Not all doctors prescribe in the same way because not all have the same type of information – because of their age, where they were trained, and also their own opinions and fears, but also of their critical training.

Doctors are subject to 3 types of pressure: what they personally believe, what they are made to believe (the pharmaceutical industry, in particular) and what patients expect of them. It is easier and faster to prescribe “standard” hormone replacement therapy (HRT) (as listed in pharmaceutical company leaflets, or in articles subsidized by manufacturers) than to test with the patient. its symptoms one after the other and to weigh the pros and cons of a treatment …

Thus, in August 2009, an article in New York Times¹ revealed that the Wyeth Laboratory, one of the leading manufacturers of hormonal products (including Premarin and Prempro) had paid to write articles to promote HRT from 1998 to 2005 in high profile medical journals, which inevitably influenced their prescription by many American doctors (and probably around the world).

Other articles have shown that the same has happened with osteoporosis treatments.

As for the use of progestins alone, it does not make sense, and for good reason: in principle, estrogen is given to alleviate symptoms related to the lack of estrogen, and progestin is combined with it to counteract the harmful effects of estrogen which, if given alone, tends to stimulate the endometrium (inside the uterus) and breast tissue, causing bleeding and swelling of the breasts.

But progestin alone has no effect on the symptoms of lack of estrogen, and it’s unclear what its long-term dangers are.

Therefore, if the woman wants treatment, it makes more sense to give her HRT combining the 2 drugs rather than just one drug… which will not relieve her. The alternative is therefore not “HRT or progestin alone”, but “HRT or no hormones at all”.

Maybe, but we can’t say for sure. It is intellectually tempting, because plausible, that a bioidentical hormone has less significant side effects than a synthetic non-bioidentical hormone.

BUT bio-identical hormones, even if they are of plant origin, are not “natural” for all that: they had to be modified after having been extracted from the plants from which they come.

And anyway, “natural” or not, if they have the same effects as female hormones, they run the same risks in terms of moderate elevation of the risk of cancer, and vascular accidents.

Remember that the risk of disease (cancer, heart attack) increases due to factors independent of hormones: age, weight, tobacco, diabetes, hypertension.

For the age, we can not do much, but we can act on the other 4. With or without hormonal treatment.

The hormone deficiency is much greater after an oophorectomy than after natural menopause, because at menopause, the ovary continues to make hormones, which are active. After an oophorectomy, the tissues suffer from the sudden absence of female hormones, which have an activity on their elasticity, but also on the cellular balance. Therefore, replacement therapy is essential after oophorectomy in a young woman (less than 55 years old) and should be continued at least until this age, in the absence of risk factors. From the age of 50 to 60, the replacement therapy can surely be gradually reduced to a minimal dose that makes the woman feel well. After 60 years, it has not been proven to be of any use.

Taking phytohormones more than 2 years after a natural menopause has no interest in itself when you are well (even to prevent osteoporosis), and presents dangers, because you suddenly increase the risk of “blazing” a. pre-existing cancer or causing a stroke, while one is well.

At 50, I would be greatly surprised if you already have advanced osteoporosis, because it is especially important from 15 to 20 years after menopause. A decrease in bone density is normal with age for people of both sexes. It does not lead to complications (fractures of the neck of the femur, compression of the vertebrae) until after the age of 65. Osteoporosis is not a threat to all women; those who are most at risk are very small women (less than 1,60 m) who are overweight. Moderate exposure to the sun, taking small amounts of vitamin D in winter, absorbing dairy products (which contain enough calcium), maintaining a healthy weight and regular physical activity (walking for 30 minutes per day). day) are sufficient to prevent complications of osteoporosis. Menopause does not justify performing bone densitometry, which is of no use to “measure” osteoporosis, but essentially serves to justify costly and irrelevant treatments; the diphosphonates prescribed for the prevention of fractures have not been shown to be effective and even seem to increase the risk of fractures! As for Menaelle, it is progesterone, and it has not been shown that this drug has an interest in the prevention of fractures linked to osteoporosis.

Who can you trust? To yourself, above all. Doctors’ recommendations (myself included) are influenced (see above) by many factors (including their own desire to do well), but ultimately it is the patient’s decision that takes away. In any case, it is not dangerous to NOT take substitution treatment. And not taking HRT doesn’t make you age faster! Menopause and aging are not synonymous. Menopause does not accelerate aging (which has been going on since the moment of our conception), although the symptoms that accompany it are sometimes distressing. Taking HRT does not prevent aging; not taking it does not accelerate aging. But fighting against overweight and keeping physical and intellectual activities (reading, writing…) all have beneficial effects on well-being, whatever our age.

Unfortunately no. Because even when they are not metabolized by the liver, hormones have effects on the blood vessels. However, the history of pulmonary embolism is an absolute contraindication: your risk of having one again 13 years later (or after 50 years, once you are menopausal) will have increased, due to your age. It is therefore formally not recommended to take estrogen. As for progestins, they have no usefulness taken alone after menopause.

It doesn’t make sense to give them to yourself in small doses every day, because if you stop them periodically, you will have a period on the off days, along with the symptoms for which you were prescribed. And if you don’t have a family history of early breast cancer (before age 50) there is little risk in taking this HRT for 3 to 5 years. It is also not forbidden, after 18 months, to try to interrupt it gradually (by taking it every other day, for example, then space out the catches). If the bothersome symptoms don’t return, it means you probably don’t need them anymore.

A priori no, because it could be a hormone-dependent cancer. Even if the cancer has (apparently) been removed, the risk of isolated cancer cells remaining scattered around the body and being stimulated by hormones is not impossible.

The effect of phytoestrogens (isoflavones found in soybeans, lignans in flax seeds) would be similar to (but less potent than) that of natural estrogens. It takes the place of estrogen on cellular “receptors” which are sensitive to their effects. Their use has therefore been proposed to reduce the effects of estrogens (but this is illogical, since they are less powerful…) or to compensate for their absence (which is possible, but has not been demonstrated) during menopause. It therefore does not seem justified to me to take phytoestrogens BEFORE menopause. At menopause, on the other hand, it seems legitimate to use it to fight against the most troublesome symptoms (hot flashes, in particular), instead of resorting to synthetic hormones.

You can, after talking to your doctor if you prefer, try decreasing the dose gradually by using smaller patches and spacing the patches over 8 to 10 weeks. The reappearance of symptoms is indeed more frequent when you stop taking hormones suddenly: the disorders you describe are those of a withdrawal syndrome, similar to that which occurs when you stop a substance that has effects on the brain. (alcohol, nicotine, tranquilizers…). However, hormones have an effect on the brain: this is why women in the reproductive period sometimes have PMS with the same symptoms. PMS is a withdrawal syndrome caused by a drop in hormones, which triggers mood disorders and then the onset of menstruation a few days later.

It’s only been a few months and the risk does not increase (see above) noticeably if you take hormones 5 years. It is possible not to take progesterone, because progesterone mainly has a preventive effect on uterine cancer (however, you no longer have a uterus). When combined with estrogen, it contributes to a (small) increase in the risk of breast cancer. So, since it’s not really useful, why take 2 hormones if you’re fine with just one?

While waiting to find out more and to have asked the doctors who take care of your mom about it, it is safer to stop, but if you are taking estrogel to alleviate problems during the menopause, do not Do not stop too abruptly, in order to avoid suffering from withdrawal symptoms. It is safe (and less inconvenient for you) to quit by taking your time, gradually, over several weeks.

No. Because you have no sign that justifies it! Good life to you.

The principle is to take the lowest dose with which you are the best. It is therefore not forbidden or dangerous to start with 1 capsule every day in 1. If you do not have any unpleasant symptoms with this dose, it is good. Talk to your doctor.

Unfortunately, there is none: all sex hormones more or less increase the cardiovascular risk.

If you don’t have a family history of breast cancer, there is little cause for concern (see above). But if your breasts are sore, it is because the respective proportions of estrogen and progestin are out of balance, and you are taking too much estrogen. By reducing the dose of estrogen after advice from your doctor, you should stop this problem.

In general, HRT also acts on mood disorders inherent in the relative lack of estrogen. But it is a treatment for menopause, and it is not recommended for a woman who has not gone through menopause. In contrast, premenopausal people who suffer from PMS do better when they take an oral contraceptive (containing estrogen) continuously (30 days per month). Because thus, they do not feel the effects of “withdrawal” in the second part of their cycle: under contraceptives, their cycle is put to rest.

However, keep in mind that the disorders you describe can also be due to something other than hormonal variations: the brain is an organ sensitive to stress, and everything can be a source of stress: work, the couple, parents, children, the car always broken down, etc. Insomnia and the feeling of being on edge are not always linked to hormonesâ € ¦

1. Article of New York Times : www.nytimes.com. Read also: PLoS (Public Library of Science) Medicine study: www.plosmedicine.org