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Menopause & Perimenopause Ask The Expert

ASK THE EXPERT
Questions answered by
Ronald Barentsen, MD, PhD, Netherlands
Chairman of the OBGYN.net Menopause Advisory Board

[Dr. Barentsen]

 

 
Are these symptoms of Menopause? Page 1
Am I experiencing Menopause? Page 2
What should I expect from HRT? Page 3
Doctor, What should I expect from HRT?
 
Question:  My physician has prescribed Oesatrodose and Utrogestan for my severe hot flashes (I am unable to take pills as I am lactose intolerant and all the pills have lactose). As I am very sensitive/allergic to many medications and have had problems with gelatin capsules before, I am trying to find out what is in Utrogestan besides progesterone and peanut oil. The information sheet with the capsules has no information, the importer none, and unfortunately I do not understand French. Can you help me with this?


Answer:  This question has to be addressed to the manufacturer.

Google search engine has translation capability.  The translation from the manufacturers package insert can be viewed here:  UTROGESTAN 100 Mg oral or vaginal soft capsule, translated version

Question:  I have a question regarding prolonged use of combined HRT drugs. Historically, the females in my family have experienced menopause fairly early in life (mid-40s).  I also, am following the same pattern.  Pre-menopausal in late 30s and it progressed from there.  I have been on combined HRT (recently Prempro) for about 9 years now (I'm  49 years old).  Everything seemed to be fine for the past years, but recently I have experienced:  (a)  Daily spotting -- light pink; (b) abdominal bloating; (c) menstrual-type cramping; (d) some insomnia; (e) periods of alternating energy and fatigue.  Can break-through bleeding and other combined-HRT side effects come on after prolonged use of the medications?  I had none of these problems until recently.  Thank you.


Answer:  Breakthrough bleeding can be the result of prolonged atrophy of the endometrium due to the long duration of combined therapy. It is completely harmless (after excluding endometrial malignancy by biopsy) but difficult to treat. The other complaints are not related to long duration of therapy.
Question:  I am chronically taking Prednisone for Systemic Lupus and have developed Diabetes from the steroid use.  I am not menopausal, age 43.  My Ob/Gyn gave me Combipatch and it raised my fasting blood sugar considerably and my post prandial sugars went through the roof.  Is this a common occurrence or do you think the Prednisone is playing a role in this? I don't know what to try next. I bought a book today on natural progesterone cream - any thoughts of that subject? Thank you in advance for your help.


Answer:   I have not the slightest idea why your ob/gyn prescribed the combipatch while there is no manifestation of menopause. In women with regular periods frequent breakthrough bleedings are observed with combipatch. Combipatch (and other continuous combined hormone replacement regimens) are designed for use in post-menopause. Natural progesterone cream will not help you maintain stable blood sugar levels.
Question:  I am 48 years old.  Are there any side effects from combining Atenolol and Prempro (i.e., weight gain)?


Answer:  No placebo controlled clinical trials are done on this relationship. But I find no reason to be afraid of side effects due to that particular combination.

Question:   I had ovaries & uterus removed 9 months ago d/t fibroids & anemia.  I developed a noticeable difference in my sinuses.  Am I way off base or is this  coincidental? I am on Climara 0.1 mg patch weekly.  It seems like after about 4 days after applying my patch I get bad sinus headaches.  The problem seems to be getting worse. Lots of sinus drainage (doesn't look infected, no fever and seems cyclic). I have found info on "dry eye syndrome" which increases with estrogen alone therapy compared to combined hormone therapy (JAMA Nov. 2001 study).  So I figure if your eyes are affected by hysterectomy/hormone replacement, maybe mucous membranes can be affected also.  I do have an appointment in April, but if my sinus problems are female related, I'll talk to my MD ASAP.  I just don't want to appear like a "crazy lady".

Answer: Mucous membranes can be influenced by estrogens. When your problem really
exists only during the last three days of the weekly Climara patch, you can try to take a new one on day 4 or 5. The estrogen dose is the highest during day 1 and gradually decrease during the week. maybe the dose is to low during the second half of the week. When the relationship between the complaint and the days of the patch is not clear, others causes have to be sought.
Question:  Is HRT via patch a safer alternative (than oral) for treatment of menopause symptoms in a 51 year old woman with HX of RA and phlebitis and elevated anticardiolipin titers?


Answer:  There is no study suggesting a preference for one of those two forms of administration regarding risk of thrombosis. Also no preference regarding RA.
Question: I was put on Loestrin 1/20 for perimenopause symptoms and it worked like a charm.  The only problem was lack of libido. I have been switched to Loestrin 1.5/30 for the increased androgenic activity.  I take the pill at night, and after only one week I am having sleepless nights and am always too warm to sleep under the blankets.  Could this be the effect of the increased hormone level in the evening on my body?  What other complications may occur when switching OC formulations?


Answer:  I can not relate these nightly symptoms to a change of the OC formulation. You could try taking it in the morning and see if it helps.
Question:  I noticed intense itching to my shoulders and upper limbs with subsequent rash during pregnancy, breastfeeding and with the low dose birth control pill. Is the itching a reaction from the estrogen or the progesterone?


Answer:  Probably the diagnosis is herpes gestationis. Because of the itching with a rash in pregnancy. This is initiated by unknown mechanisms but exclusively during pregnancy. it is well-known that it can have a flare-up during breastfeeding. And also during the use of oral contraceptives. Estrogens promote recurrence, but do not initiate the disease. It is only seen by users of oral contraceptives after an earlier manifestation during pregnancy.

The Merk Manual has a description of symptoms and treatments for this poorly named condition, it is not related to herpes.  Please see this article for information. 
Question:   Is there any connection between elevated cholesterol and elevated FSH?  I was just tested for both, (first time for FSH since experiencing perimenopause symptoms), however, my cholesterol has never been this high.  I am 47 years old and my doctor wants to put me on HRT. Thank you for your time.


Answer:  There is no connection between cholesterol and FSH.
Question:  I am a 43 year old woman - excellent health and in very good physical condition - exercises 5-6 days/week. Last month period came 1 week early.  On the pill for 15 years - no problems, regular periods.  Experiencing extreme bloating, tingling in left toes, feeling like I'm on my period, experiences dry mouth.  What advice can you give? I'm going to see my MD end of this month and ob/gyn in March. Being on the pill for so long, am I taking any risks?  Better to get
tubes tied?  Is this risky? What is recovery time? Any help you can give is appreciated.


Answer:  Breakthrough bleeding with oral contraceptives can occur in any woman at any time. Even after many years without complications. Do not worry about that. Ask advice of your doctor only when this occurs several times. It is very rare that a serious problem is involved.
Question:  I am a 48 year old using loestrin for heavy menstrual bleeding for 6 years.  For the past six months I have had an increased heart rate during the week off of my pill.  I had an echocardiogram and a holter monitor.  My echo was fine.  My holter showed instance of 142 rate at rest and an average rate of 91 over the 24 hours.  ( normally its around 70 - 80) My cardiologist dismissed the menopause connection.  Do you think the decrease in hormones during the week off of the pill is my body's reaction to a decreased hormone level.  I sometimes get it during my pill cycle, but less so.  Please let me know what you think!

Answer: This is quit unusual. But you can try it by taking extra estrogens during the week off (daily 0.625 mg premarin or an estradiol patch).
Question:   How long does a woman need to stay on either natural or synthetic hormone replacement therapy?  If you are not having any symptoms do you still need to start on HRT?


Answer:  HRT can be used for alleviating climacteric symptoms or to prevent some chronic diseases like osteoporosis and cardiovascular disease (and especially myocardial infarction). Without any complaint a woman needs no HRT for alleviating complaints.

The prevention issue is more complex. For osteoporosis fracture risk assessment is essential. Although HRT is very effective in maintaining bone mass, fracture risk is only substantial reduced in women with low bone mass. And not with normal or even high bone mass. And for women with low bone mass (severe osteopenia or osteoporosis) long-term use of HRT is advised. The current idea is that only very long duration (10 years or more, maybe lifelong) is necessary for diminishing fractures.

The same holds true for cardiovascular disease. With HRT the risk for myocardial infarction is halved. But in women with very low risk, halving the risk does not have much benefit, whereas in women with high risk, the benefit can be tremendous. But only in current users and recent past users. When starting HRT for primary cardiovascular prevention, nearly lifelong use is advised. And of course, you must know that lifelong use of HRT has some increased risk for breast cancer. It is always a matter of judging the benefits and risks.

Question:  I am 45 years old and have concerns about approaching menopause. Around 17 years ago I had allergic reactions to the birth control pill and estrogen.   The reactions were fairly severe, but not anaphylactic.  My obgyn physician has advised me not to take these hormones unless it is a serious situation that warrants taking this risk.  What are my options during menopause?   I know there are drugs for bone loss, but what about the other benefits of hormones, such as maintaining sexual libido, etc.   Please give some information or direct me to a source of answers.


Answer:  Allergic reactions to birth control pills are caused in the majority of women involved by the colors and not by the hormones. Furthermore, there is a choice of estrogens and of progestagens. When you are really allergic to ethinylestradiol (the estrogen in birth control pills), you are probably not allergic to estradiol or to conjugated equine estrogens. But allergy to both estradiol and progesterone exists. In case of doubt, you can ask an allergist to test the substances chosen.
Question:  I just started Activelle and it makes me nervous.  Can I cut it in half and take a half a day or maybe one every other day


Answer:  It is possible, but how effective will it be? It depends on the indication for the use of HRT. Activelle is already a low dose regimen.
Question:  I had a complete hysterectomy in June. I am 38 years old and have 4 kids. I am taking premarin during the last month I have experienced a extreme amount of Joint pain in all joints, elbow wrist knees, etc. Could this be because of my medicine or surgery?


Answer:  Not because of the surgery, and also not because of the Premarin. Sometimes joint pains are related to hormonal levels. In such situations relief will come from increasing dose of Premarin (1.25 mg instead of 0.625). But also rheumatoid disease is possible.
Question:  Will premarin cause dark spots on my face down by my jaw line?


Answer:  It depends on the aspect of the dark spots. A brown coloring just like many pregnant women experience is possible with estrogens. We call it chloasma. This brownish staining is not in circumscript spots. The borders are not sharply marked. Brown spots as dark naevus are not caused by hormones and need further investigation.
Question:  I just turned 54. I have been having this problem now for about a year and a half. I am now taking Estratest tab, I was on Prempro. Everything  I take has some kind of sexual side effects. What do you suggest?


Answer:  Loss of sexual desire can have more causes than hormonal deficiency. Sometimes one needs a sexuology consultant for relief. Are there other signs of depression? How is the marital relationship?
 

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Note: Opinions expressed here are for educational purposes only and, as such, do not constitute and should not be interpreted as initiation of a physician-patient relationship. This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.