Question 80
Hi Doctor N,
I am 46 years old and I had a hysterectomy in l995,because of a large cyst in my uterus. I do not have my ovaries. I am now taking Prempro.
This prescription renewal was the first time there was a cautionary statement concerning skipping doses. Previously I had taken Prempro daily, and had quiet a bit of breast tenderness. So I had started taking a Prempro only on Monday, Wednesday and Friday. Now I am being told by my doctor not to skip doses. What will skipping doses do? I would prefer to take something more natural but need to combat hot flashes, and vaginal dryness. Any "natural" suggestions.
Thank you
Reply:
The cautionary note was likely intended for women with a uterus for whom this product is intended. It addresses the need for adequate suppression of the uterine lining, to prevent the development of abnormal changes of the endometrium. The progestin dose in Prempro is low as compared to women who take progestins 10-12 days a month in a higher dose for over stimulation of the lining. Women who have a uterus and are using this product may have spotting and/or inadequate protection of the uterine lining and this is the manufacturers concern.
As you do not have a uterus, there is no need for you to include a progestin in your regimen. Progestins are associated with breast tenderness, irritability, mood swings and fluid retention. Women who have been hormonally deficient may have breast soreness beginning a few weeks after beginning estrogen. Low estrogen levels can result in an involution of breast tissue and when the breast tissue is stimulated by estrogen replacement the breast tissue can be sore and tender for 2-3 months as the breast tissue regenerates. Women who are estrogen deficient may notice a reduction in breast size and then notice a return to their pre deficient state after taking replacement estrogen.. If a woman does not recognize this for what it is it can be very frightening. If the tenderness persists for more than 2-3 months, a reduction in dose may be required. Of course it would be prudent for her to discuss this with her physician and have an examination if it persists.
I would suggest you speak to your doctor about a replacement product that is estrogen only, or one that contains estrogen and testosterone if you have problems with fatigue, or low energy levels.
If you would prefer an HRT. program that is more reflective of naturally occurring hormones, you could speak to your doctor about an estrogen patch which contains estradiol which is the biologically active hormone produced by the ovary. If you would like to include testosterone as you are likely testosterone deficient due to your absence of ovaries, you could use a estradiol/testosterone gel, or subcutaneous hormone implants.
If you have the time, read the sections of the web site under the HRT heading and question 52 in the Ask Dr N section as they address these issues. You may reach these links on our home page at www.DrN4u.com
Dr N