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 73 years old, work full time, have happily never married and have a long-term lover and wonderful sex life. I use Vagifem, a form of vaginal estrogen. I take vitamin D and I use Astroglide for lubrication. Sex is completely comfortable and frequent.

I used the birth control pill until I was 50, then my doctor gave me Premarin and Provera. I never had menopause. I stayed on my hormone pills until I saw a new gynecologist three years ago when my previous gynecologist retired.

This new doctor made me slowly wean myself off the hormone replacement and gave me the cocktail for sexual comfort. I have to admit that I did quite well and understood that my personal and family history did support her decision to take away my hormone pills. (My father died at 50 of a heart attack. My mother had breast cancer at 40.) I’ve been diagnosed with high blood pressure, which has been treated successfully for 10 years now.

I don’t have any of the usual complaints about menopausal symptoms. I sleep fine. I don’t have hot flashes. My mood is the same that it always has been. But I am mad as hell at this doctor because I want to restart my hormone pills and she refused. I liked my skin better on hormones. My face has more wrinkles and the skin is sagging on my jaw line. My breasts were firmer on hormones.

I know that these studies that were done on hormones and women’s health have turned out to have lots of flaws. I explained to my doctor that it was my body and that I could choose what medicine I wanted since I was willing to take my own risks. She told me that I would have to begin a relationship with a new gynecologist if I wanted hormone therapy and referred me to another doctor. I don’t think this is right. — Peggy

Dr. Pat: Let’s start with the science. The most important studies of hormone therapy in women over 60 are the Women’s Health Initiative and HERS studies. You are correct in your assumption that the WHI study continues to undergo intensive evaluation. This study was done to test the hypothesis that hormones given to women would lower the risk of heart attack.

Observational studies of women followed for more than 20 years had indicated that there was a 50 percent decrease in heart attack risk in women who used hormones at menopause. The WHI initially issued a broad statement in July 2002, when the study was stopped prematurely because of an increase in heart attack, stroke and breast cancer in the group treated with hormone therapy.

The results were initially presented as relating to all women regardless of age or health. In the five-plus years since the estrogen and progestin arm of the study was stopped, there has been intensive evaluation of the design of this study and the outcomes.

What is important to you is that all continuing information indicates that older women continue to be at greater risk for blood clots, stroke, heart attack and increased risk of breast cancer if they continue to use estrogen and progestin.

Strokes are a kind of cardiovascular disease. A small clot — and remember estrogen promotes clot formation — can block the increasingly narrowed arteries leading to the brain or within the brain itself. Arteries become more rigid and smaller in diameter with increasing age and high blood pressure, which you acknowledge that you have.

The small coronary arteries that provide oxygenated blood to the heart muscle also become smaller and less flexible with age and high blood pressure. These vessels are more vulnerable to clotting and producing angina — or an outright heart attack or death of a part of the heart muscle.

As we age, many of us develop electrical abnormalities of the heart such as atrial fibrillation. This is an extra, frequently unrecognized risk factor for clots.

I agree with your gynecologist. You have been remarkably fortunate in your life, professionally, personally and sexually. Your parents certainly would have been grateful if they had your good health at this age. It would not be in your best interest to take the real risks of estrogen and progestin use at the age of 73 in order to have firmer skin and breasts. I hope that you reconsider and stay with this doctor who seems to have your best interests at heart.

* * * * *
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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