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Q&A with Australian Health Practitioners
Should I stop taking oestrogen or reduce the dose?
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I had a hysterectomy and bilateral oophorectomy at 29yrs, now 47yrs. I've been on 2mg estrodial for 18years. My right breast was terribly painful for months and when I forgot to take my estrofem as I had run out a few days later the tenseness had gone. I realised it was the oestrogen. I was also waking up in the early hours of the morning nauseous. I decided to try stopping my estrofem. I went for a BMD second one in 5 years and I felt I needed a baseline so I could recheck in a year if I stopped my oestrogen (L hip -1.98 and L spine -1.96 no significant loss in 5 years). Hot flushes are a bother. I really don't know what to do and my GP doesn't either. Do I perhaps take something for my bones and stop the oestrogen? I'm worried about the other benefits of the oestrogen I lose out of. I'm only 47. It's just that I don't think I'm feeling well enough on it anymore. (I suppose I could drop to 1mg?) feel a bit emotional too - however I know why ;) Thank you in advance. -
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Thanks
Dr Joseph Jabbour
Gynaecologist, Gynaecologist - Infertility (IVF) Specialist, Obstetrician
Dr Joseph Jabbour is a specialist Obstetrician & Gynaecologist and Fertility Specialist with Monash IVF situated in Sunnybank (Brisbane Southside). Dr Jabbour has had the … View Profile
Hi. The symptoms of menopause can be quite debilitating as many women know. Hormone Replacement Therapy (HRT) has been proven to be effective in the management of these symptoms. It has also been shown not to increase the risk of Breat Cancer for up to 5 years after the onset of menopause. One of the common side effects of oestrogen is breast tenderness and nausea. Nevertheless I would recommend you have your breasts examined for any lumps.
There are different modes of delivery of the oestrogen. There are several studies that look at oral versus patch form and the patch has been shown to be superior. It has a reduced risk of blood clotting in the legs and lungs and has a better side effect profile. This is mainly because you are not ingesting the oestrogen orally and the effect is different. Estrofem is a tablet so changing to a patch can be the first option. There are a few oestrogen only patches (I prescribe the Climara as it lasts for a whole week). If you prefer the tablet form, then you can certainly reduce the dose to 1 mg or take the 2mg on alternate days.
The recommendation is to have the oestrogen HRT until age 50 and reassess at that stage whether you wish to continue with a reduced dose or cease it. The benefits of oestrogen are numerous: Bone protection, improved Quality of Life (hot flushes and sleep disturbances), improved libido, mood stability, cardioprotective and it reduces the risk of heart attacks, and reduction in risk of Alzheimer's.
For reducing the risk of osteoporosis, doing weight bearing exercises, having a good calcium intake (multiple serves of dairy and green leaf are more effective than calcium tablets) and Vitamin D (occasional sun exposure).
I have a link to an article on menopause and its management which I hope can shed some more light on this question.
Good luck.
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