Archive for hormone replacement
A recent survey on use of female hormone therapy for treatment of menopausal symptoms yielded some surprising results. Over the past several years, there has been an increase of information on the safety of hormone therapy when different modalities are used. Researchers have speculated that this would change the use of hormones in a similar way that the Women’s Health Initiative caused a drastic decrease in overall use of hormone replacement therapy.
Researchers at Stanford University School of Medicine use data collected by the IMS National Disease and Therapeutic Index, where information on prescriptions written in the outpatient clinic setting was collected, to analyze trends in prescriptions for estrogen and progesterone hormone therapy. This data was collected between 2001 and 2009.
Researchers expected to see a trend of increased use of lower doses of estrogen, and use of estrogen patches instead of pills. Research in recent years has shown that:
- Up to 2/3′s of women respond equally as well to the lower doses of estrogens for relief of their menopausal symptoms.
- There is also some indication that use of a more natural form of progesterone called Prometrium may carry less cardiovascular risk over Provera. It also produces less side effects, but is more expensive.
- Estrogen patches bypass metabolism in the liver and reduces risk of blood clots.
The surprising results indicate that there has been a mild increase in use of low dose estrogen, but less than 1/3 of prescriptions reflect this trend. Additionally, there was no appreciable increase in the use of transdermal estrogen therapy.
Additionally, female hormone therapy is felt to be safest and most effective when used close to the onset of menopause instead of years later. The trend does not indicate that this change in initiation of therapy is being utilized.
While there are many concerns and risk factors for use of estrogen and progesterone hormone therapy, they are very effective in preventing menopausal symptoms as well as helping to prevent bone loss, and improving memory issues associated with loss of estrogen. Recent years have yielded information on maximizing safety in using these medications, to include different forms of estrogen and progesterone as well as lower doses.
So what do you do when you see your medical provider? Talk to them about using a lower dose of estrogen, continue to decrease the dose until you reach the lowest dose at which your symptoms are still controlled. Ask your provider about using an estrogen patch instead of pills. Encourage your provider to tailor your dose of medication to you.
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A reader recently posted a question:
What do you do when your health requires you to stop taking your hormone therapy?
Many specialists would simply say, stop your medication and in essence, deal with it. Your gynecologist or family practitioner could no doubt offer more advice than that. My first advice would be to contact your regular provider to ask their advice on controlling symptoms.
The time of menopause is also the time of increase risk of stroke, heart attacks, cancers, and blood clots or DVT ( deep vein thrombophlebitis). Estrogen and progesterone can cause inflammation of blood vessel walls, thus helping to cause stroke, blood clots, and heart attacks. Estrogens can fuel a breast cancer or other cancers of the female organs. Since having one cancer places you at risk for any other cancer, it makes sense to discontinue estrogen for any cancer a woman may experience.
So what do you do when you are told to suddenly stop the therapy which is helping you feel sane and in control?
There are many other therapies which are safe and can help control symptoms, but first you must check with you provider. One thing which will be vital for controlling the symptoms of menopause is a healthy life style. Because of how food is metabolized during this time, it is important to limit foods high in sugar as this can lead to fatigue and sometimes fuel hot flashes. It is also important to limit caffeine and alcohol as these items can trigger hot flashes both daytime and nighttime. Alcohol also causes difficulty with sleep mostly due to the sugar content.
We all know a bad night sleeping can lead to
- fatigue, which leads to
- low energy and avoidance of exercise,
- leads to convenient food choices for comfort and ease of preparation.
- lack of sex drive
- difficulty concentrating
- all of the above leading to low self esteem and possibly depression over lack of control
How do you gain control of all this?
A diet high in antioxidants helps. This means fresh fruits and vegetables, brightly colored or deep leafy green. Consuming less sugar, caffeine, and alcohol. If you are sensitive, a diet low in dairy. If you are not sure how dairy sensitive you are, stop all dairy for 1-2 months and see how you feel. You may have more energy, less respiratory problems and skin problems. Exercise of any kind that gets your heart beating faster and uses your muscles in a way not normally used in your average day.
For medical help when the above measures are not enough, there is clonodine or effexor (low dose) which can help with hot flashes. There are sleep aids which are generally safe for short periods of time. Doing cross word puzzles or other memory type games can help some with “brain fog”, as does some low dose antidepressants if applicable. Herbal products should be used with extreme caution if they contain soy or black cohosh; these products can theoretically be irritating to blood vessel walls as they are estrogen like in their action.
There are measures you can take to control your symptoms, nothing may be as completely relieving as hormone replacement therapy. Talk to your medical provider to get advice targeted to your health situation. Then, write us back and let us know what worked for you! Share your successes with our readers.
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