Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

I read your medical advice to menopausal women, and I have a sense that you are not a big fan of hormone therapy. I am now forty-nine years old, and my last period was two years ago. I am very healthy and try to find the best information I can to make intelligent choices about my health. I have tried for the last 18 months to take the right vitamins, to exercise daily, to do yoga and meditation, and to use Vagifem and Vitamin D and lots of lubrication, so that I could have sex if I desired (even though I had sort of lost interest, if you want to know the truth).

I am a full time lawyer and a mother of three almost-out-of-the nest children, all of whom are fine. I have a good marriage, but the sex used to be better when I didn’t have to worry each time about discomfort. I don’t have any of the risk factors for having a bad outcome from hormone therapy: no family history of cancer, stroke, blood clots or early heart attacks. I’ve have never had a serious medical or gynecologic problem. My internist said he found no reasons for me to be at any higher risk of a complication from hormones than anyone else.

Therefore, three months ago I began hormone therapy,  telling my gynecologist that I would do all that I need to do to monitor its potential side effects. She gave me a low-dose patch of estradiol, and a daily oral dose of micronized progesterone (Prometrium). I still need Vagifem twice a week. But — my life is back!



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I have my old energy and focus. The quality of my sleep is so much better. I am cheerful. I am optimistic. My performance at work is also much better. I am interested in sex, and have comfortable sex three times a week. My husband is overjoyed.

I am comfortable with my decision; I know that it is not a risk free choice, but the life I had before beginning hormone therapy was not the life I could live.

I thought you might like to hear from a woman who made her own decision, and is grateful that we have options for treatments in this period of life. I know that many women can get through this time with no trouble but I wasn’t one of them.

— Patsy

Dear Patsy,

We often get letters from readers who have given up because of decision paralysis. They do not want to take any risk or they want the doctor to just tell them what to do. I hear so often from many women who feel that “doctors just won’t give them the right information…if only they had the right information, they could make a safe decision”. In the meantime, they are overwhelmed, confused, and angry. They are sure that someone, somewhere, has to have the right “information” that will allow them to make the right decision. These are usually women just like you — and they are suffering.

You are an inspiration to all women who refuse to allow fear to run their lives. There will never be enough “information” to take away anxiety and fear. It is well known that menopausal syndrome can ruin a woman’s life. No sleep, no energy, no libido, mood disturbance, cognitive disturbances are recognized symptoms that some women suffer during this unpleasant time. You have chosen to get the right evaluation for risk estimation; you have committed to careful monitoring for breast and endometrial cancer; you understand that blood clots, stroke and heart attack can be rare complications from hormone use, and learned that you do not have the risk factors that increase the chances in such complications.Then you made a decision.

So, you have done the brave thing. You made a decision in the world of gray we live in when others insist on black or white, yes or no. And, you have your life back.

Just remember that in two years, you will need to re-evaluate your choice of hormone therapy. The risk of bad events increases as we increase either the dose or the length of use of hormone therapy. But your story is a wonderful testament to intelligence, courage and determination.

By the way, when it is time for you to use only vaginal hormone therapy for comfortable sex,  we know other things now that can make sex comfortable without the use of systemic hormone therapy.  Send me a question when you are ready.

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  • Laura March 5, 2010 at 4:14 am

    “By the way, when it is time for you to use only vaginal hormone therapy for comfortable sex, we know other things now that can make sex comfortable without the use of systemic hormone therapy. Send me a question when you are ready.”

    Wow, you can’t just end your article with a statement like that; tell us about these other things!

    I am recently menopaused (55yr) and my only real problems now seem to be diminished interest in sex, vaginal dryness, and a change in vaginal PH which leads to very unpleasant odors when my husband and I do have sex.
    My gyn prescribed vaginal suppositories to help with the PH and vaginal hormone therapy. Between these two vaginal treatments I have stuff running out of me all the time and do not feel sexy at all. I am considering oral hormone therapy just to get away from this constant vaginal stickiness. I have always loved oral sex and fear that my husband will never again be tempted to do that for me.

    Help,
    Laura

    Reply
    • Lombardi Chris March 5, 2010 at 12:54 pm

      Laura – we’ve submitted your question to our publisher and menopause expert, Patricia Yarberry Allen. We’ll post your letter and her reply this week. Thanks for writing. — Chris Lombardi, editor

      Reply