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Re: Hormonal Replacement Therapy From: Zach Newton (zbnewton@atl.mindspring.com) Tue Dec 31 20:23:11 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Ed Uthman: "PAP Smear after TAH" Previous message: dahmd@gate.net: "Re: Routine Sonograms ?" Maybe in reply to: Garry E. Siegel: "Hormonal Replacement Therapy" Garry E. Siegel wrote: <snipped> > Anyway, a woman on Premarin 1.25 mg. daily and Provera 2.5 mg. daily for > many years is having breast soreness, and has hot > flashes on lower doseages of Estrogen, and thus resists lowering her dose. > Is she on enough MPA to prevent endometrial hyperplasia? I have not seen > anything that comments on using continous combined therapy (ie Prempro or > the equivalent) with higher doses of Premarin than 0.625. If serum estradiol 12-24 hours from last dose is greater than 150 pg/mL, reduction of Premarin by step-down to 0.9 or 0.625 would be prudent. There is evidence -not at hand- that breast cancer incidence increases with supraphysiogic estrogen levels. This can not be known without establishing response of individual patient to a given theraputic estrogen/dose/schedule by measuring serum estradiol within 24 hours of prior dose. Oral estradiol has a shorter half-life than Premarin. The threshold for suppression of hot flashes has been shown to exceed threshold for mean estradiol levels required to achieve end points of cardiovascular and bone protection. At physiologic levels of estradiol (say, 50-150 pg/mL), hot flashes experienced after reduction of dosage from higher levels should dissipate in reasonably short order. Malcolm Whitehead has nicely shown the protective efficacy against endometrial hyperplasia of MPA 2.5 mg on a continuous basis and 5 mg for 13/14 days on sequential basis. I'm not sure which estrogen he used, possibly ethinyl estradiol. Breakthrough hyperplasia occurred with 10 day dosing in his studies. So, the key is mean serum estradiol in projecting protective effect of established MPA regimens, regardless of estrogen agent and dose used. Happy New Year to fellow travelers on this eve. -- Zach Newton Z.B. Newton, III, M.D. Atlanta/Gyn Next message: Ed Uthman: "PAP Smear after TAH" Previous message: dahmd@gate.net: "Re: Routine Sonograms ?" Maybe in reply to: Garry E. Siegel: "Hormonal Replacement Therapy"

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