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Doctors' Answers to "Frequently Asked Questions" - Hormone Therapy

Related Women's Issues

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Considering Cardiac Risks of Premarin Use [posted 11/5/98]
Question: Is there any medical risk of cardiac or CVA problems with the long term use of Premarin for a woman who has had a total hysterectomy? I take .625 mg per day and have been for the past 11 years.

Answer: There may be a slightly increased risk for the first year of use, then the risk drops. Most physicians would strongly recommend estrogen use to decrease vascular disease.

Bellamine S tablets for Menopausal Symptoms [posted 11/4/98]
Question: I'm taking Bellamine S tablets by amide for menopausal symptoms and find that it is working well for me. I'm curious though about its history and where I might find more information about it on the internet. My D.O. prescribed it for me instead of hormone replacement therapy (HRT) and said that this was used before HRT was available. Could you tell me more about it? How does it work? What are the main ingredients? Thank you.

Answer: As to the history, I would contact the company, a list of numbers is in the front of the PDR. Side effects are usually constipation and dry mouth. This class of drugs was used extensively in the 60s and 70s;but, stopped due to law suits as I recall. There were few actual problems, just legal ones.

Premarin Concerns [posted 11/4/98]
Question: I had a total hysterectomy in 1994 and was immediately prescribed Premarin. I asked my doctor how long I need to take Premarin and her answer was "forever, it keeps us young." I dislike the idea of taking anything forever and would like information in order to make an informed decision as to whether I need to take Premarin "forever," or if I can discontinue, or decrease gradually as nature must have intended. What would be the side affects? Could I do well with one of the newly advertized "natural" or herbal estrogens? I have listed the medication I currently take and I will soon be starting Lipitor to control cholesterol. Thank you.

Answer: The best current drug to decrease cardiovascular disease is estrogen. Women still die most frequently from this class of problems, not cancer or other problems. A very good study was done on nurses which showed both an increase in longevity and an increase in quality of life in women taking estrogen. If there is a strong family history of breast cancer it should probably be avoided and reloxafene taken instead. For a women who has elevated cholesterol, this would be one of the best drugs going from my prospective. As to natural estrogens, there is no direct evidence that there is any difference in your body's response. Nature must have intended for us to have elevated blood pressure and diabetes mellitus;but, we treat these with increased longevity. Your call, but, a great drug for longevity and quality of life.

DepoLupron & Hormone Production [posted 10/30/98]
Question: Please describe the recommendations for this drug, side effects, and how it works in the body. I am looking up this information for a friend prescribed this drug.

Answer: DepoLupron is a synthetic nonapeptide analong of gonadotropin-releasing hormone. It works as an LH-RH agonist inhibiting sexual hormone production. In this manner, it effectively decreases or stops natural production of testerone(in men the usual receptors ). Side effects center on those seen with steroid absence-similar to what women experience in menopause. Hot flashes, decreased sexual drive, impotence, difficulty concentrating, weakness etc.

Finding Plant Based Alternative to the Animal Based Premarin
Question:I found your web site most interesting. However, we are looking for Estropipate, the plant based estrogen which has been prescribed for my mother-in-law. We think it is made by Ogen. Can you help? would like to know exactly what this is and if there are any side effects. She is 80 years old and in very good health. she was originally prescribed Premarin, which we are opposed to her taking.

Answer: Opposed due to what? Estropipate is made by Ortho/McNeil and is stucturally different from other types of estrogen. However, seems to have the same risks/benefits of the other estrogens. These include hypercoagubility, hypertension, cancer of the breast and uterus, and fluid retention. There are no major differences in side effects between Premarin and Estropipate.

Hormone Replacement Therapy
Question: I have been on Prempro for 6 weeks. I have had spotting daily for 4 weeks. Is this unusual and, if not, how long should it continue? Once I stop spotting, will it reoccur? Except for enlarged breasts and tender nipples, I have no other reactions to the drug. I am 73 years old, with severe osteoporosis, and I am also taking Fosamax.

Answer: It sounds like you have just recently started taking hormonal replacement. Usually, Prempro will not cause spotting, one of the reasons for its popularity. However, the spotting represents build up of your endometrium and may require a burst of progesterone to cause a regular period. I'd give it two or three more weeks to see if it goes away. If not, you will probably need a regular cycle or switch to an estrogen regimen followed by a progesterone burst (causing regular periods).

Estrogen Therapy
Question: My wife has been on estrogen therapy for about 25 years. A year ago her prescription dose was cut in half. Since then she acts like a different woman. She's become very easily upset. Acts like a know it all. Quick to contradict. Laughs after making a statement which is not at all humorous. Could the reduction in her estrogen dose have caused this pesonality change?

Answer: Sure. Double the dose and see if it vanishes. If not, get a complete workup by a good internist.

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