WOMENS-HEALTH Messages for June, 1997: Re: surgical menopause/migrains.

Re: surgical menopause/migrains.

From: Richard M. Chudacoff, MD (anonymous@obgyn.net)
Mon, 16 Jun 1997 12:34:49 -0500 (CDT)

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At Mon, 16 Jun 1997, Joanne wrote:

>Oh wonderful. Another question then. Is there anything that can be done,
>to help prevent them? That is other than estrogen replacement, as that
>isn't possible as yet.

Why is estrogen replacement not possible? Often headaches are caused, not by estrogen, but the lack of estrogen. Woman who have menstrual headaches have them when the estrogen is at it's lowest concentration. This condition is often relieved with low dose continuous oral contraceptive pills. So, I would imagine that your headaches are caused by the lack of estrogen, not because of it.

>Actually, I do believe the migraine, most likely, was from the Black
>Cohosh. I had also experienced an episode of extreme depression, with
>weepiness and feelings of wishing I was dead, though not bad enough to
>act on the thought, shortly after the first dose of BC.

Then why are you taking this herb? What are you trying to gain by taking it?

>The migraine
>happened several hours after the second capsule.
>Now I know depression is also common with menopause, but it does seem so
>coincidental that these two things happened, both of which I've not been
>subject to in the past, after beginning Black Cohosh.
>I've decided not to tempt fate, so I'm staying away from it, altogether.

Actually, depression with menopause can be associated with the insomnia the occurs with the night sweats and hot flushes. As the estrogen levels lower,the hypothalmus in the brain resets, causing burst of hormones, including LH. This causes the hot flushes. The hot flushes, if not actually waking you, cause a decrease in the REM stages of sleep, thus you become tired, irritable and depressed. >
>Another question for everyone. How long does one usually experience
>menopausal symptoms, post hysterectomy? Are we talking, on average,
>months or years?

Often the first symtoms, the 'immediate' symptoms, can occur before you leave the hospital. These are the symptoms I've described above. Intermeditate symptoms of vaginal dryness, bladder problems, skin changes, occur within 3-5 years of estrogen deprivation. Osteoporosis, cardiac and cerebral symptoms occur 20-30 years after estrogen deprivation, but actually the damage begins relatively quickly, say within 3-5 years. >
>I'm also looking to find the lowest dose of estrogen replacement, I can
>find, to alleviate the symptoms, prevent reactivation of endo, yet give
>me the benefits of ERT by protecting my bones, and heart. Tall order, I
>know. I've heard there is a Climara patch that is only .1mg. That seems
>a pretty low dose to me. Anyone know anything about it? Have any of your
>patients had success with it?

The patch is approximately the same dose as the most common oral estrogen replacement dose, and there are lower patches. The problem with patches, in my opinion, is that they bypass the liver, thus they do not give the same cardiac and stroke protection that the oral agents give. They do relieve symptoms of menopause and help prevent osteoporosis, but more women deprived of estrogen die from heart disease and stroke than do from osteoporsis. Conjugated estrogens and esterified estrogens have been shown to prevent all three diseases at the oral dose of 0.625 mg, equivalent to the patch you mentioned, and can often relieve menopausal symptoms. I don't know your age nor the situation for your ovary removal, but if you were still ovulating, which it sounds like, you may need the equivilent of 1.25 mg to relieve your early symptoms, which can then be decreased down the road.

>
>Thanks again.
>

Well, I hope this helps.

-- Richard Chudacoff, MD Baylor College of Medicine BaylorMedCare Houston/Richmond, TX

This post is intended for eduational purposes only. As with all medical conditions, you should seek consultation with your health care provider prior to instituting any therapy derived from this post or any posts receive on the Internet.

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In reply to: Joanne: "Re: surgical menopause/migrains."
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