I have a 59 year old female patient with many medical problems, including osteoporosis and history of stroke, was previously taking Provera/MPA 2.5 mg daily and estrace/estradiol orally 0.5 mg daily. The Provera was stopped in December 2015, but Estrace was continued. The patient is wishing to restart Provera. Would you prescribe hormone therapy? Any alternatives?
If a woman has a uterus then she needs not just estrogen, but progesterone/progestin or BZD like in Duavee to protect the endometrium/uterus. For women with stroke or clot, it is preferable to use transdermal estrogen (there are estrogen-progestin patches in the weekly ClimaraPro or twice weekly Combipatch.)
If one is using hormones for the bones/osteoporosis, there are many other non-hormonal options to treat osteoporosis. For vaginal atrophy, local estrogen therapy or FDA-approved vaginal DHEA, are options.
There is one non-hormonal FDA-approved option to treat hot flashes, Brisdelle (paroxetine 7.5mg at night). For menopausal women needing hormone therapy who have complicated medical histories it may be best to see a menopause specialist.
All My Best,
Speaking of Women’s Health nurse
February 17, 2017 at 12:00am