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| Doctor, What should I expect from HRT? | ||
| Question: I began menstruating when I was
8 1/2. I've had PMS & spasmodic dysmennorea my entire life, beginning
w/ my first menses, consisting of severe cramping, nausea
& depression. I have been taking oral birth control since the age
of 17. I am now 37 & although my cycle is regulated by the
pill, I sense a change in my body. I've begun having headaches prior
to my period & my cramping has increased. I experience extreme
fatigue several days prior to my period. I have night sweats &
occasional hot flashes where my ears turn red. Am I experiencing
perimenopause? If so, what does this mean? Answer: With the use of birth control pills there is no activity of the ovaries. The pill contains a lot of estrogens and inhibit FSH production. There is a steady state of pill use and no signs of perimenopause can occur with the use of the birth control pill. Please check-out the OBGYN.net PCOS Pavilion for more information about this question. |
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| Question: My doctor has prescribed Evista
for me. I am 50 years old. Another Dr. told me he would
not recommend Evista until I was 60. Also I saw that it was
subscribed for breast cancer patients. Should I take it? Answer: Evista is advised for prevention and treatment of osteoporosis. During the studies for this approval, it came evident that during the course of Evista less women developed breast cancer than in controls. But this is not yet substantiated enough. Evista is nowadays not advised in breast cancer patients. It is never studied in that population. When you are at risk for osteoporosis, Evista is a good choice, after menopause. When still menstruating, it is not appropriate. |
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| Question: I am 55 years old, have three
children, weigh 120 lbs, and am premenopausal.. I took birth control
pills for many years, then was treated for breast cancer five years
ago and took tamoxifen for five years. I always experienced
regular menstrual cycles and no breast pain but since stopping
tamoxifen I have experienced menstrual cycles of 2 and a half to three
weeks with very heavy bleeding for the first two days. During the
weeks without bleeding I have extremely painful swollen breasts.
My estrogen levels were tested and were normal. My doctor checks my
uterus lining frequently but has no suggestions. This unpleasant
cycle lasted seven months, stopped for three months but now has
started again. Is this a hormonal imbalance? Would progesterone
cream help? Would natural estrogens help? Is there anything you
can suggest I can take to stop the short cycles and the swollen
breasts? Answer: The most likely diagnosis is anovulatory bleeding. Progesterone cream will not be helpful fro this. Also natural estrogens can do nothing, because you have enough estrogens produced by your ovaries. I propose cyclic use of progestagens (Provera 10 mg or Prometrium 200 mg on days 15-26 of your cycle). That will make regular bleeding pattern and almost certainly give relief to your breast tenderness. As long as your ovaries produce estrogens, bleeding will occur after stopping the progestagen course. Without estrogen production no bleeding occurs anymore. Progesterone cream locally applied on your breast will reduce breast tenderness. Please check-out this article "Tamoxifen" from 4Woman.gov. |
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| Question: I am post menopausal and my
basic complaints were with mild hot flashes, lack of mental acuity,
and irritability. But the great part was that I didn't have my
periods. I am 51. The doctor put me on 1 mg estradiol and 2.5 mg
medroxyprogest tablets that I take every day and the symptoms
disappeared but my periods came back. I hate my periods. Is
there anything that can be recommended that will get rid of both
symptoms and periods? Answer: This problem is a common problem with HRT. I wonder if you can call this bleedings periods. When using a continuous combination of 1 mg estradiol and 2,5 mg medroxyprogesteron, the aim is to have no bleeding at all. But unfortunately about 30-40% of women using this kind of low dose continuous combined HRT experience breakthrough bleedings. But they are not regular. Usually it becomes lesser when continuing the medication. Periods are to be expected with a cyclic course of progestagen with continuous use of estrogen. With low dose (1 mg) withdrawals are seen in 80%. There is no way to guarantee to become bleeding free. But with low dose continuous combined HRT the chances are high. Bleeding is the payment for the benefits of estrogens. |
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| Question: Is there a suitable combination
therapy available to women who have had a full hysterectomy? I
have no sex drive at all, and am interested in testosterone treatment. Answer: Estratest is a combination of estrogen and testosterone. |
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| Question: I can't find any information
about HRT and paraplegia. Is there any contraindication in
offering HRT to a patient confined in wheelchair for MS? I am
concerned about the possible increased risk in thromboembolism
(immobility and HRT). I would like to know your opinion. Answer: Nothing is known about paraplegia and HRT. Your concerns of thrombosis are real. With HRT the risk doubles. But you have to consider the indication for HRT also. Regarding MS and hormones also hardly anything is known. I found one abstract. From the Journal of the Royal Society of Medicine,
1992 Oct; 85(10): 612-3 |
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| Question: I'm 36 years old and have been
suffering from mood swings, strong hot flashes, night sweats,
palpitations (at times severe), irregular periods and panic attacks
for 4 years. My doctor says my estriol (serum) is at 28 and that is
too low and indicates perimenopause. I have these episodes of panic
and palpitations and bloating right before or during my periods. When
the period decides to show up. My question is this: I can't take BC
pill due to a mild stroke while taking it and smoking 10 years ago.
What are my options? I know progesterone crème has no proof of
working-but since I've been on it(2 months) my cycles are a little
easier to handle. What can I do to feel better? I exercise regularly
and eat right. But the hot flashes and palpitations are debilitating!
I have been to a cardiologist and several specialists. This is the
only thing they can find - the low serum estriol. Answer: I think that the lab test was estradiol and not estriol. But the level of estradiol in women still menstruating is not of much value. The level has to be higher in other parts of the cycle. Otherwise you will have no bleeding. So they have found nothing until now. Your symptoms and especially the panic attacks can maybe be handled better by a psychiatrist. With panic attacks many of the perimenopausal symptoms are mimicked. |
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| Question: I am 38 years old. I went to my
regular ob/gyn I had been having emotional problems and decided
to ask him about depression. I had been feeling like I was on an
emotional rollercoaster as well as feeling tired. He said that I was
perimenopausal and put me on the combipatch. I was on the patch for
approximately 6 months. They always put sores on my stomach and so I
requested something else. He now has me on Estratest. My husband is
very worried about me being on either of these medicines. Should I get
another opinion? Answer: You have not mentioned the effect of the combipatch. Did it have any benefit to you, or did it give no cure at all. Stomach sores are not a well known complication of patches. Estratest will not be a good choice because it is a combination of estrogens with androgens and estratest contains no progestagen. It will likely cause bleeding problems. When decided for further hormone treatment (only when the patch cleared the symptoms) sequential combined hormone therapy will be better (like Premphase or other brands). |
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| Question: I had a hysterectomy 12 years
ago and have been on Premarin till a couple weeks ago. Doctor
took me off Premarin due to my having frequent bouts of thrombosis in
my legs. He made no other suggestions and I feel I need to be on
some type of hormonal therapy which is either herbs or something
natural. I am in my 50's. Answer: What are frequent bouts of thrombosis in your legs? What is the precise diagnosis? After thrombosis you have to be careful with hormone therapy. But frequent thrombosis is rare and you will need anticoagulant treatment. Have you? |
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| Question: I just recently reached
menopause. My doctor has put me on FEMhrt. I have been
taking it for approximately 1 month now. I have a strong history
of breast cancer...my mother, her mother and my mother's sister. I
know the pros and cons of taking HRT. However, I am torn between
taking it or not taking it due to the breast cancer issue. I
feel uncomfortable taking them when everyday I hear something on the
news or in the papers that if you take estrogen and progesterone
combined that you are more than doubling you risk of breast cancer.
I believe I would like to stop taking HRT. I am very uncomfortable
taking it. I really need another opinion. Answer: There has to be an indication for taking hormone therapy. Why did you start the treatment. Because of complaints? Because of high risk for osteoporosis (alendronate or raloxifene are alternatives)? Because of high risk of cardiovascular disease? For preventive indications there are several alternatives. With a high risk of breast cancer the only reason for estrogens can be heavy complaints. And then you have to weight the pros and cons. There are some studies that indicate that combined therapy have a higher risk than estrogens alone. However, the studies are of the observational type and give no proof, only a possibility. |
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| Question: I am 38 years old, and without
question, am experiencing symptoms of peri-menopause. I
have irregular bleeding, night sweats, no interest in sex, and
vaginal dryness. Most are tolerable at present, except for the
loss of sexual desire. I had noticed a gradual decline over the
past 6 months or so, but now it has gotten to the point where it
is totally non-existent. This really bothers me more than
anything. Is there a treatment for this? I am in excellent
health. I exercise every day and have no other health issues. Answer: When the loss of sexual desire becomes a problem, the reason has to be searched for. Perimenopause is no reason for this kind of sexual problem. Maybe a sexuologist can give you good advice. |
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| Question: I was recently switched from
zovia bcp to demulen due to the fact that my pms was beginning to get
worse again (it had gotten better for a few months on the zovia
initially) I am noticing a few things that I am wondering if they are
related to the pills or perimenopause: big increase in appetite, feel
numbness in legs (if crossed) and fingers, extreme afternoon fatigue
(even after 7 or 8 hours sleep), itchy scalp, face (not the kind that
feel like ants), increase in vaginal discharge with strong odor. Is
there a major difference in these two kinds of pills? I am a 38 year
old healthy mother of two. Work full time and do not smoke or
drink alcohol. Answer: There is no difference at all between the two kinds of pills. Demulen and Zovia contain 1 mg of ethynodiol diacetate and 35 mcg of ethinyl estradiol. So it is not clear why you get the advice to switch. And your symptoms are certainly not caused by the switch. |
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