Articles
Register for
|
||
|
|
||
| Are these symptoms of Menopause? Am I experiencing Perimenopause? |
||
|
|
||
| Doctor, What should I expect from HRT? | ||
| Question:
I am 61 and had been taking Prempro for about 14 years. I
began to read research on this medication and decided that it was
dangerous for me to continue. I talked to both my Gyn and
general physician and they both told me I should continue the
medication. I stopped taking it about 2 months ago and then just
hear the news about the current negative research on Prempro. I have
read that this research has been available to physicians since 1999.
Can the negative results of Prempro be reversed if you stop
taking the medicine? Answer: The negative results for Prempro were not available before |
||
|
|
||
| Question:
The
recent HRT study followed women who used Prempro. Has there
been any study or recommendation on the use of Estradiol and
Prometrium? I
take 1MG Estradiol and 100MG of Prometrium. I'd like
to stay on it because my OBGYN told me it helps prevent colon
cancer, for which I am at risk.
Answer: No study has been done with estradiol and Prometrium. But the good results for colon cancer are known from the same products as the bad news for breast cancer. It is a matter of risk profile and individualization to discuss with your own OBGYN. |
||
|
|
||
| Question:
I was told by a friend of mine that HRT can increase the incidence of
heart attack. There is an article that had come in the Times
of India which said the same. Please clarify. Answer: The continuous combination of conjugated equine estrogens with medroxyprogesteronacetate marketed as Prempro gives an increase of myocardial infarction and not a decrease as was supposed by earlier investigations. With this particular combination of HRT 8 cases of myocardial infarction were observed per 10.000 women years of use more than with placebo. This became statistically significant after 5.2 years of trial. At the same time a small but significant increase of the incidence of breast cancer was observed in the same group. This arm of the Women’s Health Initiative was stopped recently because of these results. Another arm of the trial with estrogens alone continues. After 5.2 years no increase or decrease of myocardial infarction or breast cancer was observed. |
||
|
|
||
| Question: After
22 years of ERT (Estraderm) following a hysterectomy & BSO at age
32, I have tried to "wean" myself off the patch (fear of
increased risk of breast cancer)---I am now
on .5mg and have been having mood swings, unexplained crying, etc. I
WANT to continue to use estrogen replacement ---I feel that I really
NEED it for life. Aren't the benefits greater than the risks for a
woman like me?? Answer: Until now no increased risk for breast cancer is observed in good trials with estrogens alone. Furthermore your risk of breast cancer is exactly the same as in a woman who is still menstruating at your age (54). The source of the estrogens does not matter. It is the same when estrogens comes from the ovary or from pills or patches. Long term ERT (10-15 years) are calculated after the normal age of menopause. So your risk will be the same after 30 years of ERT as other women with menopause at age 51 and 10 years ERT |
||
|
|
||
| Question:
I am a healthy 73 year old . I have taking
Premarin .0625 for 20 years and Promethium l00 every evening.
this has been working great for me. Now with the latest findings I
have cut my Premarin to .03, Prometrium to 12 days a month and I am
having hot flashes and more malaise than before. I am confused
about what to do and my Gyn is leaving it up to me I notice you
have questions from younger woman. Could you answer my age
related question?
Answer: The problems with the Women's Health Initiative are related to the combination of Premarin with MPA (Prempro), another progestagen. It is unknown how the results of this particular combination can be translated to other combinations. For the time being, we consider prevention of cardiovascular disease not an indication for hormone supplementation anymore. Furthermore, the WHI results are based upon a population who started hormones at the age of 63. In your case, you started much earlier and with another combination and that is very different. In case of vasomotor complaints oestrogens are the best treatment. Lowering the dose of Premarin is a good idea, but with maintenance of the dose of 100 mg Prometrium daily. When you still have complaints with the daily combination of 0,3 Premarin and 100 Prometrium, start again with your older regimen. The risk of problems as demonstrated in WHI is very small and all problems together not more than 3 per 1000 per year. Vasomotor complaints is also nowadays a very good indication for hormonal treatment, also for the long term. |
||
|
|
||
| Question:
I am 49 years old & have been on Demulen for 11 years. I
don't have many of the usual menopausal side effects, except a 15 lb.
weight gain, slight night sweats & some tiredness. I guess
that is due to being on the BC Pills. I had a FSH test done
the week I was off my pills & the level was 71. My
doctor says I am post menopausal , can go off the BC Pills for good
& wants to start me on FemHRT. Is this good advice?
Answer: FemHRT is a continuous combination of estrogens and progestogens, designed for use in the postmenopause after at least 12 months of amenorrea. Earlier use gives breakthrough bleedings in a very high proportion of women. In early postmenopause a sequential combined regimen is much better. I agree with your doctor that contraception is not required any longer. But personally, I have no objection for the use of birth control pills in the next 5 years. |
||
|
|
||
| Question:
I am 52. Partial Hysterectomy 11 yrs ago. A right mastectomy
a yr ago. Did take Tamoxifen for a couple of months
but made sick to my stomach and I was taken off of it. Now I am
being treated without anticancer meds. Presently, I am experiencing
profuse hot flashes, my neck is dripping with sweat, insomnia, cold
intolerance, postural dizziness. Since my breast cancer was
estrogen related, would I be a candidate for the "natural"
plant estrogen alternative?
Answer: Natural estrogens from soja or red clover will be helpful for some women. And as far as we know nowadays (and we know not very much of these compounds) the phytoestrogens in those products are not harmful for the breast. But for many women with severe complaints these compounds are not strong enough. Some women are successfully treated with SSRI's (serotonin reuptake inhibitors). Others use estrogens because of the quality of life aspects despite the breast cancer history. |
||
|
|
||
| Question:
With the new data, is taking long term (15 years) Premarin (post
hysterectomy) now considered more of a health risk? What are you
advising your patients? If the above answer is yes, what do you advise
for "hot flashes"? Thank you.
Answer: The new data are regards exclusively the combined therapy of conjugated equine estrogens and medroxyprogesteronacetate and not estrogens only. Premarin only is also studied in the Women's Health Initiative, and this study arm continues. Estrogen treatment is also nowadays the first line treatment of hot flashes. |
||
|
|
||
| Question:
I am currently on HRT and have continuing problems of break-through
bleeding which only ceases when I stop taking the HRT. It starts
off quite lightly and gets heavier and heavier until I stop the
hormones. After that, the bleeding can take up to 2 weeks to stop.
As well, as soon as I cease HRT I experience extreme hot flashes and
sleeplessness. I am awakened by the hot flashes approx.
10x/night and as a result am continuously tired. I have tried
all natural therapies, such as Black Cohosh, Remifemin, Oil of
Primrose(?), yams, etc and none of these helped with the hot flashes.
I have been on HRT for 5 years for hot flashes. The bleeding is
something new this year and last month I had a DC which did not help
at all. I am at a total loss as to what to do.
Answer: What regimen of HRT. Usually breakthrough bleeding occur with a continuous combination of estrogens and progestagens. With a sequential combined HRT regimen withdrawal bleeds occur, but scheduled. Low dose sequential combined HRT gives withdrawal bleeds in 60-70% of users, but usually the bleeds are lightly. |
||
|
|
||
| Question:
We need help! Like countless other women out there right now, I'm not
a "happy camper"! I'm in the 4th week of tapering off
of HRT after 14 years (I'm 64 yrs. young!) and experiencing some
unpleasant symptoms: hot flashes, feeling jangled, concerned
about losing the benefits HRT gave.
Question 1: I switched from oral Estradiol to a lower dose Climara Patch about 3 months ago and changed from Provera to oral Prometrium about 1 1/2 years ago which I felt very good about . *In light of the HERS II study or other data, what is the feeling about the use of the patch and Prometrium vs. Prempro?...doesn't seem to be much information on this regimen. Question 2: For vaginal atrophy, I would like to use Estrace cream,
but my GYN says, "we don't like to use unopposed estrogen".
Is there an estrogen/progesterone cream available? Though I read on
this site that progesterone doesn't absorb well vaginally, would it be
effective enough to counter the estrogen? Thanks very much for some
help on these issues.
|
||
|
|
||
| Question:
Dear ask the expert, My obgyn and I are trying to come up with a hrt
formula that my insurance will pay for. I had rectal cancer last
year and my ovaries were fried by the radiation therapy. still have my
uterus. she recently increased my prempro 0.625/2.5 mg dose to x2 qd
to control my menopausal symptoms. this works well. i would like to
try methyltestosterone to see if i can find my libido again. my
insurance company suggests Estratest and Prometrium. does this sound
like a good option. my doc says this should meet my needs. don't want
to go the "natural" route right now. Thanks for your advice.
Answer: Estratest and daily 100 mg Prometrium is an excellent combination. |
||
|
|
||
| Question:
Help. I've been on Estrogen patches for 13 years...after I had a
hysterectomy. (I still have my ovaries). I feel great on them
but after the new studies, I would like to get off of them. I've
tried so hard. I tried just cold turkey and about went
nuts...hot flashes, night sweats, insomnia, just felt lousy. I lasted
about 1 month and I went back on them. I tried cutting the
patches in half (since I'm on the lowest dose now) but it was very
iffy and I had a lot of ups and downs. My patches have to be
changed every 3 to 4 days...so now I'm pacing them out to 6 days....
HOW IN THE WORLD DO YOU GET OFF OF THEM WITHOUT ALL THE MENOPAUSE
SYMPTOMS? I have a job and have to work and can't feel so lousy.
My doctor says maybe I should stay on them until I'm 65 and am home so
the symptoms won't affect my job. CAN YOU PLEASE OFFER ME SOME
SUGGESTIONS? I use ESTRADERM 0.05.
Answer: The results of the WHI ca not be translated to your situation. The study arm with estrogens alone is still in progress and until now no excess of problems is seen in this study arm. Especially with severe vasomotor complaints, my advice to you is continue the patches. Try once a year for a month to quit (eventually with half a dose: this is not possible with Estraderm TTS, but it is with Estraderm MX or Vivelle). When complaints are still there, restart for a year and so on. |
||
|
|
||
| Question:
Can Prometrium bring on phlebitis?
Answer: No association of Prometrium and phlebitis is known |
||
|
|
||
| Question:
I am going to my DR. this Tue. and I want to get off HRT Transdermal
Patch. Will you please tell me how you would get me off HRT
Transdermal Patch? I want more then one opinion before I do this,
and can't find much info on this subject. I have been on HRT for 5
yrs. I am 65 now.
Answer: Two methods. One is simply stop. And wait and see if any complaint (hot flashes) starts again. The other is first to halve the dose and stop four weeks later. |
||
|
|
||
|
Read Past Ask The Expert Topics
|
![[Dr. Barentsen]](http://www.obgyn.net/all_advisors/images/barentsen-ma.jpg)
