Part 2: Unpleasant Side Effects

Side effects … Why they occur and strategies to avoid them.

Most unpleasant side effects of HRT, are related to (1) the oral route of administration, (2) progesterone and progestins and (3) the physiologic action of the hormone on its target tissue.

Side Effects Related To The Oral Route Of Administration:

The most frequent unpleasant hrt side effects associated with the oral route of administration are nausea, vomiting and loss of appetite. These hrt symptoms can be due to either a direct effect of the hormone replacement on the lining of the stomach, or secondary to the affect of the rapidly rising hormone levels on the brain. In the latter case this is not unlike “morning sickness.” If the symptoms do not resolve after a few weeks a reduction in dose, or switching to another oral product may be in order. If this does not alleviate the symptoms a change to a non-oral route of administration will be likely be required.

When a hormone is taken orally it is absorbed by the gastrointestinal tract and transported “en masse,” or as a “bolus” to the liver. This is referred to as the “first-pass” affect. During this passage the absorbed hormone alters the normal production of liver proteins. While most women seem to be unaffected in some women the alteration in the blood levels of these substances have the potential to cause an elevation of blood pressure and/or an increase in the frequency of migraine headaches.

Side Effects Unrelated To The Oral Route Of Administration:

One problem that is not specific to the oral route and can occur with any route of administration is breast tenderness. It can be perfectly normal for a woman who has been hormonally deficient to have breast soreness beginning a few weeks after starting estrogen replacement. Low estrogen levels can result in an involution of breast tissue and when the breast tissue is stimulated by estrogen replacement the breast tissue can be sore and tender for 2-3 months as the breast tissue regenerates. Women who have been estrogen deficient may notice a reduction in breast size and then notice a return to their pre-deficient state after taking replacement estrogen. If a woman does not recognize the reason for the breast soreness, she may suspect the discomfort has a more serious origin, become frightened and stop her HRT. If the tenderness persists for more than 2-3 months, a reduction in dose may be required. Of course it would be prudent for her to discuss this with her physician and have an examination if it persists, or if the physician believes it is warranted.

It is also possible to experience allergic reactions to HRT preparations. Women who are allergic to peanuts need to be aware that some hormone replacement preparations including Prometrium contain peanut oil and are capable of producing serious allergic reactions in those who are susceptible. Many women are allergic to the adhesive in transdermal estradiol patches, or find that they are intolerant to the vehicle in the patch resevoir that contains the medication. In some instances this can be resolved by using another brand of transdermal estrogen patch.

One frequent reason given by women for not starting HRT, or discontinuing its use is the prospect of continued uterine bleeding. A woman who has an intact uterus and is an estrogen user requires the use of a natural, or synthetic progestin to prevent potential overstimulation and the development of abnormal changes of the uterine lining. Women who are on a program of sequential therapy in which the progestin is give for 10-12 days a month will experience an expected withdrawal bleeding. HRT preparations are available that contain a combination of estrogen and a smaller dose of progestin which have been designed to be taken daily and prevent any uterine bleeding. These preparations are widely used and are preferred by many physicians, but others have a concern about the affects of daily use of progestins. Most women tolerate this combination well, but others are intolerant to daily use of even a small dose of progestin and/or find that they continue to experience spotting, bleeding, or cramping while using it. The subject of progestin and progesterone intolerance will be addressed further in the next section.

Many women are concerned that weight gain may occur if they use HRT. The research evidence does not support this and suggests that women who are users of HRT are actually less likely than non-users to put on extra pounds. This is discussed in the section of the web page, Menopause & Weight Gain.

Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

 

Subcutaneous Hormone Implants

Relief from Persistent Menopausal Symptoms And Sexual Dysfunction "…a wonderful hormone replacement option for my patients."

Appointments with Dr. N can be made by calling (248) 644-7200 and speaking to Caroline

I have tried several types of hormone replacement therapy and I still have severe menopausal symptoms. Is this just me or do other women have this problem?                                                                                                                             office-picture-suzanne

It's not just you. Most menopausal women do well while using the routine methods of hormone replacement, but unfortunately 10% to 20% experience persistent life-altering menopausal symptoms unresponsive to their prescribed therapy. This occurs with greater frequency in those women who have had a hysterectomy irrespective whether the ovaries have been removed, however it can and does occur after a natural menopause. While some women who are hormone deficient at least on the surface seem to have few symptoms, others may suffer from sleep deprivation, depressed mood, debilitating hot flashes, night sweats, body aches, irritability, loss of libido, decreased quality of sex and memory problems.

My desire for sex is completely gone and this is causing problems in my relationship with my partner. Is this because of my menopause, or is it a normal part of aging?

The loss of your desire for sex is not due to aging but rather to the fall in hormones associated with your menopause and is reversible with a more optimum program of hormone replacement therapy.

I would really like to feel like myself again. Is there anything that can help?

Subcutaneous implantation of hormone pellets may be the treatment of choice for you. This hormone replacement option is almost always successful in relieving persistent menopausal symptoms and restoring, libido, sexuality, quality of life and sense of well being. The pellets used are derived from plant source and contain estradiol. This form of estrogen is biologically identical to the natural estrogen produced by the ovary. If the patient is testosterone deficient, a pellet containing testosterone can be implanted as well. Testosterone is a naturally occurring female hormone and is the hormone most closely related to sex drive, energy levels and the maintenance of muscle mass. This rarely fails to relieve even longstanding menopausal symptoms, or restore sexuality.

How is this done?

The procedure is performed in the physician's office with a minimum of discomfort and takes only a few minutes. A small amount of local anesthesia is injected into the area where the hormone pellets are to be placed, usually the buttock. The hormone pellets are then inserted into the subcutaneous tissue through an instrument designed for this purpose. Pressure is applied to the site for 5-10 minutes. No sutures are required as the actual incision is very small. As with any other surgical procedure, postoperative infection, or bleeding is possible but uncommon. The pellets, which contain the biologically identical form of natural estrogen produced by the ovary are absorbed into the blood stream producing hormone levels that are physiologic and remain relatively constant day-to-day.  The hormones are absorbed slowly directly into the bloodstream and mimics natural ovarian secretion. Depending on the metabolism of the individual and the number of pellets implanted they last from 3-6 months and the procedure is repeated at that time.

I have never heard of this method of hormone replacement, is it something new?

Actually, it has been available in the United States and other countries for over 50 years. In general, it is offered by physicians who specialize in menopausal issues. This method of hormone replacement was developed by Dr. Robert B. Greenblatt, of the Medical College of Georgia, a pioneer in menopausal medicine and a founder of the International Menopause Society.

Have you used this method in your patients?

I have offered this method of hormone replacement to my patients for 30 years. I believe it is the most successful treatment for persistent menopausal symptoms and decreased sexuality even when the problems have existed for several years. It has been a wonderful hormone replacement option for my patients, capable of restoring them to a previous quality of life, sexuality and intimacy.

Dr. Jerry Nosanchuk is a physician who has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.