The truth is that all drugs have side effects; even drugs that we have been using for years as over the counter aids for headaches and muscle and joint pain like asparin, Advil, Alleve, Motrin and other drugs of this class of medicines known as anti-prostaglandins can cause stomach ulcers, erosions of the esophagus and be the source of serious problems. My grandmother always said, “Every drug has a little poison in it. Better think twice about those pills”. And she never went to medical school or became a journalist!
There is important ongoing evaluation of women who use hormone therapy and the “timing hypothesis” that suggests that hormone therapy administered to younger menopausal women may be beneficial to the cardiovascular system (Menopause Volume 15, Number 3, May/June 2008). This would obviously be good news for women who begin hormone therapy in the early part of their symptomatic menopausal transition who may not only have less to worry about in terms of heart attacks, but could have some actual protection from cardiovascular disease. However, there is ample evidence that women who use hormone therapy for longer than 3 years do have a small but real increase in breast cancer and any woman who uses the birth control pill or hormone therapy has a greater risk of developing a blood clot than women who are not taking these medications. Once again, this is a small risk.
Your gynecologist listened to you when you were in crisis and helped you find hormonal therapy that was low dose and effective in giving you back the quality of life that you needed. Now, it is your turn to listen to this doctor. The current recommendations of the North American Menopause Society are clear. Women who need hormone therapy to function should use the lowest dose possible and for a short period of time. Cut the patch in half and use it this way for two weeks. Then leave the half patch on for 10 days while beginning vaginal estrogen for sexual comfort. Stop the Prometrium now.
Be prepared for some hot flashes to return and develop a night-time ritual for management. Do not entice the adrenal glands to join the hot flash party by using VERBS to deal with your symptoms. Do not THROW the covers off, then RIP your nightclothes off, and then RUN to the bathroom to THROW cold water on your face! This just causes the production of adrenal stress hormones to be produced, worsening an already unpleasant situation. Instead, do your part in this trial of no hormone therapy. Prepare for the certainty of night-time hot flashes that will interrupt your sleep. Put a thermos of ice water by the bed with a small glass and a bowl with a wet washcloth in it. Meditate with deep breathing before going to sleep and remind yourself that you will wake up, you will manage the individual hot flash and you will meditate and return to sleep. Be positive. When you wake up, be calm. Breathe deeply 3 times, then drink a small amount of ice water and put ice water on the cloth then place the cloth on your forehead, chest or neck and take 10 meditative breaths. Remain calm. Remove the cloth. Go back to sleep.
Arrange your life to be as stress free as possible for the first 3 months off hormone therapy. Let the family know that you need their support for a few months.
Many women find after they have used hormone therapy for the management of their difficult menopausal syndrome for 2-3 years, that they can manage their symptoms without drugs. You have a concrete plan to evaluate how you feel now, after 3 years of hormone use. If you find that your symptoms are still unmanageable, then speak to your doctor about the risks and benefits that apply to you if you return to hormone therapy for another short period of time.