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| Doctor, What should I expect from HRT? | ||
| Q:
I am currently taking 4.0mg of premarin daily. It is the only estrogen
helping me mentally and relieving pain throughout my body since a complete
hysterectomy last Feb. (TVH/BSO) I started out on a much lower dose but
my symptoms of pain and mental fogginess and depression came back so the doctor
increased it. She is now afraid I am taking too high of a dose and my symptoms of pain have come back. Any suggestions? A: Absorption of estrogens from the stomach/intestine can be different in different women. With such a high dose as 4 mg, your doctor should check estrogen levels. When very high, an other treatment of your depression has to be sought. When normal, or even low, continue the high dose of premarin. |
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| Q: Is there
any evidence that topical use of oestrogens (eg estriol créme or
ovules) has a smaller risk of developing a deep veinous thrombosis in
comparison to oral treatment with hormones, and is there a greater
risk anyway?
A: Topical use of estriol has no risk of endometrial cancer. (Oral estriol has a small increased risk with long-term use). Estriol is not studied with regard to venous thrombosis. No epidemiological data available. I postulate no increased risk or only a very small one, even in throbofilic families, when used for short term courses. |
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| Q:
I am 43 yrs old, and may be having a hysterectomy to deal w/ fibroids
and polyps. My Dr has suggested I consider removal of my ovaries at
the same time, as what they do, in his opinion, can be duplicated by
one pill a day, and I would significantly reduce the threat of ovarian
cancer. (No known history of same in family). My concern is the wisdom
of removal of the ovaries if there is nothing apparently wrong with
them, other than small cysts and the HRT if I do have them removed.
Does HRT interfere with any other drugs? Is there an increase in
problematic cysts on the ovaries after a hysterectomy? A: Don't remove normal ovaries. No HRT is so perfect as the function of ovaries. The risk of ovarian cancer is extremely low. Sometimes cysts arise in ovaries after hysterectomy, because of problems with blood supply. But they are harmless and usually cause no complaints. |
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| Q: Is
provera used as treatment or as a preventative measure for
endometrial hyperplasia for postmenopausal women who have endogenous
estrogen levels that are normal, i.e. elevated and not in menopausal
range? A: Yes. A regular course of Provera will reduce the risk of endometrial cancer. Use it as long as withdrawal bleeds occur. |
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| Q:
I have been on Femhrt for a week now and feel really good.
Everything I read about it says it is for postmenopause. I can't
really find anything about women who are perimenopausal. What is your
feeling bout the Femhrt in perimenopausal women? A: FemHRT is designed for postmenopausal women. It is a continuous combination of estrogens and progestogen. In perimenopausal women combinations like this will give a lot of bleeding problems. In perimenopause sequential combined HRT is much better. Like Premphase. Evista is also not suitable for perimenopausal women. It is only studied in postmenopause and in perimenopause it will induce ovarian cysts. |
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| Q: I was recently diagnosed with
advanced endometriosis, and my ovaries and uterus were removed but the
cervix left in at my request. I've been trying to find good
information on HRT for people with surgical menopause. What sort
of HRT should I be looking at now? Should progesterone be included?
Testosterone or other androgen? A: Progesterone is only needed for protection of the endometrium and with supracervical hysterectomy all endometrium is removed (in most cases). So no progesterone necessary. Androgens are sometimes useful after ovariectomy when libido problems arise. Without libido problems I see no reason for androgens. The estrogen level in HRT is low and a return of endometriosis because of unopposed estrogens is very rare, when this occurs, a continuous combination of estrogens+progesterone is advised. |
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| Q: I was told about 1 1/2 - 2 years ago
I was in perimenopause. My periods up until then were very
regular. I was experiencing hot flashes, trouble with memory,
vaginal dryness, irritable etc. I just went back to the doctor
for my annual and he did blood work and told me I now was back in the
normal range (estrogen & FSH). I had started taking
Shaklee's phytofem and GLA products. I have been on them about 3
months and all my symptoms disappeared. My doctor said the Shaklee
could treat the symptoms of menopause but it would not have altered my
blood work. My estrogen went from 40 to 120, and my FSH from 45
to 24. I feel great, is it the Shaklee? I haven't had a period since
9/1/00. I have gone on provera last month & still didn't
have one. Do you have any ideas? Could this have been
started by stress? I am 36. A: It is very nice that you feel great with Phytofem and GLA products. These product are never studied in a scientific way, so no one can answer your questions. FSH and estrogens can fluctuate very much and a FSH of 24 is certainly not a low level. Stress can induce cycle disturbances, but when life normalizes then normalizing periods are expected. |
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| Q: I am 50 years old, had a
hysterectomy 5 years ago and am on estrogen for osteopenia and for an
improved quality of life because the menopause symptoms I had were
unbearable. I had a hysterectomy for fibroids. Is it safe for me to
add more estrogen to my body when I have been estrogen dominant? Is
there research out about which type of estrogens are giving women
cancer? For instance is it known whether it is safer to take by pill
form or patch or shots? Does it make a difference? It seems I
have a lot of inflammation since taking HRT like I get tendonitis
easily & inflamed hips and knees, etc. Is this caused by
menopause, HRT, or something else and what can I do about it. It seems
I always have an injury. Lastly, if it is decreased progesterone that
causes these menopause symptoms why did my doctor give me estrogen? Is
there a safe estrogen to take? A: There is no reason not to take estrogens after hysterectomy for fibroids. Estrogens can even be used by women with fibroids in an intact uterus. It is just as safe as in other women. The only cancerous risk with long-term estrogens is breast cancer. And there is insufficient proof that some estrogens will be better than others in this respect. In theory the new compound Tibolone (brand name Livial) will be better in respect of a decrease of the risk of breast cancer, but there is no proof for that statement. Pill, patch or implant give the same results. Personally I have some objections against injections because of the rapid change of blood levels with it. Progesterone is only necessary for protection of the uterine lining. After hysterectomy there is no reason to take any progesterone. Inflammation is not caused by HRT, nor by menopause. |
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| Q: I had a partial hysterectomy 3 years ago. I
am now 52 years old and I am not sure if I have gone through menopause
or not. My blood work showed a level that indicated I was at the
mid-point of perimenopause. I was having very frequent bouts of
mood swings and hot flashes. My doctor prescribed premarin,
which I took for only 6 weeks. I was not convinced that this was
the solution. I have not had any sign of hot flashes for 6
months but the mood swings are not as frequent but when they do occur
I am at my lowest. I did experience very emotional mood swings
with PMS. Any correlation between PMS and menopause?
How often do I need to get blood work? Any herb that may
help to curve this depression? I would really appreciate any
information. Thank you. A: There is no reason to have any blood work further. You know that (peri)menopause is there and that your ovarian function is decreasing. Further blood work will give no extra information. After hysterectomy PMS is still possible. PMS is often aggravated during perimenopause, maybe because of further changes in serotonin brain level with changing estrogens. These emotional swings without hot flashes can be treated with serotonin reuptake inhibitors like Prozac. St. Johns Wort is a herb with proven effect against depression, but is not without side-effects. |
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| Q: I am 46 years old
and in good health. I have been taking Prempro 0.625 for two
years because I was not sleeping well, my FSH level was high. I
have not had a period in over a year. I have a complete
physical exam every year. My hair seems to be thinning. Is
this from the Prempo? Aging? What is your opinion? Which
is safer to use the Prempro pill or the patch? Also, when I have a CBC
my RBC is always low. I have been told this is because I am of
Mediterranean descent. Please comment. Thanks! A: Prempro is just as good as a combined patch containing both estrogens and progestins. Hair thinning is a matter of general health and not of HRT. Mediterranean women have sometimes a defined form of anemia. This is a inheritant hemoglobinopathy with the name thalassemia. |
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| Q: I
became menopausal at 42. I had 30 or more hot flashes a day.
I was put on Mircette, oral contraceptive. My hot flashes
stopped, but I gained weight and lost all sexual desire. I've
been tried now on Ortho-Est and Pempro. My hot flashes came back
and sleep was impossible. I've now been put on Estratest.
Should that be the next step or should I be put on Estratest HS?
My hot flashes at night are bad. A: I think that the best thing is to return to low dose oral contraceptive pills. Weight gain must be avoided by decreasing food intake or increasing exercise. Ortho-Est, Estratest and Estratest HS contain no progestagens. Unopposed estrogens (with or without androgens) carry a high risk of endometrial problems. |
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| Q: Are there any effective herbal
remedies for the symptoms of perimenopause such as irritability,
tension and intermittent mild depression? A: The problem with herbal remedies is that they are not tested in a scientific way for any effect. Many women are satisfied with herbal remedies, and some symptoms will also disappear spontaneously. In all studies with herbal therapy the placebo group shows 50% improvement. The only thing you can do, when you want herbal remedies, is to read on the package what the manufacturer advices. Be sure to check for any drug interactions before taking herbal remedies. |
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| Q: Can HRT cause leg pain? My
doctor had me on PremPro and I had to stop taking it because I
suffered from leg aches (not blood clots, which I know can be a
symptom). It hurt severely and I could not walk far. So
now, I stopped the HRT and the leg pains stopped. My doctor is
at a loss as to what causes this and now I am back to all the horrible
symptoms of menopause. Do you know what might be causing this? A: Maybe it is a spasm of blood vessels, described with the use of medroxyprogesterone acetate. Try another formulation without MPA, but with another progestagen. |
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| Q: I'm 50, and still have monthly
periods. For the past several years I have had migraines which come
and go for 3-4 days every month during my period. I've tried Elavil,
progesterone cream, soy, and pain killers. The only one that has
worked is the nasal spray form of Imitrex. This takes the pain away
but the headache is back 15-24 hours later. This is generally the only
time during the month I have migraines. Using the Imitrex 3-4 times
during the month seems excessive. Should I be looking at something
else. My internist and ob-gyn don't seem to have any other
suggestions. Can I use hormone replacements when I still have periods? A: Menstrual migraine is sometimes cured by extra oestrogens during this week. Try a sequential combined HRT regimen like Premphase. |
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| Q: I am 45 and in good health with
an excellent diet. My nutritionist wants me off birth control pills
due to breast cancer risk. I have been on birth control pills
for basically 20 years (Nordette). I'm on them now to reduce my menstrual
flow (I had a laparoscopy in 1/99 due to endometriosis).
Articles on this website seem to promote birth control pills at this
stage of my life until menopause sets in. I'm not sure whether
to keep taking them or not. A: The risk of breast cancer because of birth control pills is very small. The benefits (among them the decreased risk of endometrial and ovarian cancer) outweigh the risk very much. I have only some hesitations in women with a hereditary breast cancer. |
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| Q: Can you please tell me about
Prefest and if it is safe for perimenopause? A: Prefest is a regimen of 3 days of estrogens and 3 days of a combination of estrogens and norgestimate. Starting with a regimen like this before menopause (when periods are not stopped already for a year) is famous for bleeding problems. The best method of HRT in perimenopause is a sequential combined regimen: continuous estrogens and 10-12-14 days a month progestogens added to it. This will induce most times a regular cycle. Try premphase or another sequential combination. |
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| Q: I have been taking premarin for
six weeks and experienced some bizarre symptoms. I had vertigo,
blurred peripheral vision headaches and nausea. I stopped this
medication five days ago and am still having these symptoms. Is this
to be expected? I have heard from other women that they have had these
symptoms and that they took a while to diminish? A: These symptoms are unknown to me as side effects of premarin. Sometimes such bizarre symptoms are seen with medroxyprogesteroneacetate, a progestagen frequently combined with premarin ( in prempro and premphase) but not with estrogens alone. |
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