Question of the Month
Q:
I've been given a prescription for Estratest
(low dosage) for HRT because I complained of sexual dysfunction and hot flashes.
Previously I've been controlling hot flash symptoms for 3 years by taking birth
control (Alesse) pills. I am 50 years old. Recent studies show possible problems
with HRT but no problem with birth control. Why not just stay on the birth
control pills?
Also, since I have a healthy uterus shouldn't I be taking a combination of
estrogen and progesterone anyway? Estratest seems to be lacking progesterone. My
research shows an increased risk of uterine cancer if I don't take the combined
dosage. If I should have testosterone also (for libido) should my testosterone
levels be checked before prescribing and then monitored while on the hormones?
A:
You raise some important questions regarding
prescriptions for Hormone
Replacement Therapy or HRT.
First, if a woman has her uterus -- that is, did not have a hysterectomy -- and
goes on estrogen, she needs a form of progesterone to prevent an increased risk
of cancer of the lining of the uterus. Occasionally, estrogen is used alone but
requires special monitoring.
Estratest and Estratest HS have a form of testosterone in them. This sometimes
increases sex drive but many women
who take it do not find it makes any difference. However, the testosterone can
cause oily skin, acne, increased facial and
body hair and loss of scalp hair (alopecia).
So I recommend using this with caution, if at all.
Testosterone blood tests are of no use in predicting who will respond to
testosterone with an increase in sex
drive. It is a matter of trying it. If it has not worked in 2 to 3 months,
it probably won't -- but can still have side effects.
I take a dim view of all the hype about how great testosterone is for women.
Most of those advocating it have no idea of the possible harmful effects.
Hope this is helpful.
Sincerely,
Geoffrey Redmond, MD
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