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| Doctor, What should I expect from HRT? | ||
| Question:
I'm 45 years old. About 6 months ago I began adding soy
products to my
diet. This month, my period was on time but very light.
Then, 2 weeks
later, I began bleeding again - initially spotting for 3 days, then
going
into a period which is regular in flow but has lasted 7 days at this
point. Could this irregularity be related
to the soy? I understand that it boosts estrogen levels (one of the reasons I
began
eating it) - I have a history of fibroids which apparently are
adversely
affected by increased estrogen levels. What are your thoughts?
Should I
stop eating the soy while waiting to see my doctor?
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| Question:
Regarding use of low-dose birth control pills or HRTs to counter-act
perimenopause symptoms, can one take low-dose birth control pills
non-stop to avoid the dips in levels that seem to coincide with my
worst symptoms? Or must one go off them part of the month? What
is the dosing schedule for HRTs in the form of a Combipatch or
gel? Will the HRTs help regulate the period, whether used all
month or only part of the month? Do hot flashes always mean low
estrogen? Answer: Yes non-stop hrt can help. But after some time breakthrough bleeding will occur. In some women already during the second month, in others after many months. After several months many women like to stop them for a week because of a puffy feeling. The main reason that the BCP regimen is 3+1 week is: the acceptance by women in the early days of the introduction of the pills with a regular cycle just as it was before. The combipatch is a combination of estrogen and a progestogen, a so called continuous combined system. You have to take it without interruption every day. Be aware that continuous combined systems will cause frequently breakthrough bleedings especially when taken during perimenopause. Actually it is designed for postmenopausal women. During perimenopause sequentially combined HRT is much better: continuous estrogens (patch, gel or tablets) and 10-14 days a progestogen extra. The gel is an estrogen only preparation. You can use it continuously, but progestogens are needed for protection of the endometrium lining. When sequentially combined with a progestogen it will regulate the period. In a continuous combined regimen it will not. It will cause unpredictable bleeding. Hot flashes usually mean fluctuating (or decreasing) estrogens. Furthermore, anxiety attacks can mimic menopausal symptoms as thyroid disorders can. |
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| Question:
I have been taking premique cycle for just over two years. I
have not had a withdrawal bleed for almost three months. Do I
need to change my prescription or is this just a natural change in my
body? Answer: No, bleeding is not necessary. With Premelle/Premique Cycle 10-15% of all women have no bleeding at all and still it is safe. The progestagen in the combination counteracts the mitosis and that is necessary. |
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| Question:
I am 47 years old, and I
started to have menopause 3 years ago. I have been on estrogen
replacement ever since. I am currently on the medication called
Prempro. I also used Premphase before. However, after using the
medication for a while, I have found my face skin has some brown
spots, and they tend to get bigger. I am not sure if they are
definitely related to the medication. Please advise. Also, what is the
best Estrogen replacement medication available for me. I will very
much appreciate your advice. Answer: Both Premphase and Prempro are very well studied. And brown spots are not recognized as side-effects. As with all estrogens sometimes chloasma (A brownish coloring of the skin) can be seen. We know this problem with oral contraceptives and in pregnancy. And although I am not aware of chloasma with HRT, I think that here is also a kind of chloasma. If this is true, it will disappear slowly over several months after stopping HRT. By the way, chloasma worsens with sunlight. When you avoid the sunshine, no problem exists. Also sun blocking creams are helpful. |
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| Question:
I recently quit taking
PremPro. I was also taking Vitamin E, A, Selenium & C.
I have started having hot flashes again as a result of quitting the
PremPro. Are the vitamins I'm taking okay and what do I need to
take in the way of vitamins to replace the PremPro? Or is there
something in particular that I need to take in the way of vitamins to
make the hot flashes stop? I heard that at soy drink would make
the hot flashes stop. Will it? Answer: The vitamins are OK, but they cannot replace Prempro for combating hot flashes. Soy drink and some other herbal medicines (black cohosh) are believed to reduce hot flashes, but not as good as estrogens. But maybe enough for you. The vitamins are not effective for hot flashes, but as antioxidants to prevent cardiovascular disease and perhaps some forms of cancer. |
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| Question: I
have a friend who had breast cancer 3 years ago and had radiation and
chemotherapy. Then a year later had a cancer in her fallopian tubes.
Subsequently she had a hysterectomy. She is going well but as she is
50 years old and going through menopause the normal remedies, like hrt,
are not available to her. She has a lot of hot flushes and mood swings
to the point where it is affecting her quality of life. Is there any
alternative for her? Answer: Estrogens are formally contraindicated but without sound scientific base. We are afraid that silent breast tumor cells can revive with estrogens. But when symptoms are very serious, estrogens can be subscribed to women after breast cancer treatment. But this has to be discussed thoroughly with the patient. For hot flushes black cohosh or soy products will help some women. But also for phytoestrogens we do not know if it is really safe for women after breast cancer. She has to discuss these kind of problems with her oncologist. |
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| Question: I am a 36 year old female I had
a hysterectomy when I was 28. I have a left ovary that at this
time is not working. I have been on hormone therapy for about 5
years. They put me on estratest. I have talked to
different people and they ask why I am taken this drug when I don't
have a uterus? Can you tell me if I should be on a different
medication? I also find that this causes an excess of hair
growth on my face. Is that common? I have also been told that I should
be taken vitamins b6 and E but have never been told what dose to take
or if it is true?
Answer: Estratest is designed for women without a uterus. With an intact uterus combinations of estrogens and progestagens are used. Estratest is a combination of estrogen and androgen. Extra hair growth is possible because of the androgen. Estrogens are necessary when your ovaries are out or are not working any more. Progestagens are needed with an intact uterus. Androgens are sometimes given because ovaries produce androgens, and without ovaries some women have libido problems. With healthy food one gets enough vitamin B and E. It is especially used for deficiencies and for believers in extra vitamins. |
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| Question: I have read books on
natural progesterone replacement creams and on estrogen and progestin
combination (Prefest). I am torn as to which is best. Can you guide me
to more understanding? I lean toward the cream. Answer: Natural progesterone creams have no proven benefit. It has gained much popularity, but without any scientific base. The amount of progesterone absorbed from the cream is extremely small and it is certainly not enough to counteract estrogens. The choice for an estrogen and progestagen combination depends of the need for it. Every medication needs an indication. |
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| Question: I am a 43 year old woman who
had a hysterectomy 11 months ago in which the doctor removed
everything except my cervix due to adenomyosis (ovaries because of a
family history of ovarian cancer). I have Climacterone injections
every 3 to 4 weeks. Sometimes the injection causes a lump that doesn't
go away for months. It also seems that when I get a lump, I still
suffer from menopausal symptoms which gradually go away (10 - 12
days). The lump gets itchy (after the first painful day). I have a
feeling that I'm really not getting the full impact of the medication
because it seems "stuck" in the lump. Why does the injection
cause a lump? Is it because the needle was put into the muscle too far
or not far enough? Answer: I do not know why the lump occurs. But why HRT by injection. There are a lot of tablets and patches. The problem with injections is that the estrogen level fluctuates very much. High shortly after injection and decreasing fast. With tablets or patches the differences are much smaller. And the fast decrease can provoke flushes again. |
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| Question: I am 43 years old. I have
been having irregular periods for about a year. My regular ob/gyn
has told me that it is stress related and wants me to go back on the
pill. I have not been on birth control for over 14 years and I
do not want to start again. I want some tests done to determine
if I have a problem, and what is going on. So where do I go from
here? I get mild hot flashes, no night sweats. I am not
overweight and I exercise and eat pretty healthy. Please let me
know your thoughts. Answer: Problems with the menstrual cycle on your age are nearly always because of perimenopause. And birth control pills are excellent to regulate the periods. Women on BCP are hardly seen by the gynecologist, while women without the pills are seen often because of cycle problems. Another possibility is a regular course of progestagens from day 15 to 26 of the cycle. That will also regulate the cycle. Or you can accept the irregularity. Discuss this with your gynecologist. |
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| Question: I am 43 years old and had
a hysterectomy 7 years ago. I can't cool down, and now have
depression. I am on Prempro and Zoloft, and am gaining
weight. Is there anything else to take that does not cause
weight gain and helps with hot flashes and depression? Answer: Prempro causes no weight gain. Weight gain and depression are closely related. Why do you use Prempro (a combination of estrogens and progestagens), where estrogens alone (Premarin) is enough? The progestagen in Prempro is possibly related with your mood disorder. |
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| Question: I've tried three different low
dose birth control pills and I either have heavy break through
bleeding and still feel jittery or I just feel lousy with no period at
all. My symptoms include hot flashes, night sweats and the
jitters. I usually feel okay until after the tenth day of my
cycle and then everything goes down hill from there. Am I one of
the women who should be taking the mini pill? or should I just
keep switching birth control pills until I find one that makes my life
more comfortable? Answer: Breakthrough bleeding with birth control pills are seen very often. It occurs in 5-10% of all women using BCP. And breakthrough bleeding and/or spotting in 10-15%. So it is nothing to worry, but very unpleasant. The other symptoms are much more alike premenstrual tension. And switching to a minipill will not be helpful for that. Maybe you can better direct the attention of your doctor to the premenstrual problems and ask for help (maybe with serotonin reuptake inhibitors). |
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| Question: I am a 48 year old female &
I had been put on HRT for 2 years. The first I tried was Prempro. They
told me that I would not have periods. I continued to have periods for
2 years & I told them that it was not unusual to have a period for
2 1/2 to 3 weeks at a time. They increased my dosage & this still
did not work. They discontinued the Prempro & put me on femhrt. I
continued to have the same problems. They discontinued the
Femhrt & put me on Fosamax. I have been on Fosamax for
approximately 6-8 weeks. I have not had a period in approximately 2
months. Does taking Fosamax cause your periods to discontinue, or is
my body still adjusting to all the HRT & Fosamax? Answer: Fosamax does not influence the menstrual cycle. Bleeding problems with Prempro are not unusual. Especially when prempro is started before the periods are finished. Amenorrhoea with Prempro is seen in postmenopausal women. How more postmenopausal how more amenorrhoea. The same is true for FemHRT. With such bleeding problems sequentially combined HRT is much better: continuous estrogens with progestagens during 10-14 days every month (like Premphase) with a withdrawal bleed after the progeatgens in 90% of the women. No bleeding for 2 months now has nothing to do with Fosamax or with past use of HRT. It is your (peri)menopausal pattern. |
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| Question: I want to stop taking HRT, I
have been taking it for 5 years. What body changes can I expect to
occur if any. Also will there be any spotting and or bleeding? I have
not had a period since menopause. Also the reason I want to quit
taking HRT, I read an article that after 5 years on HRT the risk of
getting breast cancer goes up. I have also gained weight that I cannot
seem to get off. The article also said women who have taken HRT for 5
years are protected from heart disease and osteoporosis. What is the
best way to quit gradually or cold turkey? By the way I am 58 years
old still in good health so far. When I started taking HRT I took it
for menopause symptoms only, hot flashes, insomnia, mood swings.
Please check-out Breast Cancer and Hormone Replacement Therapy by Ronald Barentsen, MD |
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| Question: My doctor has suggested birth
control pills as a way of dealing with perimenopause. With a
history of breast cancer from my Mom I am reluctant to do so. Are
there any recent studies that show a connection between the pill and
cancer? Do you have any resources on perimenopause and estriol or
other natural alternative remedies? Answer: The relationship between birth control pills and breast cancer is still a debate. Maybe a very early start and long duration of use wil increase the risk somewhat. Otherwise the extra risk is extremely small. And disappears in 5 years after stopping. Other risk factors like the age at the birth of the first child, high body mass, use of alcohol are of greater importance. Estriol is a weak estrogen and used in Europe since a long time. It is especially useful for vaginal dryness and vaginal atrophy. In high dose it is also effective against hot flash, but the high dose influences also endometrium and breast. Natural alternative remedies as black cohosh or phytoestrogens are not tested for perimenopause. However, many women experience benefit for hot flushes. Why to start hormonal suppletion at the age of 42? Do you have any complaints? Symptoms alone are not a reason for hormones. Complaints (and that is something different from symptoms) can become a reason. |
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| Question: I recently started Femhrt
and was wondering if this medication had any effects on a diabetic's
blood sugar? Answer: FemHRT (a combination of norethindronacetate and ethinylestradiol) is neutral with regard to carbohydrate metabolism. |
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| Question: I was wondering if you could
give me some information on Raloxifene. I have been on premarin for
almost 15 years and I am 48 years old. It was suggested by my
doctor to try Raloxifene. But in all the research on the
medication that I could find on the net, it doesn't appear to me that
it would be any better to take than premarin. Is it better to
take because it reduces the risk of breast cancer? Also on the
premarin, I never have any hot flashes, but in the research that I did
on the above drug, it was clear that there were a significant number
of women that got hot flashes with this drug. Answer: Raloxifene is approved for prevention of osteoporosis. It will induce hot flashes in about 20% of patients. There is a hope that raloxifene will reduce breast cancer with 70-80%, but this is not proven. It takes many years before we can really tell you something about this potential benefit. Please check-out
Doctor, what are these "new"
estrogens that do not cause breast cancer?
by Marshall |
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