Ask the Nurse

I am 75 and very healthy. I was prescribed oral conjugated estrogens 0.625 after a complete hysterectomy in 1983 and have taken it without problem ever since. I'm now getting push-back from my Medicare plan and they want to do a pre-authorization before allowing a prescription renewal. I have no other health problems, take no other medications, sleep well, eat a primarily vegan diet, exercise and am a healthy weight. If I'm forced to go off the estrogen I'll suffer bone loss, sleeplessness, hot flashes, which I can't imagine. I have no breast cancer in the family and no diabetes. My mother died at age 95 from congestive heart failure and had severe osteoporosis, and my father died at age 91 from congestive heart failure. My mom did not take HRT. What do I do to convince my doctor to allow me to remain on oral estrogen. Would reducing my dosage to 0.3 make a significant difference in how I feel or lessen the benefits to my bones, sleep patterns, etc?

There is NO time limit to the use of estrogen in women with hysterectomy. Women who take estrogen even into their seventies have a reduced risk for breast cancer. Estrogen helps the bones and vagina at all ages.

However, there is one extra case of stroke per 1,000 women on the 0.625 dose of oral conjugated estrogens in women over 65. So looking at a reduced dose like 0.045 or 0.3 or a transdermal estrogen patch is reasonable at your age as long as it controls your symptoms. Estrogen is not very expensive even if you have to pay for it without insurance. Unfortunately, most Medicare plans automatically consider estrogen ‘high risk’ when usually it is not, particularly if you have been taking it all along. The North American Menopause Society (NAMS) says you do not have to stop estrogen simply because you have lived past age 65. You may want to check the for a menopause specialist near you.

All My Best,
Speaking of Women’s Health Nurse

February 13, 2019 at 3:24pm