Hormone Replacement in Menopause
Menopause is the natural change in ovarian function. One of the most obvious symptoms of the menopause is hot flashes. Hormone replacement therapy (HRT) in menopause can treat hot flashes AND keep bones healthy and strong. HRT is probably best at doing BOTH of those things in an inexpensive, effective, tolerable fashion.
We can often reduce or prevent hot flashes by using estrogen and tapering the dose over time. The speed of the taper is based on symptoms: if a lower level of estrogen does NOT cause hot flashes then we keep going down. A typical interval is 3-6 months. If you begin experiencing hot flashes we can slow the taper, until the number and severity of hot flashes is OK, then go down in dose.
Hormone replacement MAY help control irregular bleeding, too. Usually, as time goes on, there is little need or no need to treat bleeding in menopause, because there is NO bleeding.
Side Effects & Risks
A July 2002 study found that some women taking estrogen AND progesterone in menopause had MORE breast cancer, significantly more heart attacks, and more blood clots and strokes…[read more] The cause effect relationship between HRT and “bad things” form menopausal women appears only to become significant after five years. Given the newness of this information, we can expect MORE information on this topic to be published in the next few years. Right now we do not have much more on which to base our decision to use, or not to use HRT in menopause.
The cause-effect was NOT found in women only taking estrogen. Those women already had hysterectomies.
Alternative Treatment Options
There are alternatives to estrogen and progesterone use in menopause to control bleeding, hot flashes and keep bones strong. None of the alternatives are as elegant in addressing those problems. The medications are less effective or less tolerable or less easy to take, so something sub-optimal. However, the alternatives do not appear to pose the risk of breast and heart problems associated with long term estrogen and progesterone use in the menopause.
Some of the alternatives include progesterone without estrogen, SERMs, bisphosphonates, and SSRIs. This page will focus on estrogen and progesterone together.
The goal is to have you OFF all hormones (estrogen and progesterone) within two years. The 2002 WHI study found that problems with estrogen and progesterone took about FIVE years to show up. So, as far as we know, and according to the best available medical recommendations, we can use estrogen and progesterone in menopause for as short a time as is necessary.
There are many different medications on the market to get you estrogen and progesterone. One of the easiest to use is a pill that combines estrogen and progesterone. This combination comes in many different doses, making it simple to taper the dose. For example:
- Step 1 – begin PremPro 0.625estrogen/1.5progesterone.
- Step 2 – decrease to 0.45/1.5 in 3-6 months.
- Step 3 – decrease to 0.3/1.5 in 3-6 months.
- Step 4 – decrease to 0.3/1.5 every other day.
- Step 5 – STOP all medication, and see “how you feel.”
If the hot flashes are tolerable/gone, then we can move on to NON estrogen “treatment” of the menopause…[read more]
What You Do
- Read information, contact me with questions, contact me to say ok to start the planned prempro taper
- Tell me which pharmacy to call in you prescription
- Start taking the prempro
- You can expect a little bleeding in the first month of the new pills; contact me with symptom updates.