What Are The Side Effects Of Hrt
About 5 to 10 percent of women treated with HRT have side effects which may include breast tenderness, fluid retention and mood swings. In most cases, these side effects are mild and do not require the woman to stop HRT therapy.
If you have bothersome side effects from HRT, talk to your doctor. He or she can often reduce these side effects by changing the type and dosage of estrogen and/or progestin.
If you have a uterus and take progestin, monthly vaginal bleeding is likely to occur. If it will bother you to have your monthly menstrual cycle, discuss this with your health care provider.
What Are The Possible Side Effects Of Estradiol Injection
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
- heart attack symptoms –chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
- signs of a stroke –sudden numbness or weakness , sudden severe headache, slurred speech, problems with vision or balance;
- signs of a blood clot –sudden vision loss, stabbing chest pain, feeling short of breath, coughing up blood, pain or warmth in one or both legs;
- swelling or tenderness in your stomach;
- jaundice ;
- memory problems, confusion, unusual behavior;
- unusual vaginal bleeding, pelvic pain;
- a lump in your breast; or
- high levels of calcium in your blood –nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, lack of energy.
Common side effects may include:
- breast pain;
- vaginal itching or discharge, changes in your menstrual periods, breakthrough bleeding;
- thinning scalp hair; or
- nausea, vomiting, bloating, stomach cramps.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What To Expect At Your Appointment
During your initial appointment, you will be evaluated by a physician and speech pathologist. This visit could last up to two hours. A nurse will seat you in an examination room and will take an initial history, then a resident/fellow will ask you questions about your medical history and initiate the physical examination. The speech pathologist and laryngologist will then perform specialized tests . This examination will be recorded and reviewed with you. This will help the team complete their assessment to help you meet your goals.
The Airway, Voice, and Swallowing Center at UCSF is world renowned as a leading multidisciplinary center designed to serve patients with voice, airway, and swallowing disorders. We provide advanced medical, surgical, and behavioral services for the accurate diagnosis and appropriate treatment of a wide range of voice and speech complaints, swallowing complaints, and other disorders of the upper airway, including larynx and trachea.
The mission of the Center is to provide state-of-the-art care for patients, develop technology for the diagnosis and management of upper airway disorders, participate in research for improved understanding of voice and swallowing disorders, and develop educational programs for trainees interested in field of laryngology.
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What Types Of Hormone Therapy Are Used For Prostate Cancer
- reducing;androgen production by the testicles
- blocking the action of androgens throughout;the body
- block androgen production throughout the body
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer;and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
How Successful Is Femara
Studies show that the success rate of Femara is higher than Clomid for women with PCOS. One study found that while 19.1 percent of women with PCOS who took Clomid had a successful pregnancy within five cycles, 27.5 percent of women with PCOS who took Femara had a successful pregnancy within five cycles.
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The First Thing You Should Do
If you have any of the traditional symptoms of high estrogen or low estrogen, you should first and foremost get blood work with a sensitive assay test to see where your estrogen levels lie.
Some labs use a standard assay test, which is tailored for women almost exclusively, so you would be wise to request the sensitive assay version.
Even with high testosterone levels, you can still experience ALL of the unwanted side effects of out of range estrogen levels if they are too high or low.
Common symptoms of high estrogen include:
- Acne, oily skin
These are all quite unpleasant side effects, and it isnt uncommon to experience several of them at once if your estrogen levels remain too high or low.
After seeing where your Estrogen levels lie, you can decide what dose of AI, and which AI is appropriate to combat those symptoms.
If these symptoms go away and your sex drive is perfect, you have no erectile dysfunction issues, etc. you can conclude that your dosage of AI is satisfactory for the time being.
Obviously the best way to confirm where your Estrogen levels lie though is via blood work.
However, it isnt uncommon for individuals to overshoot the Estrogen sweet spot, and tank their Estrogen without even knowing it.
This is far less likely to happen with the weaker AIs like Arimistane and Aromasin, but it is very common with Arimidex and Letrozole.
Using a predetermined dosage for your AI simply makes zero sense.
Estrogen And The Cardiovascular System
Scientists are still learning about the actions of estrogen in the body. Studies have shown that estrogen affects almost every tissue or organ system, including the heart and blood vessels. Estrogens known effects on the cardiovascular system include a mix of positive and negative:
- Increases HDL cholesterol
- Promotes blood clot formation, and also causes some changes that have the opposite effect
- Relaxes, smooths and dilates blood vessels so blood flow increases
- Soaks up free radicals, naturally occurring particles in the blood that can damage the arteries and other tissues.
Estrogen probably affects the cardiovascular system in other ways that are as yet undiscovered. New research continues to give scientists and physicians more information and raise more questions about this important and controversial hormone.
Over the years, evidence was accumulating that suggested estrogen also helped protect women against heart disease. With heart disease is the number one killer among women over age 65, this is an important issue. Women develop heart disease 10 years later than men, but by age 65, their risk is equal to that of men.
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How Successful Is Clomid
The success rates for Clomid are encouraging. If failure to ovulate is the only problem, approximately 80 percent of healthy women will ovulate, and 30 percent will become pregnant within three months of treatment.
Theres also a 5 to 8 percent chance of conceiving twins on Clomid because Clomid ups the odds that more than one egg will be released.
How Does Femara Work
Femara works in a similar way to Clomid, suppressing estrogen leading to an increase in FSH production, which stimulates the ovarian follicles to mature and triggers ovulation.
Youll take 2.5 mg of Femara per day on days five through nine of your cycle .
Women who havent had ovulation luck using Clomid may find more success with Femara, especially if they have polycystic ovarian syndrome .
Many doctors are finding significant success with Femara, and prefer to use it over Clomid because it has a lower risk of side effects and a reduced chance of conceiving multiples.;
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Diagnosing High Or Low Estrogen
A doctor will have you take a laboratory blood test if they believe you may have either high or low levels of estrogen.
For this, youll go to a laboratory that collects samples, and someone whos trained to take samples will use a needle and vial to collect the blood for testing.
You should receive your results in about a week. Youll see your blood estrogen levels shown in measurements of picograms per milliliter . Once you get your results, your doctor will let you know what youll need to do next.
If theyre normal, you wont necessarily need to do anything. But if your levels or high or low, your doctor will recommend the next steps to help get your estrogen levels balanced.
Here are some of the possible treatments a doctor may recommend to help control your estrogen levels.
Other Factors To Remember:
Hormone replacement therapy works very well and has multiple different options you can choose from. Based on the cost of just the prescription, you may want to say the pills are your best bet. However, we want you to remember that there are other factors involved.
The cost of the doctors visit is not in the price of the prescription. If you have a co-pay for a doctors appointment, this can quickly add up to hundreds of extra charges for your therapy.
The same is true with bloodwork to monitor your levels. You have to pay for these tests, as many insurance companies have caps on how many blood tests they will pay for in a given year.
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Taking Estrogen With A Progestin Vs Estrogen Alone
Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy or combined hormone therapy. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus . Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus . EPT can be given 2 ways:
- Continuous EPT;means the same dose of estrogen and progestin is taken each day. Women often prefer continuous EPT because it rarely leads to menstrual-like bleeding.
- Sequential EPT;means different amounts of each hormone are taken on specific days. There are different ways to do this. For example, estrogen can be taken by itself for 14 days, then estrogen plus progestin for 11 days, then neither hormone for 3 to 5 days. Other schedules involve taking progestin only every few months. This lowers the amount of progestin that you are exposed to. Monthly regimens are also thought to result in hormone levels that are more like the natural menstrual cycle. Cyclical EPT can produce bleeding like a menstrual period, but it can occur less often than monthly.
Does Having Or Not Having A Uterus Make A Difference In Deciding What Type Of Hormone Therapy I Should Take
Yes, it does.
If you still have your uterus:
Progesterone is used along with estrogen. Taking estrogen without progesterone increases your risk for cancer of the endometrium . During your reproductive years, cells from your endometrium are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in your uterus, a condition that can lead to cancer.
Progesterone reduces the risk of endometrial cancer by making the endometrium thin. If you take progesterone, you may have monthly bleeding, or no bleeding at all, depending on how the hormone therapy is taken. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously.
If you no longer have your uterus :
You typically won’t need to take progesterone. This is an important point because estrogen taken alone has fewer long-term risks than HT that uses a combination of estrogen and progesterone.
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Why Do Some Women Need Hormone Replacement Therapy During Menopause
For some women, these symptoms go on for years or decades after they’ve stopped their periods — into the time called postmenopause.
Sarah L Schneider Ms Ccc
Sarah L. Schneider, MS, CCC-SLP, is Speech Language Pathology Director and Health Sciences Assistant Clinical Professor in the Department of Otolaryngology Head and Neck Surgery. She practices clinically at the Voice and Swallowing Center. Clinical and scholarly interests include the evaluation and treatment of all aspects of voice and upper airway with special expertise in the professional speaking and singing voice, transgender voice and communication, spasmodic dysphonia and vocal tremor, irritable larynx including PVFM and chronic cough, and alaryngeal voice restoration. In addition, she has experience with pediatric voice and instrumental assessment of velopharyngeal insufficiency.
She joined the UCSF Department of Otolaryngology, Head and Neck Surgery at the Voice and Swallowing Center in 2007. Since that time, she has helped to further develop the speech language pathology program throughout the Department of Otolaryngology striving to provide interdisciplinary and world-class care to those with voice, swallowing, and communication complaints. She has her Certificate of Clinical Competence in Speech-Language Pathology from the American Speech Language and Hearing Association and is licensed in the state of California.
Professional affiliations include ASHA, the Special Interest Groups – Voice and Voice Disorders and Telepractice of ASHA, and the California Speech and Hearing Association. She is a Lee Silverman Voice Treatment certified clinician.
A Note From Cleveland Clinic
The decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Discuss the risks and benefits of hormone therapy with your healthcare provider at an office visit specifically dedicated for this conversation. Youll need the time to address all the issues and answer questions in order to arrive at a decision that is best for you. Factors considered should be your age, family history, personal medical history and the severity of your menopausal symptoms.
Be sure to talk about the pros and cons of the different types and forms of HT as well as non-hormonal options such as dietary changes, exercise and weight management, meditation and alternative options.
Estradiol Valerate Injection Dosage And Administration
When estrogen is prescribed for a postmenopausal woman with a uterus, progestin should also be initiated to reduce the risk of endometrial cancer. A woman without a uterus does not need progestin. Use of estrogen, alone or in combination with a progestin, should be with the lowest effective dose and for the shortest duration consistent with treatment goals and risks for the individual woman. Patients should be reevaluated periodically as clinically appropriate to determine if treatment is still necessary . For women who have a uterus, adequate diagnostic measures, such as endometrial sampling, when indicated, should be undertaken to rule out malignancy in cases of undiagnosed persistent or recurring abnormal vaginal bleeding.
Care should be taken to inject deeply into the upper, outer quadrant of the gluteal muscle following the usual precautions for intramuscular administration. By virtue of the low viscosity of the vehicles, the various preparations of Estradiol Valerate Injection, may be administered with a small gauge needle . Since the 40 mg potency provides a high concentration in a small volume, particular care should be observed to administer the full dose.
Estradiol Valerate Injection should be visually inspected for particulate matter and color prior to administration; the solution is clear, colorless to pale yellow. Storage at low temperatures may result in the separation of some crystalline material which redissolves readily on warming.
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Whats Been Approved By The Us Food And Drug Administration
The U.S. Food and Drug Administration approves all estrogen therapy medications. Some hormones are sold as bio-identical hormones and are not FDA-approved. They are available without a prescription, and they are not held to the same safety standards as prescription medications. Despite marketing claims, these hormones are also not more natural than the FDA-approved treatments.
What Else Can I Do To Ease Menopause Symptoms
There are many things you can do to curb hot flashes, night sweats, insomnia, vaginal dryness, and lost libido. Lifestyle changes — such as regular exercise, a healthy diet, relaxation techniques, and keeping a regular sleep schedule — can help. If you smoke, quit . Avoid caffeine and alcohol. Lubricants can greatly ease vaginal dryness and heighten sexual sensation.Stay active to avoid depression and seek social support from woemn like you
Your doctor can give you more information about these techniques and other treatment options. The use of selective serotonin reuptake inhibitors has become more common in women who are not good candidates for hormone therapy or prefer not to use hormones. Paroxetine is the only non hormonal therapy specifically approved by the FDA for hot flahes, but some relief has been found with gabapentin .
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What Should I Discuss With My Health Care Provider Before Using Estradiol Injection
You should not use estradiol if you are allergic to it, or if you have:
- unusual vaginal bleeding that has not been checked by a doctor;
- liver disease;
- a history of heart attack, stroke, or blood clot; or
- a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina.
Do not use estradiol if you are pregnant. Tell your doctor right away if you become pregnant during treatment.
Using estradiol can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, if you are overweight, or if you smoke.
Estradiol should not be used to prevent heart disease, stroke, or dementia, because this medicine may actually increase your risk of developing these conditions.
Tell your doctor if you have ever had:
- heart disease;
- porphyria ;
- endometriosis or uterine fibroid tumors;
- high or low levels of calcium in your blood; or
- hereditary angioedema .
Using estradiol may increase your risk of cancer of the breast, uterus, or ovaries. Talk with your doctor about this risk.
Estradiol can slow breast milk production. Tell your doctor if you are breast-feeding.