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Dr. Andrew Rynne

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What are the side effects of estrogen replacement therapy?

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Dr. Prakash H Muddegowda

Geriatrics Specialist

Practicing since :2004

Answered : 2138 Questions

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Posted on Tue, 19 Aug 2014 in Women's Health
Question: I am a 62- year old, who had a total hysterectomy at age 36. I have never taken replacement hormone therapy but am considering it at this time. I am a nurse, who has researched estrogen replacement therapy and am concerned about the CV risks (strong family history). I wanted to ask about taking progesterone/testosterone cream and if it would help relieve depression, decreased sex drive and inability to sleep. Your thoughts?
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Answered by Dr. Prakash H Muddegowda 1 hour later
Brief Answer:
HRT is required and combination helps

Detailed Answer:
Hi XXXX,
I am Dr. Prakash HM and I will be answering your query.
My thoughts would be that estrogen and progesterone combined hormone replacement therapy (HRT) is beneficial in improving the overall self esteem and well being.
Estrogen therapy is necessary for the reducing osteoporosis and improving cardiovascular well being.
Along with testosterone, improved significant sex life is noted.

I believe if you can take it strictly under guidance of a doctor, the doctor can monitor the risks of cancers particularly breast and endometrium which will allow them to modify treatment accordingly.

Therefore to improve your present life, I think you should undergo HRT.

Any further queries, happy to answer again.
Dr. Prakash HM

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Prakash H Muddegowda 13 hours later
Are you familiar with bioidentical hormones, and would that be more beneficial in my case? I saw my physician (internal med) today, and she feels strongly that any HRT after age 60 is too risky and will not prescribe. I can always go to a GYN or other physician (several specializing in bioidentical HRT in Kansas City, in close proximity to me), if I want to pursue. Reminder, I had a total hysterectomy at age 36. Your last thoughts?
doctor
Answered by Dr. Prakash H Muddegowda 9 hours later
Brief Answer:
it was not ovarian removal - only uterus

Detailed Answer:
Hi,

After going through your text, I can say a few things.
1. I understand After age of 60, its risky. It could prove beneficial by starting with a low dose. And treatment is considered if benefits out weigh risk. In this case the benefits are many.
2. I have no experience with bioidentical hormones, but adverse effects are similar to HRT or more. Studies are still not suggestive for its use in present environment.
3. Total hysterectomy is only hysterectomy, not salphingo-oophorectomy. Unless I am mistaken about the surgery you had, I believe the ovaries were functional until recently.
4. My last thoughts, you should try HRT.

Any further queries, happy to help you again.
If you have no further clarifications, you can close the discussion and rate the answer.
Dr. Prakash HM
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Prakash H Muddegowda 11 days later
Sorry for the confusion. In the "nursing" world, "total hysterectomy" is the same as salpingo-oophorectomy, which I had at age 36 - so uterus and ovaries removed. Does that change your opinion. I had a Dr. appointment after your first response and asked for a low dose of estrogen/progesterone, and she said definitely no because of the CV risks. She did suggest if I want to pursue, to see a GYN, which I might do. Just wanting to make sure the clarification in information does not change your opinion?? Thanks, XXXX
doctor
Answered by Dr. Prakash H Muddegowda 29 minutes later
Brief Answer:
It could complicate CV problems, if you have.

Detailed Answer:
Hi XXXX,
Looking at the new settings, still I would think it would be beneficial in terms of non-cardiovascular reasons. It is definitely not going to help the heart.

However, I have to caution you, that if you have any cardiovascular risk factors, it could get accelerated, as starting at this point of time, would not help the heart and it could well increase the risk of CV incident.
If you think, you do not have any cardiovascular risk factors other than family history, you can give a try as it could help in improving the bone as well as lipid profile, while helping the overall well being. If you still want to pursue, go for low dose.
Be careful as it will be difficult to predict, how the body will react to the hormones after a long time.
Any further queries, happy to help again.

Dr. Prakash HM
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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