PROFOX A Post HRT Nightmare:
(click here to read)
This is a protest from me because many women who
need hormones for depression and osteoporosis are given non-hormonal treatment in
the form of Prozac for depression and Fosomax for low bone density by
physicians who have not learned how to use oestrogens in a way that any general
practitioner would be able to deal with. I have named this therapeutic disaster
PROFOX. (after PROzac + FOsamaX)
DEPRESSION
The worst
culprits are the psychiatrists who although accepting that depression that is
more common in women than in men do not recognise the link with changes of
hormone levels – a condition that we should call reproductive
depression.
This should be obvious because this excessive depression occurs at times
of sudden hormonal fluctuation in that the patient can have premenstrual depression, postnatal depression and menopausal depression. These often
occur over the years in the same woman All of these types of depression have
been shown in careful randomised trials mostly published in a first class
journal like the Lancet but these have not been repeated by psychiatrists who
really view oestrogens with suspicion and fear rather like Dracula’s fear of garlic.
It is equally illogical. Thus women may start their treatment of postnatal
depression with antidepressants, which work for a time, then they are changed,
and then the periods return, and the depression becomes worse as premenstrual
depression. They can have ten years of
antidepressant drugs or mood stabilising drugs or even electroconvulsive
therapy. This is a tragedy because most
of these patients are better treated at the beginning of their illness with
transdermal oestrogens.
An even more unhappy occurrence is that these
patients with premenstrual depression can be and are being misdiagnosed as
bipolar disorder and given inappropriate hard-line mood stabilising drugs and
even ECT. This alas is not uncommon and I
am now collecting a large number of such women who have been completely cured
by estrogens for publication. Severe PMS with cyclical mood changes; bloating,
and breast pain loss of energy and libido can easily be treated by suppression
of ovulation and suppression of the cyclical hormone changes, which produce the
cyclical symptoms. They should rarely need antidepressants if treated
correctly.
OSTEOPOROSIS
A similar problem occurs with osteoporosis which
should be treated with oestrogens but physicians now have a huge armamentarium
of expensive non-hormonal drugs that they prefer to use. I have been fighting this for sometime and at
last we are getting the message through so that general practitioners and the
public are being advised that oestrogens are a worthwhile treatment for women
under the age of sixty with low bone density.
My view is that it should be first line therapy for women under the age
of sixty I am sure that this will happen
because most physicians are becoming aware of the many severe complications
that occur with long term bisphosphonate therapy particularly in the younger
woman.
The nightmare is
that these patients who are already are prescribed Prozac for depression and
Fosamax for low bone density will have these drugs in combination. This is
happening already but an even greater nightmare is to have these 2 drugs in the
same capsule .It is not happening yet but who knows of the extent of the lunacy
of pharmaceutical progress! It should be clear that women below the age of 60 needing
therapy for hot flushes, sweats, low bone density, depression, loss of libido
and sexual problems can be treated effectively and safely with oestrogens possibly
with the addition of androgen.
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10 Reasons to be happy about HRT: (click here to read)
This is an up to date patient guide to the benefits
of HRT and the indications for such treatment, and the importance of using the
correct dose of the correct hormone for a particular indication. The current
uncertainty of the safety of estrogen therapy comes from the American WHI study
in which a “one dose for all” policy was used in women whose age ranged from 50
– 79 with 22% starting after the age of 70. They were also without symptoms and
any indications for therapy. Subsequent analysis of the data make it clear that
any excess side effects occurred in women stating this combination of oral
Premarin and progestogen over the age of 70 or 20 years past the menopause.
Incidentally many of us warned the Americans and the British MRC that this was
the wrong drug used in women of the wrong age only to be rewarded by being
slung off the steering committee of the MRC. Such is life!
The published article
itemises the principal benefits of estrogen therapy starting with the
characteristic hot flushes, night sweats , insomnia, palpitations and the local
problems of vaginal dryness and painful intercourse. There is also a beneficial
effect on bone density in that it can correct osteoporosis and also protects
the intervertebral discs. Estrogens have a beneficial effect on mood and sex
drive although the addition of testosterone (a female hormone!) may be
necessary for improving libido and difficult or impossible orgasms. The
protective effect of estrogens on the frequency of heart attacks is outlined
and this will be a subject of my next newsletter. The paper also quotes from
many patients in that they claim to me nicer people for their husbands and
children to live with as a result of shaking off their tiredness, depression,
irritability and general bad temper that frequently occurs as part of the years
approaching the menopause. Please note that “menopausal” symptoms are usually
at their worst in the four or five years before the cessation of periods in the
so-called menopausal transition.
Best Wishes
Next month I
will discuss the current thoughts on estrogens and the possible reduction of
heart attacks and also the role of estrogens and testosterone in restoring
libido for those with a problem.
I will be happy
to answer questions by email .
Best wishes,
John Studd
46 Wimpole St
02074860497
mobile 07774774999
www.studd.co.uk
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