7 responses to “Step by step approach to determine the safety of prescribing Hormone Replacement Therapy”

  1. Thanks for this information, Dr. Leon. It sounds like a practical & useful approach to MHT. Further on this topic, recently one of my patients brought the CeMCOR (The Centre for Menstrual Cycle and Ovulation Research, http://www.cemcor.ubc.ca) website to my attention, as she wanted to be on progesterone as well as estrogen despite having had a hysterectomy – this was a new concept for me. For those who don’t know, CemCOR was founded by Dr. Jerilynn Prior, whose name many of us recognize (she was one of my lecturers in medical school in the late 1980’s). The website has areas for patients and healthcare providers. It’s worth a look.

  2. Thank you for the information Dr Leon. I am definitely going use this approach in my practice.

  3. I think the 5 question approach Is a useful guide in deterimining eligibility for MHT.

  4. Thank you I did appreciate this article as well and encouraged to return to more HRT use with a strong approach. I wonder about the use of progesterone only in perimenopausal woman. It seems to work well for symptoms. Would progesterone only hold any benefit for menopausal women?

  5. Thanks, very helpful and straightforward article. I wonder about small doses of vaginal estrogen (i.e. estrace cream).
    I had been told no need to also rx progesterone, but should we still have the woman on both estrogen and progesterone in this case?

  6. useful article

  7. Diana (and Christine): thanks for the info Diana. I know Dr Prior has always been keen on using progesterone. I see no harm from using micronized progesterone. Medroxiprogesterone acetate appears to increase proliferation of breast cells (and hence breast cancer), and affect the lipoproteins in a negative way, so I wouldn’t use it if the patient had a hysterectomy. Thanks for the referral to her website. She seems to make a good point, i.e., progesterone increasing MBD for using it.

    Jenna: the table didn’t come out formatted. I hope it clarifies your question. The intermediate dose is optional. I discuss it with the patient. If they are at high risk for endometrial cancer, I strongly recommend it. Problem tends to be the cost more than anything else, as women feel good (not all) on the progesterone. They sleep better too.
    If local estrogen is prescribed, the need for progesterone is dose-dependent:
    Dose Estrogen Frequency Added Progesterone
    Low Vagifem 10 Twice a week Not required
    EstRing Q 3 months
    Intermediate Premarin 0.5 gm Twice a week Controversial
    Estragyn 0.5 gm Twice a week
    High Premarin >0.5 gm Twice a week Highly recommended
    Estragyn >0.5 gm Twice a week

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