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Question
Posted by: felix | 2003/03/04

estrogen

Will you please tell me if I am using the right HRT. I was on Climen for 7 years and my Gynae recommend me to take I higher dose of estrogen, because I was Menstuating on the 13th and 14th day of each month. He prescribed Perfesta but it look like that it contains only 1mgEstradiol and Climen contains 2mg. I phoned him and he told me that he looked at it as a whole combination, but I can't understand it - estrogen is estrogen. Please help me and please don't tell me to sort it out with the ginae - he keep to this answer and I can't understand it.
Thanks

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Our expert says:
Expert ImageGynaeDoc

Climen consists of estradiol ( a type of oestrogen) 2mg for the first 11 tablets and oestradiol plus cyproterone in the next ten tablets. This combination is designed to have effects on the endometrium which, in the majority of women, will result in regular periods. In some women, however, breakthrough bleeding occurs as in your case. The problem with this is that irregular bleeding may indicate other problems and it is difficult to distinguish between a problem wiht the uterus or cervix or just the homonal effects of HRT. At your age, there is always a worry about cancer,. so you would need constant tests and checking if the bleeding persists. It is therefore better for you to take a pill which does not cause irregular bleeding. I am not familiar with Perfesta and it is not in the Drug Reference manual. Is this a generic? In any event, your gynaecologist is correct that it is the effects of the oestrogen dose as well as the progesterone/ cyproterone component which has effects on the uterine lining. The type of oestrogen also differs in different preparations. It is not as simple as looking at the dose of oestrogen.

Best wishes

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