Emmitsburg Osteopathic Primary Care Center
121-123 West Main Street, Rear Entrance
P.O. Box 1219
Emmitsburg, MD 21727
301-447-3310

Estrogen/Progesterone Combination Therapy

The first concern of medicine is to do no harm. This rule applies when we know the good. Every chemical medical intervention is both a treatment and a poison. The likely-hood of doing a greater good should overwhelm side-effect or potential harm. It seems there is new information that for many women on combined estrogen/progesterone therapy for hot flushes, insomnia, bone bone loss and depression associated with menopause some may be in real danger.

The brain, the heart, bladder, breast, bones and many other tissues in the body have estrogen receptor. Some tissues, even after the ovaries quit making estrogen, make their own estrogen. Intuitively it would seem that estrogen is a good thing.

Wyeth-Ayerst pharmaceutical company helped fund a study that started in 1993 to look at the long range benefits of PremPro combination hormone therapy. Today the stock of the company has fallen because the evidence unroofed showed that combination therapy showed a trend toward more fatal strokes, more memory disturbance, more heart attacks, breast cancer, blood clots and even more gall bladder disease. The numbers who experienced the effects were not high. Roughly 8 more per 10,000 women on the combination therapy than expected if they were not on the medicine. This is really way too many to say the medicine is safe for all menopausal women.

Why can the medicine be dangerous? Some women have inherited clotting disorders. For example "Factor" deficiencies in the blood that predispose toward blood clots. Many women are smokers. By itself, tobacco is a causal factor for strokes, heart attacks and 40% of cancers. Our diet full of fried foods, fast foods, large meals, and high cholesterol has a similar criminal profile. Introduce a couple of hormones that stimulate insulin and other chemicals in the body that can trigger inflamation, there could be trouble. This pathway is suggested by elevated inflammatory markers such as C-Reactive Protein, sedimentation rate, white cell count.

Women with auto-immune diseases such as Diabetes or Lupus already have extra inflammation in their bodies that puts them at greater risk of heart and brain attacks and disease. Combination estrogen/progesterone therapy seems more risky in these situations.

For some women, uterus still in place, combination estrogen/ progesterone therapy may be essential to their well being. Depression, intolerable hot flushes, bone loss, to mention a few, can be improved. There is also a synthetic compound called Tibolone that does not cause uterine cancer and can also address these effects of menopause. For the most part, plant estrogens do not help as much as would be desired. Some say soy should be limited to 50 grams per day. The search goes on for a really good answer to having many of the challenges of menopause addressed.

In the meantime, follow your dreams and make them happen, become tobacco free, become fried food (including donuts) free and become as healthy as your body will allow. If you are on estrogen/progesterone combination therapy, talk with your doctor and your gynecologist about the pathway most comfortable for you.