Answering the Questions Women Have About Menopause – Part II

There are a few risks created by taking estrogen, but the benefits outweigh them.

After the big 3 questions about menopause that I answered last week the next most frequently asked questions include:

#4 If I need to take estrogen, what type is the safest?

There are a few risks created by taking estrogen, but the benefits outweigh them.  One risk is the increased incidence of blood clots when taking ORAL ESTROGENS ONLY.  To avoid that risk, take non-oral estrogen, like an estrogen patch, vaginal estrogen ring, or I use long-acting estradiol pellets.

Another risk is stimulation of the uterine lining that can make you have vaginal bleeding, growth of fibroids, and after extended use, uterine cancer.  All forms of estrogen carry this risk but balancing the dose of Progesterone (Prometrium® or BLA Progesterone) with the dose of estradiol, and suppressing the production of estrone through weight loss, Arimidex and Testosterone pellets. Any and all of these methods make the prescription of estradiol safe when it is in the hands of a skilled physician/NP/PA.

Oral estradiol is a stimulator for weight gain.  If you want to lose weight, estradiol patch and estradiol bioidentical pellets with testosterone is the best choice for you.

There are many caveats to the management of estradiol replacement, and I cannot address all of them, but these facts are what patients should know when seeking HRT from her doctor.

#5 Do I have to take progesterone if I take Estrogen to treat my symptoms?

If you have a uterus, the answer is yes unless you have a Mirena IUD that protects the lining of the uterus for up to 8 years.  The type of progesterone you use is critical

If you have had a hysterectomy the answer is no.

In either case we use nightly progesterone for sleep, anxiety, relaxation without side effects.