Question 61
Dear Doctor N,
My mother had a kidney transplant 3 years ago (at age 50) and stopped having periods after the surgery. Recently her gynecologist put her on HRT (Ortho-Prefest) due to Osteoporosis. Now she is bleeding many days out of the month with only about 4 days in between bleeding. This is more than "break through" bleeding, but the doctor says it will quit eventually. Mom is very concerned about this and it is zapping all of her energy. What is your opinion? Is this really normal?
Thanks
Reply:
I am sorry that this has been a problem for her. I am sure it is upsetting.
Ortho-Prefest falls into the group of HRT products referred to as continuous combined therapy agents. In this group, which is intended for women who still have a uterus and need protection for the uterine lining, a progestin is included in a tablet along with the estrogen and taken daily. The rationale is that when a small dose of progestin is given daily that this will eventually cause the lining of the uterus to shrink and no further uterine bleeding will occur. This is in contrast to what is called sequential therapy where the estrogen can be given daily, but the progestin is only given for 10-12 days a month after which an expected withdrawal bleeding will occur, a day, or 2 following completion of the progestin and last for 2-5 days.
Unfortunately, some patients may require up to 6 months for the spotting, or bleeding to stop while taking products like Ortho-Prefest and as you already know this can be upsetting. I think that it would be of benefit to return to the doctor and discuss the nature and amount of bleeding and see if this falls in what would be the expected range. In addition, the issue of your mother's concern and whether she can be comfortable with things as they are, or another approach is needed.
If you would like, you can look at the web site for Ortho-Prefest, http://www.ortho-prefest.com
as this may be of help to you. I have also written a section of my web site that addresses continuous combined therapy, Methods of HRT, which you can access from the Main Menu on the home page, http://www.drn4u.com
I hope that this is of some help to you.
Dr N