Re: HRT and vaginal bleeding
From: Rafael Haciski (haciski@earthlink.net)
Tue Nov 21 21:27:25 2006
The dearth of responses surprised me somewhat.
There is no secret formula - I use continuous estrogen and
progesterone therapy, preferring transdermal approach, if agreeable
with the pt. Less frequently I use one of the combination oral
preparations (FemHRT, Activella) - some pts just do not do well with
transdermal approach. Being a fan of drosperinone, I am looking
forward to the new Angelique.
I have not used cyclic HRT in years, just because of bleeding, even
though it is regular/cyclic.
--
Rafael Haciski MD FACOG
Palmetto, FL
On Nov 21, 2006, at 3:59 PM, Atkinson, Samuel M wrote:
> 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
>
