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Re: Is vaginal estrogen unnaposed? From: Atkinson, Samuel M, Jr (ATKINSONS@ecu.edu) Thu Feb 26 08:41:51 2009 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Atkinson, Samuel M, Jr: "Re: Looking for listers' recommendations" Previous message: Laureano Folgar: "Re: Is vaginal estrogen unnaposed?" In reply to: Laureano Folgar: "Re: Is vaginal estrogen unnaposed?" Next in thread: Joanne Bulley, MD: "Re: Is vaginal estrogen unnopposed?" Reply: Joanne Bulley, MD: "Re: Is vaginal estrogen unnopposed?" Most women hate provera especially and progesterone in general. I do agree that vaginal estrogen becomes absorbed and gives systemic effects. Note breast tenderness Joanne describes. I agree eith Dan. Vaginal cream with 1/2 aplicator full three times a week will give systemic effects and is no different than oral and a need for progesterone exists. The index case for this discussion should stand as an example. I would suggest a variation. I use 5 mg norlutate for 14 days (to mimic Mother Nature's pattern) and get the full maturation effect of progesterone--not 5,7 or 10 days) and I have them do this every three or 4 months. There is no requirement for every month. We know ubopposed estrogen can be given up to a year w/o hyperplasia. I start all women on estrace generic and have them find the dose that makes them feel best..and then add progesterone at 3-6 mos. Most women do not like creams I am told. That is why they use oral diflucan even with severe monilia. Only rarely do I use vaginal as Joanne describes estrace vaginal is moderately expensive compared to generic oral. I also agree with Joanne. Estrace is estradiol which is what the ovary produces. It is then metabolized in the pts' liver to make her human, not equine, hormones. sAm ________________________________________ From: ob-gyn-l@obgyn.net [ob-gyn-l@obgyn.net] On Behalf Of Laureano Folgar [lfolgar@vianwe.com] -- ________________________________________ Sent: Thursday, February 26, 2009 7:17 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Is vaginal estrogen unnaposed? 1. Yes, I do. 2. As progestin is not indicated in local low dose estrogen, why increase secondary effects? L. Folgar Christopher Jones escribió: > I just diagnosed a postmenopausal woman with endometrial adenocarcinoma. > Her only identifiable risk factor, if any, is a history of premarin > cream unnaposed by progestins. > > My question is > > 1. Do you consider giving local estrogen without progestins unnaposed? > > 2. In your patients on local estrogen for vulvovaginal symptoms, if you > give a progestin what is your protocol? > > Thanks > > Chris > > ------------------------------------------------------------------------ > > ------------------------------------------------------------------------ > > ------------------------------------------------------------------------ > Se certifico que el correo entrante no contiene virus. > Comprobada por AVG - http://www.avg.es > Version: 8.0.237 / Base de datos de virus: 270.11.3/1973 - Fecha de la version: 02/26/09 07:03:00 > Next message: Atkinson, Samuel M, Jr: "Re: Looking for listers' recommendations" Previous message: Laureano Folgar: "Re: Is vaginal estrogen unnaposed?" In reply to: Laureano Folgar: "Re: Is vaginal estrogen unnaposed?" Next in thread: Joanne Bulley, MD: "Re: Is vaginal estrogen unnopposed?" Reply: Joanne Bulley, MD: "Re: Is vaginal estrogen unnopposed?"

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