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Re: HRT and vaginal bleeding From: Atkinson, Samuel M (ATKINSONS@ECU.EDU) Tue Nov 21 13:57:13 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: NYTimes.com: When Young Doctors Strut Too Much of Their Stuff" Previous message: Richard Chudacoff: "Re: NYTimes.com: When Young Doctors Strut Too Much of Their Stuff" Maybe in reply to: Rafael Haciski: "HRT and vaginal bleeding" Next in thread: Rafael Haciski: "Re: HRT and vaginal bleeding" Reply: Rafael Haciski: "Re: HRT and vaginal bleeding" I have sat on a reply for a week. I must say that the collective experience of most of ue and the literature is bleeding in at least 20 %. In the first paper on combination estrogen and progesterone By sezar axsel (sic) at South Ala, she reported that 50% were amenorrheic at 6 months. Every one quickly forgot that the other 50 % were having irregular bleeding. Wyeth certainly didn't advertise that 50% were still bleeding on Prem Pro . If your patients are 100% without bleeding you need to publish your magic formula. Personally, I give estrogen continuously. After three to four months I then add Provera for 14 days. If they bleed I accept it as "Bleeding according to plan". Any other bleeding is not accepted as normal and I do an endo sampling at the most, once a year. I consider that Provera is a strong protector against endo ca and let them continue the 3-4 periods a year. I certainly do not make them stop. I do not use prempro for the multitude of things published about it in the WHI even though it was bad statistics. Sam Atkinson ________________________________ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Rafael -- ________________________________ Haciski Sent: Sunday, November 12, 2006 9:37 PM To: Multiple recipients of list OB-GYN-L Subject: HRT and vaginal bleeding Something does not compute! I was just reading the blurb about the new HRT med, Angelique (estradiol and drospirenone), and there is Dr. Archer quoting that there is a 20% incidence of vaginal bleeding while taking HRT. I find that surprising, because NONE of my postmenopausal women on HRT have vaginal bleeding. Am I missing something? What is the collective experience in administering HRT as far as bleeding is concerned? I have always considered postmenopausal bleeding an alarming situation that needs investigation thus I accept no bleeding at all, and adjust meds to achieve that. And while on the subject of drospirenone, they tout the progestin as being "almost like natural progesterone" -- then why don't they put natural progesterone in the pill? Rafael Haciski MD FACOG Palmetto, FL Next message: art fougner, md: "Re: NYTimes.com: When Young Doctors Strut Too Much of Their Stuff" Previous message: Richard Chudacoff: "Re: NYTimes.com: When Young Doctors Strut Too Much of Their Stuff" Maybe in reply to: Rafael Haciski: "HRT and vaginal bleeding" Next in thread: Rafael Haciski: "Re: HRT and vaginal bleeding" Reply: Rafael Haciski: "Re: HRT and vaginal bleeding"

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