑ +13.3%

Region	BMD 2023	T 2023	BMD 2026	T 2026
Neck	0.643	−1.6	0.729	−0.8
Trochanter	0.529	−1.7	—	—
Total	0.748	−1.4	—	—
Ward's	0.486	−2.1	—	—

What Drove the Improvement?

🩺 HRT — most powerful anti-resorptive for post-menopausal bone loss
💪 Creatine 5g/day — RCT evidence for +1–3% BMD/year with exercise
🎾 Pickleball — weight-bearing impact stimulates bone remodelling
🌿 Vitamin K2 (Thorne multi) — activates osteocalcin, reduces resorption
☀️ Vitamin D + Calcium — essential mineralisation substrate
⚠️ Estradiol now 40.1 pmol/L — HRT bone protection may be reduced. 2027 DEXA critical.

Supplements or tests not in your current stack with evidence-based rationale for your profile.

🧪 Ferritin Test

Highest Priority

Never tested in 4 years. Hb at low end of normal (11.6–11.9 g/dL). Subclinical depletion causes fatigue, cognitive fog, and immune issues without anaemia.

Request: Serum ferritin. Target: 50–100 ng/mL for active post-menopausal women.

☀️ Vitamin D3 Dose Increase

High Priority

1,000 IU/day clearly insufficient — D declining to 27.3 ng/mL. Check D3 in Thorne multi, then increase total to 2,000–4,000 IU/day. Target 40–60 ng/mL.

Endocrine Society: up to 4,000 IU/day for bone health. Retest in 3–4 months.

🔬 Omega-3 (EPA/DHA)

Strongly Consider

Not in current stack. CT-CAC score 32 (80th %ile), elevated RF, aspirin allergy — all argue for EPA/DHA. Also cognitive protection post-menopause.

1,000–2,000 mg EPA+DHA/day. No interaction with Red Yeast Rice.

🧲 Magnesium Glycinate

Consider

Cofactor for Vitamin D activation, muscle function, sleep, and insulin sensitivity. Especially relevant given bradycardia and active sport.

200–400 mg elemental magnesium at bedtime. Glycinate or malate form.

🧪 Full Hormone Panel

High Priority

FSH, LH, progesterone, DHEA-S, free/total testosterone, SHBG — never tested. Critical now given estradiol crash in 2026.

Request all at next appointment alongside HRT review.

Appointments, tests & reminders.

Patient Summary — AYYL

Female · Age 53 · DOB Oct 1972 · Chinese/SE Asian · Post-menopausal · Hepatitis B carrier · Drug allergy: Aspirin · FHx: Hypertension (both parents) · Prior surgery: Appendicectomy · Breast implants bilateral

HRT: Estraderm Matrix patch + Utrogestan capsule (doses not recorded — see Hormones tab)

🔴 Urgent

1. Estradiol 158 → 40.1 pmol/L in 12 months (−75%) on same HRT. Patch absorption issue or dose change needed? Bone implications?

2. New intramural fibroid 0.4×0.4×0.2 cm (Jun 2026). HRT contributing? Monitoring plan?

3. Vitamin D 27.3 ng/mL despite 1,000 IU/day. Recommended dose? Retest timeline?

🟡 Monitoring

4. CT-CAC score 32 (80th %ile, 2024). RYR now lowering LDL (110 direct, 2026). Acceptable approach or formal statin needed? Repeat CT-CAC timing?

5. Resting pulse 59→50→45 bpm across 3 years, sinus bradycardia on ECG. 24-hr Holter or cardiology referral?

6. RF 16 IU/mL (improving). Anti-CCP antibodies warranted? Monitoring frequency?

7. CEA 2.4→3.7 µg/L over 4 years (in range). Colonoscopy at age 53?

8. AFP 2.4→2.8 µg/L, known Hep B carrier. Increase HCC surveillance to 6-monthly USS + AFP?

💊 Current Supplements (Active)

Supplement	Dose	Notes

✅ Positives

🦴

Bone exceptional

Hip neck +13.3%, lumbar +7.2% BMD. Both sites Normal. Rare result.

🧪

Metabolic health

HbA1c 5.4% improving, glucose 74, insulin 3.2, HDL 85, TC/HDL 2.4.

💉

Liver stable

ALT 26, AST 33, GGT 20 — all normal and stable across 4 years despite Hep B + RYR.

📤 Data & Sync

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