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| Doctor, What should I expect from HRT? | ||
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| Question: I am 46 and began
menopause symptoms about 2 !/2 years ago. I totally stopped my
menstrual cycle about 18 months ago. Because of the menopause
symptoms, my doctor put me first on Prempro, then changed me to FemHRT.
I enjoy the freedom from the monthly cycle and the hot flashes and
anxiety,
but know nothing about this drug. I have researched on the
internet but I cannot find any information. I would like to know
if I have gained 10 pounds because of the drug or my age. I have
changed nothing in my normal exercise or diet routine. Also, is
it menopause or the medication, or age that decreases the sex drive?
I once enjoyed a healthy "drive" but since this all started,
it has diminished. Answer: FenHRT is a continuous combination of ethinylestradiol (a synthetic estrogen) and norethisterone (a progestagen) It is not causing weight gain. On this age the basal metabolism needs a little bit less calories for the same activity. With no change in exercise or diet, a daily small extra calories remain and will cause weight gain. It has nothing to do with the hormones but with aging. More exercise or less eating will restore the equilibrium. Sex drive has to do with androgens not with estrogens. But maybe the 10 pounds extra will cause emotional problems to you and indirectly libido problems? Sometimes a small dose of androgens is advised with serious libido problems. |
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| Question: After I turned 42, I was placed
on Prometrium Caps (100 mg) and Estratab Tab (0.625 mg). I
noticed immediately that my hot flashes, night sweats, memory loss,
and severe heart palpitations dissipated quickly. At the
beginning of this year I began having severe pain during my periods
and discussed this with my doctor. She switched my HRT therapy
and I began
taking Femhrt to stop my periods. It is my understanding that
Femhrt has both estrogen and progesterone in it. I don't
understand how this differs from my previous medication and why it was
necessary to stop my periods all together. I am currently
experiencing night sweats again with slight heart palpitations.
However, the most significant difference I am feeling is my inability
to focus and use my memory. Can you help explain the
differences between these two therapies? Answer: FemHRT and your former treatment are according to the same principals: continuous combination of estrogens and progestagens. Only the kind of estrogen and progestagen differs. When your wish is a regular monthly bleeding, sequential combined HRT will be better: continuous estrogens with the cyclic addition of a progestagen during 10-14 days every month. It is of course not possible to answer why your doctor switched. You have to ask this yourself. When you were happy with the first treatment and not with the current one, switch back again. There is nothing wrong with Estratab and prometrium. |
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| Question: I am 52 years old and have been
on natural HRT that is mixed at an apothecary and was prescribed by my
ob-gyn for the past 9 months. I have continued to have a period every
two weeks and they have changed the estrogen dosage 3 times and it
does not seem to make any difference. I have had a biopsy and an
ultrasound and all looks normal. Should I just get off hormones
altogether and start over or what? I do not have any history of
osteoporosis or heart problems and did not have hot flashes. My doctor
prescribed HRT because of my blood test and hormones levels. I would
prefer the most natural way to go about dealing with this as possible.
Should I worry about the frequent bleeding since I have been tested? Answer: When the compounds of your treatment are not known, I can not guess if this has something to do with your bleeding problems. But why take any drugs when you have no complaints and not a high risk for osteoporosis or cardiovascular disease? Any drug treatment needs an indication. |
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| Question: My physician recommended
flaxseed oil as a source of low level estrogen. What dosages
would be appropriate? Answer: I can not find any scientific evidence about this oil. I suppose that the manufacturer gives some advice on the box or on a leaflet. Or ask it the prescriber, your physician. |
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| Question: I have been on prometrium for
two years to regulate periods. During the last two years I
have had occasional blurred vision, feeling of restlessness,
extreme fatigue and times that I feel I am on speed the first two
hours after taking prometrium. Should I be concerned? Answer: This symptoms are not side-effects of prometrium, except perhaps fatigue. Prometrium can induce sleep. Therefore it is advised to take prometrium in the evening and not in the morning. |
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| Question: I am 48. I have had a
hysterectomy, but have my ovaries. I have no signs or symptoms
of menopause, but my doctor still wants me to start on Premarin.
When do you recommend starting HRT? Answer: I recommend estrogens to women with complaints, or to women without complaints but at high risk for osteoporosis or cardiovascular disease. This is only after making a risk profile. With no increased risk and no complaints, there is in my opinion no reason to recommend estrogens. But I am aware that some doctors believe that estrogens are good for all women. But there is a small risk for thrombosis, for gallbladder disease and for breast cancer. So, you have to have a good reason for a recommendation. |
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| Question: I am 55 yr. old, I am
post menopause, and 2 yrs. ago the doctor had to remove the ovaries and
the womb. Now I am on the estradiol 0.1 mg patch. I like
this patch, they do help me. Sometime I feel better in my mood. Would
dhea or pregnenolone cream's be okay to use? Answer: No, estrogens alone is sufficient for all your needs. Only when libido problems arise, sometimes a little bit of testosterone will be welcome. |
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| Question: I am 48 years
old. I was tested about 3 years and am starting perimenopause. I
have the night sweats bad. I tried all the hormone treatments.
Nothing worked. My doctor tried birth control pills. It
did regulate my periods. But now I don't want to have a period.
On the other hand, I don't want to have surgery. Can I take the
birth control pill all the time, never stopping for that week?
Just continue taking the pill? Will this be harmful? I
have read a little information on this? Answer: You can continue taking the pill. This is not harmful. But after a few months, some women will have breakthrough bleedings and others get a bloated feeling. In such a situation it is better to stop for a few days. But without bleeding or bed feelings, continue without problems. |
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| Question: Unopposed estrogen that also
affects thyroid, as described by Dr. Lee, sounds like what I
experience, but I can't find any discussion that's not by someone
hawking progesterone cream. Is there evidence in the medical community
that unopposed estrogen can inhibit thyroid function despite normal
thyroid production? And evidence that applying a transdermal
progesterone cream is effective in resolving symptoms such as weight
gain, fatigue, menstrual problems, swelling, emotional instability? Answer: That theory is not scientific based. Thyroid levels are not influenced by menopause nor by estrogen therapy. And the effect of transdermal progesterone cream is not substantiated by research. Actually the progesterone level after application of the cream is very low and probably not active at all, certainly not active on the uterine lining and on bone. |
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| Question: I am 44 years old with a
history of migraines for 7 years. As time goes on, they have
become worse. The most severe are with my period, daily 5-7 days
and mid-cycle 3-4 days, and 3-4 times per week during the rest of the
month. My periods have become more irregular in the last year.
Mid cycle I have what appears to be bloody discharge for a couple of
days also. In addition, I have been experiencing mood
swings. This all feels like perimenopause to me. I am a
smoker. My neurologist is running out of ideas, as we have tried
about all of the traditional preventative meds, but are thinking about
HRT once I have stopped smoking? Answer: There is no distinct relationship between migraine and hormone replacement therapy. Sometimes it will be better with hormones, but usually it makes no difference. Fluctuating estrogens are blamed sometimes for migraine. That is especially true with menstrual migraine. But your story is a different one. |
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| Question: I went to a new physician and
talked to her about symptoms of perimenopause. My periods are every
month, but irregular. I also
have some trouble sleeping and have a couple of days each month where
I am over-emotional. I had tried natural progesterone about 6
months ago (prescribed by my previous doctor). It made me
extremely sleepy during the day and I stopped taking it. She gave me a
prescription for Provera, has asked me to get a pelvic-vaginal
ultrasound and blood work. She told me during an exam that
everything seemed normal and in place, but after asked me to have the
ultrasound. I am a bit uncomfortable with what she is telling
me. I have looked at the internet and found the side effects of
Provera and the controversy about it. I don't know what to believe.
I think that a D&C seems a bit drastic. I just really want
to get rid of the feelings of being over-emotional and it would be
nice to know when my cycle is each month. Is this something that is
normally done?
Should I go to a different doctor and get a second opinion? I don't
want to do anything that is unnecessary. She also talked about
HRT as perhaps being needed sometime. My mother had a very easy
time with menopause and has never taken any hormones. Should I seek a
second opinion or not? Answer: There are a lot of questions here. To much to answer all. I can only add some information. Natural progesterone can cause sleeping, so it is advised to take it in the evening. Birth control pills are excellent to regulate the cycle in perimenopause. But also courses of Provera in adequate dose taken days 15-16 will regulate the periods. A D&C is a diagnostic procedure, only needed when the cause of bleeding problems remains unknown and it has no place in cycle problems. Such is ultrasound. When provera or birth control pills have satisfactory results no further diagnosis is necessary. |
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| Question: I had been taking black cohash
for peri-menopause symptoms with good results. But they
recommend only using for 6 months. Can you explain why. I
felt better while using it, would a lower dose be better? Answer: No, I can not explain why. Maybe the manufacturer is afraid for claims for advising extended use without scientific data. There is hardly any serious research done on black cohosh and certainly not with long term use. But I see no objections for long term use on a theoretical base. |
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| Question: What is your opinion of using
progesterone creams over the counter, without consulting a physician?
How much and how often would you use it? Thank you. Answer: I do not advise it at all. There is no scientific proof for effectiveness. It does not harm, so you can buy it over the counter, but the benefit of progesterone cream is very questionable. In Europe it is used only for local application on the breast in case of breast tenderness. Vaginal application of progesterone cream is different. Then it is used to administer progesterone for uterine lining protection in infertility clinics. That kind of cream is very potent and not available over the counter. |
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| Question: Within the last 3 years my wife
has had a D&C, complete hysterectomy and a modified radical
mastectomy of the right breast. She had been taking estrogen for
a couple of years until cancer had been detected. She is 53 and
is experiencing hot flashes frequently. She knows that she
mustn't take estrogen and that she will have to live with the hot
flashes. Her question
is, how long will she have to put up with hot flashes? What is
normal or what can be expected? Answer: No one can tell that. Most women have the hot flush period during 1-2 years. But in 25% it will last more than 5 years. Hot flushes can be treated also with clonidine without interference with breast cancer. There is also anecdotal information on the beneficial effect of serotonin re-uptake inhibitors, like Prozac, for treatment of hot flushes. |
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| Question: I am 39, and for about the last
year have suffered sleep disturbances, depression, worsening PMS, poor
concentration, breast tenderness, and headaches. I do not
have hot flashes or irregular periods. While the majority of my
symptoms have been irritating, the headaches are almost daily. I
suggested trying femhrt to my doctor, given the other symptoms.
I have the pills, but after reading the drug information insert I'm
confused. At a health symposium, the doctors said that the low
dose tablet would help ease the symptoms I've described; however, the
insert stated that these symptoms could be side effects to femhrt. Can
you clear up the confusion? Answer: I have no reason to consider your symptoms as perimenopausal ones. So, you cannot expect help from HRT treatment. Ask your doctor to help you with the symptoms of depression and headache with appropriate treatment. The side-effects on the leaflet are quit another story. When you follow the advice on the inserts you can never take any medicine because there are usually more side effects registered than effects. But you have to realize that you take the tablets because of problems. You have to weight the benefits vs. the side effects and then make your choices. That is the daily practice of the art of medicine. |
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