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| Doctor, What should I expect from HRT? | ||
| Q:
I am 55 years old and have been on Ortho-Prefest for approx. 10
months. Occasionally during this time I have experienced some heavy
bleeding that lasts for a couple days. This month, however, after 3
months with no bleeding, I started my period again and it has
continued for over two weeks, and is still going. I have never had
this happen. From the articles you have written, I now feel it may be
caused by the Ortho-Prefest. My question is, since I have been of the HRT
for several months with no reactions or side effects - why now? A: Bleeding problems during the use of Prefest is observed in many women. If you stop the medication for 3 months, then you can not blame the HRT for this bleeding. An investigation for postmenopausal bleeding is necessary. When still using the HRT, the bleeding is probably caused by the HRT. An endometrial biopsy is advised in this situation. But you can also try a course of sequential combined HRT first, instead of the intermittent combined therapy with Prefest. This regimen is continuous estrogens and after 2 weeks combined with a progestagen for 10-14 days. With a regular cycle of withdrawal bleeds in that regimen, further investigation is not necessary. With irregular bleeding also after the change to this regimen, further gynecologic investigation is mandatory. |
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| Q:
I have been on Combipatch constant wear for a year now. I have
slight discharge most of the time (told
that was to be expected first year to 18 months) - starting to get a
little old now.... My question is can I change this patch more than
twice a week? The edges seem to become unstuck and I'm afraid I'm not getting the dosage
I'm supposed to be getting (or do the hormones come more from the
middle of the patch?) Seems like by the time the 3rd day has arrived,
I'm ready for another patch but they have you on a 3 day then 4 day
schedule. Does it make a difference? A: The combipatch releases the hormones in a nearly constant amount during the 3-4 days of application. During these 4 days a small decrease in the rate of hormone delivery occurs. On day 4 less hormone is released than on day 1. You can change the patch earlier. This will result in a somewhat higher dosage of estrogens because the lowest days are avoided, and it is much more costly. Rising the dose is not achieved with shorter application but by using larger patches. The amount of hormones released is related to the surface of the patch. |
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| Q:
I am 52; periods every 3 months for past year. FSH 75. I
take 10 mg Celexa. I am a runner, excellent condition. Have
several hot flashes a day; memory loss, fall asleep but wake every
hour and joint pain like I am 80. Also, NO LIBIDO. Lots
of cancer history in family. Cardiac profile: Chol 198;
LDL 115: HDL 63. Dr. today prescribed Estratest HS and
Prometrium 200. You are my 2nd opinion. What do you think?
I do not want aggression, beard, low voice. Is this the
easy way to address my symptoms?
A: Libido is a matter of androgens and not a matter of estrogens, but above all the relationship with your partner is the most important factor regardless of hormone levels. For your perimenopausal problems, (hot flashes, bad sleep and joint pain) the prescription of your doctor is excellent. Estratest contains estrogen and androgen. The low dose androgen has only very rare the side effects of low voice. |
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| Q:
My oncologist advised me to ask my ob/gyn for a prescription for
Effexor 37.5 mg. to treat hot flashes due to having chemotherapy for
breast cancer. He doesn't want me using anything with estrogen.
I questioned the clonadine patch, but he doesn't want me using that.
I thought the patch doesn't contain any estrogen. I looked up Effexor,
but I could only see it being used for depression. I was
wondering how this drug reduces hot flashes? Thank you so much. A: Clonidine does not contain any estrogen but will reduce the intensity of hot flashes. Anti-depressants, from the serotonin reuptake inhibitor class, have shown a proven effect in women with breast cancer treatment. |
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| Q:
I am taking oral HRT. I read an article that take oral HRT has to pass
through the liver. Is this true, and is there any evidence that it has
any effect on the liver? Would a patch HRT with both hormones be
better? A: All oral medicines taken have to pass through the liver. Just as all food compounds do. There is no evidence of any harm to the liver in healthy women. Only with severe liver disease caution is required. The patch is not better than tablets, the effect is the same. Oral estrogens induce in the liver the production of HDL-cholesterol and that is an extra benefit above the patch. But for treatment of hot flash both ways of administration are fine. |
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| Q:
I am a 58 year old woman. I was on different HRT therapies but not
successful. Patches give me heavy bleeding for weeks.
Estrogen via pill form burns my stomach even after taking with meals.
Now the latest
researches done say that HRT does not have any affect on heart.
Breast cancer risk increases. I have High blood pressure, high
cholesterol and
a history of heart disease
and artherosclerosis. I have currently borderline lesion in my
artery. Do I take HRT or not to take?
A: The best for prevention of cardiovascular disease is a healthy diet, no smoking and enough exercise. Reducing weight is important in women with a high body mass. Estrogens are not appropriate in women with pre-existing heart disease at this time, but many researchers do believe that estrogens have an excellent beneficial effect in primary prevention of cardiac disease. |
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| Q:
I am 50...now going through perimenopause. I have no night sweats, but do have
minor hot flashes. I have no interest in sex, I feel very
"flat" emotionally. I do have all of the "no's"
that one equate with not taking HRT...mother w/breast cancer, family
history of high blood pressure, grandmother died w/blood clots,
diabetes, etc. Mother had minor form of osteo. First cousin
had breast cancer after taking HRT. I can't go on like this. Should I take
HRT or some form of it?
A: When you have no climacteric complaints, there is no reason to take HRT. Especially not when you are at higher risk for breast cancer. The beneficial effect on the cardiovascular system can also be reached by a healthy diet, no smoking, normal body mass index and exercise. |
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| Q:
I am 48 years old, and had a complete hyst. 5 years ago. My doc
put me on Premarin, but I stopped taking it. Since then the hot
flashes and night sweats are terrible. Is Premarin safe to
take? There is no history of breast cancer or other types of
cancer in the family.
A: The risk of breast cancer is determined by the total time span of estrogen exposure. The model that calculate the risk with HRT starts with the endogenous exposure from the ovaries from 12 to 50 years. After 50 years old, with 5 years use of HRT, a small increase of the number of women with breast cancer is seen. In your situation endogenous estrogen production stopped at 43 years. Without Premarin your risk should be decreased compared with women of the same age. But after 5 years of Premarin, your risk is the same as women normally menstruating at 48 years. So continue estrogens, especially when you have complaints without them. A higher risk starts after 55 years. |
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| Q:
I am almost 47 years old. I have been experiencing Hot Flashes, night
sweats, red hot ear lobes, red hot fingers, inability to sleep, poor
concentration and incontinence when I cough or sneeze hard for the
past 5 years. Vaginal dryness and painful intercourse has also been a
problem. Last year one of the NP's put me on 3months non stop LoEstrin,
one week off, then resume the three months on, one week off schedule.
It was wonderful for the hot flashes, night sweats but not for the
sleepless nights and vaginal dryness and irritation. After about 9
months on this Loestrin schedule I started to have some hot flashes
and always resumed having them during one week off the pill.
One year later I went back for my yearly exam, pap and was scheduled
with a different NP and told her my symptoms so she stopped the
LoEstrin schedule and started me on Climara 0.05 patch to be changed
every 7 days, and Prometrium 200mg. starting on the 13th for 12 days.
I have not had hot flashes, have slept a lot better, in fact too much
sleep. I haven't noticed a change in vaginal dryness , still dry and
irritated easily. When I stopped the Prometrium as directed, I had
pretty bad cramps, back ache for 3-4 days with a mild period. Do
I need the Prometrium? Can I take the 3 month Loestrin and wear the
Climara 0.05 patch? I always had a light period once I was off the
Loestrin for that one week and had very little cramping. I've had a
really bad past 4 days since I stopped the Prometrium, and really
didn't have much energy while on Prometrium for those 12 days. Any
suggestions?
A: You are now on a normal HRT regimen. Estrogens (Climara) continuous with a monthly course of progesterone (Prometrium). It has no use to combine Loestrin with HRT. The combined dose of estrogens is much higher than needed and the combination will induce breakthrough bleedings. With the use of estrogens a periodic course of progesterone is absolutely necessary. Sometimes vaginal dryness does not disappear with estrogens and local therapy is needed. This is possible with local lubricants. |
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| Q:
I am searching for a new gyn, and
an estrogen therapy that will not make my breasts extremely sore and
tender. My previous physician, now retired, leaves me searching for a
new gyn, and an estrogen therapy that will not make my breasts
extremely sore and tender. I am now trying FemHRT and have just
been placed on Actonel. My
medical physician and his assistant have recommended this therapy. I
am also on atenalol for migraine/hpb control. Have been feeling LOUSY.
Anxiety, sleeplessness, waking up after 3 hrs of sleep and not being
able to fall back asleep, mood swing, hot flashes, irritable, and most
disturbing, a feeling of being off balance several times a week, just
as if I am going to fall or pass out. And this follows usually with a
bout of diarrhea. Its affecting my mental health and outlook on day to
day living and I crave sweets, chocolates, ice cream. Am about 30-40
pounds overweight and can't seem to accomplish/stick with anything.
Also care for an 88 year old Aunt, have no other family and feel that
I am sometimes stuck. Is this what being 50 is all about?
A: FemHRT contains 5 micrograms ethinylestradiol and 1 milligram norethindrone acetate. After hysterectomy usually only estrogens are used, but sometimes in case of endometriosis one chooses to use the progestagens to because in a very rare situation endometriosis can grow again with estrogen only therapy. Sore breasts has to do with the level of estrogens and perhaps the kind of estrogen and the dose are not appropriate to you. I advice usually in this situation to use a low dose of estrogens only (Premarin 0.3, or 1 mg estradiol or a patch with 30-40 micrograms estradiol. Another point to remember is your social situation. The care for your family asks lot of energy and the problems with a lack of energy is not covered by estrogens. |
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| Q:
12 years ago I had a total hysterectomy at the age of 33. I am
currently taking Estrace 2.5mg. My hot flashes are so severe I
can not sleep. I am losing a lot of sleep.
A: Sometimes the absorption of micronized estradiol is very low, or the activity of metabolizing enzymes is very high. In such situations higher doses are needed. But before doing so, maybe you can check the oestradiol level with the medication. Another solution is: switch to another estrogen: Premarin has a total different pattern of absorption and metabolism. Also patches can change the effect. |
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| Q:
I am 38 yrs old, happily married, with 2 boys and I have always had
normal menstrual cycles, accompanied by PMS, and still do. I
have had a full medical workup and all tests are within the normal
range. I was diagnosed with depression 6 years ago and have been
taking Serzone and Wellbutrin. The medications have helped a lot
but I would like to know if there are further ways to treat my
perimenopausal symptoms (night sweats, weight gain, hair thinning,)?
My Dr. has upped my dosage of Serzone to a total of 450 mil. a day and
has no further treatment suggestions other than psychological therapy.
My main concerns are that in the last 6 months my PMS has gotten
much worse with strong feelings of worthlessness, crying jags,
and trouble concentrating, etc. My physical symptoms of major
bloating, weight gain, and general lethargy have now become every day
rather than just monthly. I feel like I am out of balance and
have a lot of stomach gas and discomfort, I am also 10 pounds over my
usual weight. I realize these symptoms are all related to
depression but my understanding is that being perimenopausal can
exacerbate these symptoms. Do you recommend herbal treatments?
Vitamins B6, E, and such?
A: I can not recommend anything because as you state yourself already your problem is a problem of depression and not a perimenopausal problem. Psychological therapy is the only way to go. Vitamins and herbal therapy have no proven effect on these symptoms. |
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| Q:
I am 45 years old and around Thanksgiving I felt incompetent and that
all the walls around me were closing in. I was told that I had a
mental disorder and at the beginning of what is know as perimenopause.
I was told to try Paxil and it seems to have taken away the
insecurities I was feeling, but I was hoping for something in the
nature of herbs to ease this transition. Is there anyone who can
advise me?
A: Depression and perimenopause are not the same. It can be dangerous to categorize symptoms of depression as perimenopause, because treatment is quit different. Hormones are not antidepressants. For depression St. Johns Wort is taken by many and there is scientific evidence of its effect. But Herbal medicines like St. Johns Wort have side-effects! |
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