Hormone Help For the At Risk Woman

The frustration women face today is that women with hormone contraindications still have reasons to need hormone prescriptions. There are patients who are obese, who smoke, who have had prior deep vein clots, who have diabetes, who even have some genetic tendency to form blood clots, yet they are experiencing untreated menopausal symptoms. And the question remains: are their ways, or situations, that are acceptable conditions by which those patients and their individual physicians can successfully use hormone therapy to treat disabling hot flashes? For women who cannot sleep, or cannot perform their work because of the hot flashes, or have unbearable embarrassment because of sweating the question is: can they find a physician who is willing to treat them when they have risk factors? Perhaps a better question might be: can we soften those risk factors? Weight loss to reduce diabetes for instance might be one way. But some risk factors are just not going to go away. So the newest study of hormone therapy in menopause has again looked at the use of estrogen in women taking pills vs taking estrogen over non-oral routes (creams, patches, etc). They have actually studied some women who had prior blood clots, which was interesting because often these women cannot find any physicians to prescribe these treatments at all. They did find that oral estrogen increases blood clots in this group, who had prior clots, a tremendous amount, about 6 times. But interestingly, they found there was actually no increased risk from the use of estrogen through the skin. Now women who have had prior clots are at risk for repeat blood clot events. So reducing that inherent risk is another issue altogether! What you need to do is see your gyno. Give her an accurate history. Get a full work up: do you have blocked vein blood flow, do you have a genetic tendency to clot, can you modify risk factors like diabetes, smoking, or high blood pressure? And then try to figure out how to best treat the symptoms that are most bothersome, and at the end of the day, maybe hormones can help. It's something to gab about!


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