Question 49
Dear Doctor:
My DR. at this time is on vacation. I took Prefest for one month. During this time my anxiety increased and continually was nauseous. I was in absolute misery. I had no idea that it could have been the hormones. I am still not sure, but since I stopped them 3 days ago, I am slowly feeling better. I have never heard of this before. Is it fairly common? I would appreciate any answers you can give me.
Thank You
Reply:
Hi,
I am sorry that you are having this problem. Nausea and/or abdominal discomfort is a common problem with orally administered hormone replacement preparations. Ortho-Prefest is a product of Ortho-McNeil Pharmaceutical and contains 1.0 mg estradiol alternating with 1.0 mg estradiol / 0.09 mg norgestimate. Norgestimate is a form of progesterone and its role is to prevent overstimulation of the uterine lining. Progestins may cause anxiety, depression and irritability in a significant number of patients who take it.
I would speak to your Dr about using another HRT product that uses a non oral route of delivery. One of the estradiol patches would probably the place to begin. If you do not have a uterus, there is no reason for you to take any progestin. If you still have your uterus, I would consider taking Prometrium, a natural form of progesterone, for no more than 10 days a month, following which you would have some expected withdrawal bleeding, as the uterine lining sheds. Although any form of progesterone may be associated with unpleasant symptoms, Prometrium seems to cause fewer problems. Taking the progesterone for a limited time each month, may help as well.
If you do not have a uterus, I would not take any progesterone as there is no need.
Discuss these things with your Dr and let me know what happens.
Dr N