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| Doctor, What should I expect from HRT? | ||
| Question:
I have been reading about perimenopause and different
treatments. Several books, espousing the 'natural' method of symptom
control, explain that the prescribed "progesterones" are
all synthetic and are in actuality "progestins". They
further say that these progestins are not assimilated and thus not
recognized by the body as progesterones. Is this true?
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| Question:
I am 42 years old and have not had a period in 4 months. Went to the
doctor, had hormone levels checked, and FSH was 60, estrogen levels
below 20. My left ovary was removed due to an endometrioma two years
ago, and my doctor and I believe that the remaining ovary has simply
failed early. He wants to put me on low dose birth control pills
instead of HRT. I can't get a good reason why from him and I don't
think this sounds right. Any suggestions? Answer: Even with this high FSH and low estradiol, sometimes pregnancy occurs. To be certain on HRT you would need additional contraception. For hormonal levels alone, HRT is enough and contraceptive pills are not necessary. |
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| Question:
I have always been exactly 28 days apart with my cycle. In the last
year I had heavy bleeding and never did before. They gave me provera
but was told that is not good to give to people who have heart disease
in the family. I always had very bad cramping and the things that go
with that. They just gave me estrace and said to rub a small amount
inside the thigh area daily. What do you think? Answer: When there is a contraindication for provera because of familial heart disease, there is the possibility to use pure progesterone such as prometrium for regulation of the menstrual cycle. I do not know why an estrogen gel can be useful for heavy bleeding. Ask your doctor what the reason is for this Estrace topical. It certainly will not diminish the heavy bleeding. |
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| Question: How does heavy
consumption of soy affect fibroids? I am 44 with one fibroid the size
of an orange. I am slender, feel fine, exercise regularly and for the
past three years had been consuming large amounts of soy (80+
milligrams per day)--soy milk, tofu, soybeans etc.--and also had an
increase in my fibroid size. Are the soy consumption and growth
possibly related? I thought the soy would counteract too much estrogen
in my system. Is this the case? Is there a connection between the soy
consumption and increased no. of cycles? If so, how would fibroids be
affected? Answer: No data is available on fibroids and soy. Soy contains several phytoestrogens. Phytoestrogens bind to the estrogen receptors. There are two kinds of receptors with different actions. The idea is that phytoestrogens in a women with menstruations counteract the ovarian estrogens. There are studies that indicate that the menstrual cycle is somewhat prolonged with soy and not shortened. After menopause, with low endogenous estrogens, phytoestrogens will act as weak estrogens. On this base, we suppose that estrogens will not have influence on the growth of fibroids. But there is no proof of that. |
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| Question: I will be 39 years old in
December and have been experiencing irregular periods since my
miscarriage in Feb. 99. I sometimes spot for 3-4 days, followed
by 4-5 days of bleeding, and ending with 2 days of spotting. This has
been going on for approx., a year and a half. I use to run a 23
day cycle now its all over the place, 23days, 30days, 14 days etc.
The most disturbing matter is my last 3 periods I've been experiencing
bad headaches, night sweats, nausea, numbness and burning in my neck
and ears. My ears hurt. I've been to UNC because my doctors
thought it was migraines. I truly believe these symptoms are
associated to the on set of my period. My OBGYN wants to put me
on Nordette which will allow me to get my period 4 times out of the
year. I've never heard of this and I'm not sure of the treatment
and reason for this. Could you tell me if I am experiencing
signs of perimenopause. I had my period 2 weeks ago and I've
begun to spot again. This spotting appears different. I
have to wear a party-liner because of the spotting. The 3rd day of
spotting I feel like I'm going to get my period I'm blotting,
cramping, weak, etc. I feel lost and I'm not sure what I should
be doing. Could you please shed some light. Thank you. Answer: As you can not understand the reason why your gynecologist prescribes Nordette, ask it directly to him or her. I suppose that the aim is to regulate your cycle and to prevent headaches during the week off. With this scheme you will only have 4 times a year a week without pills and the risk of menstrual migraine. There are several possibilities as cause of irregular cycles, perimenopause is one of them. Anyhow, birth control pills will cover most of the problems of irregular cycles. |
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| Question: I'm 37,and am experiencing
extreme anxiety, depression and fatigue during my menstrual cycle and
while I'm not on my cycle I feel fine and function normally. I
do exercise regularly and I do not feel stress from my job, family,
and am financially stable. When I visited my gynecologist she
prescribed Zoloft, but I do not get depressed any other time except
during my menstrual cycle. Answer: Zoloft is a serotonin-reuptake inhibitor. Prescribed as antidepressant, but also prescribed for menstrual cycle related problems like premenstrual syndrome. The symptoms of premenstrual and menstrual complaints are caused sometimes by high serotonine levels. And serotonine reuptake inhibitors can cure that kind of symptoms, while other antidepressants can not. |
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| Question: Will Evista increase my
appetite?
Answer: Increased appetite is not a recognized side-effect of Evista. |
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| Question: I am looking into
Estratab but haven't been able to find anything on it's effect on a
woman's breasts, and if there is the increased risk of breast cancer
as with animal estrogen. Studies seem promising, but why no
mention of breast cancer risk? Answer: The risk of breast cancer with Estratab is exactly the same as with other estrogens. Synthetic, animal or plant source does not matter. Only the duration of use counts. |
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| Question: For nearly 18 months I had
heavy bleeding during my periods that always lasted for up to 14 days.
Then I would begin my period again in 2 weeks. My Dr. determined that
I was no longer producing estrogen and placed me on PremPhase which is
estrogen and progesterone. I quit taking HRT because of the risk of
cancer. Recently I read an article that uses plant based estrogen. I
want to take this product because there are no sides but this product
(Promensil) advertises the only ingredient is estrogen. Will I need to
supplement with progesterone or do you think this can help the
bleeding and still be effective. Are you familiar with this
product and do you have another opinion that will help me eliminate
the problem naturally? Answer: Promensil is a fixed combination of phytoestrogens derived from red clover. Promensil is designed for combating hot flashes and some studies indicate that it is possible helpful in osteoporosis and in prevention of cardiovascular disease. But these claims are not substantiated. Only hot flushes will decrease in intensity but not as good as with estrogens, but better as with placebo. There is no need to take progestagens as far as we know on this moment, but the expertise is limited. |
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| Question: I am a 43 yr old woman, never
had children. I am presently taking Celexa and have been on
medications for depression for the past 10 years. I have been
having hot flashes, confusion, sever breast pain, panic attacks, loss
of memory, migraines. I purchased several natural products such
as Kava Don Quai, etc. My question is: is it safe for me to be
taking natural products while I am on the Celexa and probably will be
on some type of serotonin re-uptake medication the rest of my life? Answer: No one has studied the so called natural products in combination with antidepressants. Most products act (if they work at all) in one way or another by modifying the neurotransmitters: cerebral neuroactive compounds. One of them is serotonin. On a theoretical base there is no reason to suppose that the combination of serotonin re-uptake medication and the natural products can not be combined. |
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| Question: I am 38 and recently
diagnosed as going through menopause, I am taking premphase, zoloft
and halcion and in the past few days I have found massive bruising in
the oddest places can any of these medicines attribute to this and or
possibly the mix of these medicines. I have never bruised like
this before? Answer: These side-effects are unknown to me, please visit the OBGYN.net Women's Health Forum for more information. |
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| Question: Does taking progesterone in
synthetic form help relieve premenstrual depression? What are the latest treatments available? Answer: Progesterone, natural or synthetic, has never proved any benefit for premenstrual depression. The current idea is that premenstrual tension is cause by serotonin dysregulation. Serotonin re-uptake inhibitors are the only compounds with proven benefit on this kind of problems. Other antidepressants will have less effect. |
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| Question: At 42 I had a complete
hysterectomy and removal of ovaries. I'm 48 now. The only
HRT that worked for me and eradicated hot flashes was Premarin, 2.5
mg. daily. Although I am not at high risk for breast cancer (even
though my maternal grandmother died of the disease), my doctor felt
this dosage was dangerous and placed me on Evista a few months ago.
The hot flashes and night sweats continue and are extremely
uncomfortable. I have headaches either way I go, from the high
dosage of Premarin or being without estrogen via Evista, for
which I take medication. With the Premarin, I had a better sense
of well-being and sexual intercourse wasn't painful; with Evista, the
opposite is true. I see no signs of my hot flashes diminishing
after all this time. What can I do? Answer: Evista can cause hot flushes. And there is no proof that Evista have the same long term benefits as estrogens have. Evista is licensed for prevention of osteoporosis. With the hot flashes of this moment, start again with Premarin and continue that for a long time. As regards the dose: some women have a poor resorption of estrogens in the intestine and need a higher dose. To much estrogens can result in side-effect as breast tenderness. To less estrogens will result in flushes. Use Premarin 2,5 mg for a while and try sometimes (once a year?) if 1,25 is sufficient. As regard the risk of breast cancer: dose seems not important. It is the duration of exposure. And the duration of endogenous estrogens and exogenous estrogens together must be counted. In your case you have the same risk as women with normal functioning ovaries at the age of 48. The model that describes the additional risk with long-term estrogens starts at the age of 50, with 38 years of endogenous estrogens followed by 10-15 years of estrogens. Every year with a functioning ovary has the same meaning as a year without ovaries but with estrogen medication. |
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| Question: I've been on hormones for a
year now. I've been on prempro, premphase and now on cenestin.
Since I started on hormones my blood pressure has slowly been on the
rise. I've always had perfect blood pressure before starting on HRT. My blood pressure is 170/100 which concerns me. I was
wondering what your thoughts are as far as going off the hormones for
a month or so to see if my blood pressure will go down. My
doctor wants me to go on blood pressure pills but that would be my
last resort. She has also suggested trying Menest 0.3 mg. The
last month or so I've had some stress. Also my parents both have
high blood pressure. I'm 48 yrs old. Any helpful
suggestions would be appreciated.
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| Question: I am a 42 year old woman who has been
taking Desogen 28 for approximately 3
years due to incredibly heavy menstrual periods. My Dr. prescribed either a DNC or a low dose of Desogen.
I am now
becoming concerned about the weight gain I have experienced, even
with
dieting and exercise. Nothing seems to work as I slowly gain
(about 10 lbs.
total). Should I go off the Desogen, and see how my periods
are and then
consider the DNC if needed, or can I stay on the Desogen and deal
with the
weight gain? What is best for long term? Answer: An D&C is only a diagnostic procedure. Unless endometrial polyps are removed, a D&C will not decrease the amount of blood loss. When the actual treatment benefits you stay on it, you could stay on it for the next decade. Weight gain is a universal problem and only dieting and exercise will be helpful. |
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| Question: I have been taking
estradiol daily and from the 7th of each month until the 16th I take a
progesterone tab for the past two and one half years. What would be
the affects of discontinuing either of them and just letting
"nature" have a chance to take its course? I still
have my uterus. Answer: Unopposed estrogens (not taking progesterone) will cause erratic bleeding and a high risk of endometrial cancer. Not taking estrogens will place you again in your natural position. Maybe you will experience menopausal symptoms, maybe not. No one can predict that. You have to try it. Of course, it is important to know for what reason you started the hormone replacement 2 years ago. |
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