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ERTFrom: ainsron@sbcglobal.netTue Apr 9 13:04:50 2002
I saw a 50 yo patient, on referral from an internist today. She had a TAH/BSO 8 years ago, was initially on no ERT for six weeks, then on Premarin, 0.3 mg for a couple of years. She changed internists and because of severe mood swings and emotional lability, he went to estrogen injections and over the past two years she has convinced him to increase it to 2.5cc (12.5 mg) of depo-estradiol twice weekly and 200 mg of testerone every two weeks. She does have some early hypertrophic changes of the labia and clitoris. She is also being treated for depression with Prozac (40mg/d, but adjusts the dose herself, depending on how she feels to as little as 20mg q2-3 days). She describes symptoms of fatigue and mental confusion, to the point where she can't function which has improved on the higher doses of estrogen. Obviously I'm concerned about this high dose of estrogen, other than a psych consult, any thoughts. I did order E2, testerone levels, lipids and hepatic enzymes. My first impression is that she probably is getting some CNS benefit from this supra-physiologic level of E2, and I think she would benefit from tapering while placing her on an anti-depressant that would benefit Serotonin, Norepinephrine and GABA, such as Effexor. What do you think?
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