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Doctors' Answers to "Frequently Asked Questions" - Prempro


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.

[posted 04/8/2000]
Question: I have been taking prempro for 5 year. If I discontinue will periods start again? If so, will they continue?
I am 54 years old.

Answer: Probably not assuming you are post menopausal.

[posted 04/8/2000]
Question: I would like to know if there are herbs that gives the same result as Prempro? If so, What are they and are there any side effcts. I have been taking Prempro for 2 months.

Answer: There are some soy and yam based products that have some estrogen like activity. Check with your pharmacist for brand names.

[posted 01/12/2000]
Question: My wife had a hysterectomy a year and a half ago. After the surgery, she was given PREMARIN. Recently her prescription was changed to PREMPRO. We are concerned that this may be an improper drug for a Hysterectomy patient. We have read that this drug was not intended for patients that have had a hysterectomy. Any info that you could give us would be greatly appreciated. We are dealing with a military hospital and it is hard to get questions answered.
Thank you for your time...

Answer: Prempro is a combination of estrogen and progesterone. Premarin is only estrogen. The reason to combine progesterone with estrogen is to minimize the risk of uterine cancer by giving monthly periods(caused by the progesterone effect). Since your wife doesn't have a uterus, the progesterone is pointless. However, there are some who believe that combining estrogen with progesterone will lower the risk of cancer of the breast. Most physicians would give only the premarin or equivalent-that would be my option if she were my patient.

Prempro [posted 1/13/99]
Question: I have osteoporosis/ostermalacia. My doctor gave me .0625/2.5 mg of Prempro for several months, but then I began spotting once a month for approximately 10 days. I told my doctor about this. He gave me that new biopsy pap test with the long thin tube. It was negative and he told me the bleeding was non- specific and not to worry about it. However, I found it quite annoying. I read if more progesterone was added the bleeding would stop. My doctor then, gave me a new prescription for 0.625/5 mg, but that made it worse. I have been staining now for over 15 days and have taken the new prescription for 2 months. At least with the 2.5 mg the spotting stopped in 10 days. Should I go back to the 2.5 mg? Although he told me the bleeding was non-specific it still upsets me. My pharmacist made a mistake when I renewed my prescription. She gave me the 2.5 mg instead of the 5 mg and I took it for 2 days, but the spotting hasn't stopped. What should I do?

Answer: Sounds like you need to get a "heavy" period and completely slough the lining of your uterus. This usually fixes the problem. By the way, osteomalacia is a completely different problem from osteoporosis and would entail Vitamin D enhancement.

Prempro & Cancer Concerns [posted 12/02/98]
Question: I have been taking Prempro for about 3 years now. I understand that estrogen can increase the risk of breast cancer. I have questioned my doctor about this before, but he seemed to think that the good outweighs the bad, and told me that Prempro can reduce the risk of osteoporosis. Lately I have been reading and listening to medical experts who say that estrogen in the body definitely increases the risk of breast cancer. So I decided to start taking Calcium and a multivitamin everyday for my bones, and Glucosimine Condroitin as I have begun to suffer from arthritis in my left hip and leg. Now, I would like to stop taking the Prempro altogether. I know many women who have been through menopause who are not on hormone replacement therapy and they aren't having any problems. I worry that if I continue with these hormones, I will be sorry later on. I could really use some advice from you, as I have lost confidence in my own doctor. I don't feel that he knows as much as he should. I would really appreciate it. Thank you so much for your time.

Answer: There is an increased risk;but, it is not high. It took combining 8 different studies, over 20-30,000 women, before the risk was identified. If the risk was high, one study would have showed the correlation(like the early smoking/cancer studies). If you have a family history of breast cancer(the risk rises with number, early age and closeness of relationship) you should probably not use estrogen. Reloxifene is probably a good alternative for these women. If you do not have breast cancer in the family, your major risk is cardiovascular. Estrogen is one of the few drugs that will reduce cardiovascular risk.(We think reloxifine will, but, not proven like estrogen). However, estrogen use is an individual decision. If you are not going to use it, consider reloxifene and you will need treatment for osteoporosis(or at least aggressive monitoring).

Prempro Side Effects [posted 11/11/98]
Question: I am 53 years old and have been taking Prempro for 6 months. Soon after I started, I began experiencing a salty taste in my mouth and seem to have a dryer mouth than usual. Could this be related to the Prempro? My dentist said that usually medications are responsible for problems such as this.

Answer: A salty taste usually indicates gastric reflux, as to the dryer mouth-not clear. I suspect if you had the problem immediately after starting Prempro it could be the culprit. But, wouldn't expect it to be the cause if you have been on it 6 months.

Prempro Alternatives [posted 10/13/98]
Question: I have what my doctor has determined as Bipolar II and am on antidepressants as well as anti-anxiety medications, keeping my condition reasonably stable. Two weeks ago I began PremPro and after a week noticed periods of depression and anxiety, which at first I didn't even realize might be connected to the addition of the hormone. Is this possible? I would appreciate any information you could provide on this matter.

Answer: About 20-30% of women experience mood changes on birth control pills or estrogen replacement. Sometimes it is related to the progesterone only. Sometimes to both the estrogen and progesterone, sometimes to the relative strengths. Discuss with the md who put you on Prempro. Reloxifine may be an alternative.

Vision Changes with Prempro [posted 10/1/98]
Question: I have been taking prempro for 2 years. About 3 months ago, I noticed that my vision seemed to be changing -- my glasses were not as effective as they had been. However, this seemed to come and go. After an examination 2 weeks ago, the optician found a dramatic change which he said normally accompanied either cataracts or diabetes. However, the literature on Prempro indicates that vision changes are possible using this drug. I plan to be tested for diabetes, but also feel it would be a good idea to stop taking prempro to see if my vision stabilizes (it is still changing ).

Answer: Certainly sounds reasonable;but, not a common problem.

Prempro [posted 8/13/98]
Question: I started taking Prempro 4 days ago and for the past 4 days I my breasts have been very tender. Should I continue to use this or should I call my doctor tomorrow? Is it possibly that the dosage could be too much? I am on .625 mg/2.5 mg per day.

Answer: This is a usual problem with all the steroid replacement regimes. This does not mean that the dosage is excessive, merely your reaction to the medication. It may limit your ability to take the drug, but is common.

Prempro [posted 8/7/98]
Question: I started prempro the 1st Sunday after cycle and after taking it for only 8 days I had break through bleeding. It now has been 6 days of spottiness. How long will or should this bleeding go on? This is most unpleasant. Also, I never had hot flashes, but did have night sweats. Why am I all of a sudden bothered with flashes?

Answer: Sounds like you were fairly progesterone deficient and the progesterone sloughed a built up endometrium. As to whether you will continue to have bleeding is another story. I would guess that you need a large dose of progesterone to start with (more than prempro) to completely slough the lining of your uterus - or you'll experience further spotting.

Prempro Side Effects [posted 8/7/98]
Question: I have been taking prempro for 3 and one half months and I am 61 years old. I experience bloating and sore breasts. I recently went to the doctor for treatment of hip, back and leg pain. She put me on Cyclobenzaprine, 10 mg in the evening and relafen 2, 750 mg tabs once a day. I am noticing that my breasts are less swollen and not sore. I am also more comfortable with the bloating. Is this a coincidence? Do some of these unpleasant side effects subside after 3 and one half months? Do they ever subside?

Answer: Usually, the soreness persists for as long as you take the prempro. However, I can't figure any connection except that the Relafen is an antiinflammatory. Usually not real helpful in fibrocystic breast disease, but probably the answer with you.

Prempro
Question: If prempro does not stop periods, are there different dosages available? I am at present taking a dosage of 0.625 mg / 2.5 mg. I have been taking this amount for almost a year.

Answer: In general, women stop having periods on prempro-- a major advantage according to most women. However, as long as there is hormonal stimulation of the uterus, there will tend to be occasional periods depending on the uterus and its lining. Occasionally, a D&C will stop the periods. Also, if they are very irregular an endometrial biopsy is usually suggested.

Prempro
Question: What are the most common side effects of the hormone therapy Prempro?

Answer: Prempro is the brand name for a combination drug containing conjugated estrogen and medroxyprogesterone acetate. This drug is used for treatment of post-menopausal estrogen replacement. The medroxyprogesterone is to limit the cancer risk of estrogen on the uterus. Side effects are a combination of both estrogen and progesterone side effects. These are weight gain, bloating, elevated blood pressure, breast tenderness, phlebitis, possible increase in gall stones, edema, etc. These are really very similar if not identical to anyone on birth control pills.

Prempro
Question: Is it possible to order prempro without a prescription? How could I order this?

Answer: You cannot get prempro in the United States without a prescription.

Prempro
Question: I am looking for imformation on Prempro, specifically side effects and benefits.

Answer: Prempro is a brand name of a conjugated estrogen and medroxyprogesterone product. It is mainly used to treat menopausal women with estrogen and progesterone replacement. There are several ways to add estrogen to an estrogen deficient women. One way is to give estrogen for about 21 days followed by a pulse of progesterone(or equivalent). This produces a period and protects against uterine cancer. Another is to give estrogen and progesterone on a daily basis - the rationale for Prempro. The side effects are the same as for estrogen plus for progesterone. However, some advocate that the balance between the two creates less overall risk of uterine and breast cancer. Estrogen can elevate the blood pressure, cause phlebitis and increase the risk of blood clots, inflame the breasts, and cause fluid retention. There are many books available in the book store since this is a very hot topic. In general, I advocate estrogen replacement for most women in the absence of specific contraindications.



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