Have a question about women’s health or menopause? Dr. Patricia Yarberry Allen may have the answer. Click here to send in your question to be posted on WVFC.

Question: I am 49 years old and have not had a period for seven months. My gynecologist assures me that I am probably finished with this. I am not doing well. I always had PMS, and after the birth of each of my three children I took an anti-depressant for six months until my hormones were normal again. I feel now just as I did at those times.

I am edgy, anxious, irritable. I am having hot flashes during the day and sweating at night that wakes me almost every hour. I run a large division of a major corporation and I can not afford to be exhausted and not myself.

My gynecologist does not want me to take hormones because my mother had breast cancer at 80. I am thin and fit. I do not smoke or drink. There is no family history of early heart attacks or strokes and I have been given a great grade on a recent echo-stress test. I understand that there are risks to hormone therapy, but I can not function like this. – Beth

Dr. Pat: Clearly you have done your homework. You have reviewed the contra-indications to hormone therapy and know that you do not have any obvious ones. You have taken good care of yourself and are asking yourself what price you are willing to pay to have some improvement in your quality of life.

Doctors became very concerned about prescribing hormone therapy after the release of unexpected and negative results from the Women’s Health Initiative in July 2002. Over the past five years, many scientists and doctors have worked together to deconstruct this study and ask hard questions about how those results apply to the care of women who are suffering and especially women who are, like you, in the early part of the menopausal transition.

The North American Menopause Society issued guidelines [PDF] in 2006 about the use of hormone therapy that are very sensible. Hormone therapy can be used in low doses for a year or two by women in the early stages of menopause who have significant menopausal symptoms. Then a hormone holiday is a good idea, because many women will no longer have the significant symptoms that caused them to use hormones in the first place.

Your doctor’s question about the increase in breast cancer that you might have from this short term use of hormones is one that every gynecologist and patient must ask. You do not have a family history that increases your personal risk for breast cancer since your mother was quite old when she developed breast cancer.

Hormone therapy does not seem to increase the risk of heart attack in women who are newly menopausal unless there is a known risk for heart disease or unknown genetic risks. (Research published June 21 in the New England Journal of Medicine indicates that women who have had hysterectomies may see some heart benefits if they take estrogen in their 50s — here’s the AP story. This study, however, does not apply to women who still have their uterus, as estrogen alone can cause uterine cancer. In any case, hormones should not be used to prevent heart disease.)

Of course, estrogen may cause blood clots and stroke in any patient, including young women who use the birth control pill, but this is a very small risk in women your age and menopausal stage. Systemic estrogen therapy can be taken orally (tablets), or the hormone can be delivered through the skin, either by patch, gel or emulsion. I’ve found that the patch, when necessary, is generally well-tolerated and delivers the most consistent continuous dosage.

I suggest strongly that you arrange an extended consultation with your gynecologist about what risks you are willing to take in order to reclaim your life.

* * * * *
Dr. Patricia Yarberry Allen,
director of the New York Menopause Center, is a gynecologist affiliated
with New York-Presbyterian Hospital and a board certified fellow of the
American College of Obstetrics and Gynecology.
Have a question about sex, women’s health or the menopausal transition? Write to [email protected].

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