Hormone Therapy: Should I Switch from the Pill to HRT?
Q.
I have polycystic ovarian disease and have been on birth control pills for 15 years, as I needed the hormones. I am now 41 and am in perimenopause. When should I consider replacing the birth control pills with HRT?
A.
Recent findings in large-scale research studies suggest that HRT may increase a woman's risk of breast cancer, heart disease and stroke. In addition, when estrogen is prescribed alone, it may increase the risk of ovarian cancer. Consult a physician before starting any medication regimen.
Many perimenopausal women are on birth control pills for one reason or another -- contraception, cycle regulation, or to help with hot flashes, to name a few. Assuming she is not a smoker and does not have significant medical problems that would increase risks associated with taking the pill, a woman can use low-dose birth control pills until menopause. At that point, she does not need such a high amount, relatively speaking, of hormones; the hormones in birth control pills are about 10 times more potent than those in HRT. How does a woman on the pill know when to switch to HRT? One way is if her periods disappear or if she develops hot flashes or other symptoms. At that point her FSH level can be tested to see if she is in menopause. If FSH is elevated, she is menopausal and no longer fertile, and she can switch from birth control pills to HRT. Alternatively, if a woman reaches age 50 without experiencing any menopausal symptoms, FSH may be tested annually; when the FSH becomes elevated, the change to HRT can take place.
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