May 2010

Q. I am a 55 year old white female who just reached menopause one month ago. For the past year I have been on natural progesterone cream and nature thyroid, 15 mg. I also take vitamins, fish oil, CO-Q-10, calcium and a probiotic. I have also been under a naturalists care for allergies and taking a homeopathic remedy called Pulsatilla, also for a year. I am 5' 4", weigh 220 and my blood pressure readings have been 125/80 (at the dentist) and average 140/80 at the doctor's office. I've also had one ovary removed a year ago due to a benign cyst.

Now that I have reached menopause, I am interested in seeing where my body is. I have been off the progesterone cream for about 3 weeks now, off the Pulsatilla about 2 weeks. I just saw my primary doc this week and after testing my thyroid, which she said came back normal, she thinks I can go off my thyroid med. About a year ago, under a different doc, my thyroid panel came back normal except for my antibodies. They were 145 at the time, after being on the nature thyroid for about 2 months, they were retested and came back at a level of 88. So almost a year later, I am now seeing my primary doc, who did not want to do an antibody test due to the cost, and said if my antibodies were off, it would show up in a regular thyroid panel. So, that is why she said I can go off the thryoid med now. We agreed we would give it 6 wks for me to work on my diet and exercise to help my BP and then retest my thyroid, this time with the antibodies included and see where I am.

I am feeling very anxious, and almost a mild depression thinking about the pressure to diet and exercise. I am concerned about my blood pressure. So all that to ask, are there side effects from stopping those meds? I am not sleeping well, I do have a lot of stress at work and I have hot flashes at night and sometimes during the day. What would you recommend? My thoughts seem very scattered and I just don't feel myself.

A. You raise a number of important health concerns but overall you sound like you have been very committed to good health.

It is common for women to have their blood pressure rise as they get older - and in fact more women have high blood pressure than men. Although 125/80 is great, the occasional higher readings under stress (white coat hypertension) is probably a sign your blood pressure may eventually stay high. A low sodium and high vegetable/healthy diet and of course exercise is the best thing you can do. I wouldn't begin medication (such as mild diuretic) unless it stayed high for a longer period. Purchasing a home digital arm cuff that fits your arm and keeping track of your fist morning BP at home would be helpful too.

No serious harm can be done in stopping the thyroid - as long as you check your TSH about 6 weeks or more after stopping - and knowing it is still normal - means you don't need to take further thyroid at this point. As long as your TSH is normal, I agree that checking thyroid antibodies will not really make a difference in your care.

You obviously went through menopause on later side - and women who have a lot of body fat will continue to produce some estrogen - but even this amount may not be enough to prevent you from going through the full swing of menopause - which it does sound like you are going through. For some women a little estrogen in the form of a skin patch or cream can be helpful - but I do worry about added estrogen increasing risk of breast and uterine cancer in a woman with extra body fat who already may have estrogen...The progesterone probably helped you through menopause, but as you are now fully there, I would not take progesterone alone.

Hopefully you can get through this tough period and continue to take such good care of yourself. Not getting enough sleep and added stress are perhaps the most important things to try to come to terms with...not so easy I know.

Q. My osteoporosis recent became much worse, although I've been eating healthier than ever and taking Boniva, Calcium citrate, Vit D and exercising. Now I read so much about all kinds of healthy foods that interfere with calcium absorption....green leafy veggies, whole grains, etc (exactly the kinds of foods I've increased in my diet)...and I'm wondering if my healthier eating could have worked against me! Now I'm trying to space out the taking of calcium supplements and drinking milk, each at least 1-2 hours before/after eating meals....not an easy thing to do at all Do you have any insights as to how to work with the calcium absorption issues and still eat healthy?

A. Please don't be discouraged from eating vegetables. While it is true that the calcium in many dark green leafy vegetables will not be absorbed, as long as you are getting plenty of vitamin D and taking supplements you should be fine. Vegetables will not interfere with your supplements or vitamin D. You need plenty of vitamin D because without D you can't absorb the calcium supplement - and of course you need about 1200 mg of calcium daily as well. Citrate is the easiest calcium to absorb and doesn't require stomach acid as the carbonate forms of calcium do. You are right to space out the calcium however as more will get absorbed. If your bones are really losing bone mass despite all you are doing, I am assuming you are post menopause without estrogen? And would make sure you don't have an overactive thyroid problem or a problem with your parathyroid gland leading to bone loss?

Thanks for sharing your concerns.

Q. I am taking the Vivielle Patch (very low dosage 0.5 and even have been at 0.025) and 10 days of Prometrium (100 mg - the first 10 days of the month). Do I have to take the Prometrium for 10 days? Could I take it 5? I think it makes me hungry! I have all my female parts and am 50 years old. I had to force the issue of bioidenticals at my doctor’s office but he’s doing it my way! 

A. Assuming you still have your uterus (would be no other reason to take the preogesterone/Prometrium) the optimal dose is 200 mg for 1-=12 days/month. This may cause a withdrawal "bleed" or period depending on how much vivelle/estrogen your body is getting both from the vivelle and a small amount produced by fat. If your lining is built up from the estrogen, you will spot or bleed in the final days on the 200 mg prometrium. This is the preferred way as I feel it is most natural and safe; less stimulation to breast too. for some women who don't want to risk bleeding, they take the 100 mg prometrium every day - which will lead to some spotting at first but eventually the uterine lining thins out so much there should be no further bleeding.

Sounds like your hunger won't be helped by my answer.

Q. I am an 81 year old woman who has been on Fosimax since it came out. I believe that it has been about 10 years. I have no history of Cancer, nor bone fractures. I have been following the recent research about Fosimax and am wondering what you think about the long term usage. Should I continue using this medication, or should I just take calcium and vitamin D supplementation?

A. I am so sorry for this delayed response. Although I can't give you personal advice as I don't know all the details of your history, I can say without question that if you are otherwise healthy, do not have a pathologic bone disease and have been on Fosamax for 10 years - it makes sense to give yourself a drug holiday, stop the Fosamax indefinitely perhaps (it will stay in your bones for many years) and continue plenty of calcium 2000 IU of vitamin D daily and exercise.