Question 2 - HRT - Choosing A Program


Hi!

With all the drugs out there for hormone replacement therapy and nice drug reps provding samples of their HRT of choice....Do M.D.'s/D.O.'s have a specific criteria for determing which magic pill is the best for me? (I will soon have a VH and most likely removal of both ovaries for nasty fibroids). She mentioned Estratest. Do doctors and patients have to do a lot of tweaking to get hormone replacement?

Thanks!

Reply:

Hi,

Sounds like a reasonable question, I'll try and give you a reasonable answer.

I actually don't know what other physicians criteria are for choosing an HRT product for a patient, but I'll tell you my rationale.

With all the drugs out there for hormone replacement therapy and nice drug reps providing samples of their HRT of choice....Do M.D.'s/D.O.'s have a specific criteria for determining which magic pill is the best for me?

My agenda is to prescribe the method and product that I feel will be most appropriate in terms of maintaining a patients quality of life, safety and providing an optimum preventative health function. I have no allegiance to anyone other than the patient. I am interested in the information drug reps have to share relative to their respective products, but the responsibility for patient care is mine, not theirs.

Then the patient's preferences and desires are factored in. I prefer to use non-oral methods when reasonable as I feel this is more physiologic, but the patient may have other ideas. There are a lot of safe and effective products available, and there is no best medicine for everyone. If a patient is not comfortable with a route of administration or HRT product she's just not going to take it, and she shouldn't. She may want to take a "pill" that her sister is taking and likes, and if this provides a level of confidence and comfort for her, why not. What I can't do, is allow patients to dictate alternatives that I believe to be harmful to them. And fortunately, they're usually not interested in doing that.

Do doctors and patients have to do a lot of tweaking to get hormone replacement?

Sometimes, a patient is placed on a regimen of HRT and she feels great. Another patient placed on the same regimen may find it's not for her and a trial of an alternate program is indicated. For instance, if I start a patient on a transdermal patch and a form of oral progesterone and she is intolerant to the adhesive in the patch or finds the progesterone makes her irritable, a change needs to be made.

I try to start with the regimen that I think will be the easiest for the patient and still provide it's intended function. If that's not effective, then, in view of the patient's individual response, I go on to an alternate regimen that I believe will more appropriate.

I base these decisions on what I have learned from my colleagues who have had the kindness to share their expertise with me, and the available literature But, what has been of equal importance, is what I have learned from my patients.

Dr N