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 | ESTROGEN DEFICIENCY DISEASE: a.k.a. MENOPAUSE April 8, 1997 |
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Questions asked
in this forum:
Could severe reactions to birth control pills contraindicate Hormone Replacement Therapy later in life? How effective are "natural" hormones as an alternative to traditional medicines? Should women with a history of breast cancer avoid estrogen therapy? Are there studies looking at the relationship between menopause and lost time at work? Could women in their 80s and 90s risk overdosing their systems with by taking estrogen? Additional Comments
NewsHour Links
March 27, 1997:
Reversing a recent panel of medical experts, The American Cancer Society advises women in their 40's to receive annual mammograms.
January 24, 1997:
National medical experts meeting in Washington, D.C. say women in their 40's should decide for themselves whether to have annual mammograms.
OUTSIDE LINKS
A position paper on the pro's and con's of taking estrogen at the onset of menopause.
An extensive reading list on menopause.Judith T. Clune, Indianapolis, IN asks: I am 54 and have been going through menopause for 3 or 4 years. My problem is that I am very wary of hormone therapy. In my late twenties, I had a severe reaction to the birth control pill. Knots formed on the back of my legs and both lungs filled.
I am afraid that I might have the same reaction to hormone therapy. I can live with my hot flashes, etc., but if my health would be better I would like that too. What could I do?
Dr. Susan Love responds:
Your concerns are correct. Estrogen is known to cause phlebitis or clots in the veins of the leg and subsequent clots to the lung. These have been known to happen with postmenopausal hormone therapy as well. There is no reason for you to take hormones if you can live with your symptoms and ther is good reason for you to avoid them. If you are concerned about preventing heart disease (actually hormone therapy has not as yet been proven to do this) exercise, diet and stopping smoking will do as well.
Dr. Charles Hammond responds:
Twenty-five years ago oral contraceptives were quite high in estrogen and progestin dosage, three to five times the current standard oral contraceptives. Many people had side effects. I cannot tell from your description whether you had phlebitis and pulmonary embolus, but it does not sound as such. Replacement hormonal therapy provides estrogen and progestin in dosages that are perhaps five times lower than the lowest current oral contraceptives (15 to 20 times lower than the pills you likely took). Accordingly, I would estimate that side effects would be less.
I would suggest a trial of a transdermal delivery system at a .05 mg estradiol continuous dosage. I presume your uterus remains in place. If so, you would either add progestin as medroxyprogesterone acetate, 5 mg a day for 12 days each month, which would likely yield a short, light withdrawal period, or possibly add the medroxyprogesterone acetate at 2.5 mg a day, continuous, in the hopes of not having any bleeding. I would certainly monitor your extremities carefully for signs of thrombophlebitis. There are no data to suggest that hormonal replacement therapy causes a de novo increase in thromboembolic disease versus that of the untreated population.
There are few data to suggest that in the doses noted above it will activate phlebitis from many years before. The above recommendations obviously presume there are no other specific contraindications to such therapy. In the event there are, or you do not tolerate the replacement estrogen, I would suggest that you have a bone density study done, consider the new drug Fosamax, enhance calcium supplementation if needed, and perhaps Clonicline, which gives some limited help with hot flushes. Control of cholesterol, cessation of smoking, control of body weight and regular exercise can be of some help in cardiovascular protection.
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