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Suggest Alternative Medication For Estradiol Taken For Lupus
Question: What is the "safest" drug for someone who has lupus for hormone replacement therapy, who has a history of blood clots with birth control pills,and who has also had a hysterectomy? I have taken premarin since 1995, with no issues(that I know of) but now my insurance refuses to pay for the exhorbinant rising costs of the drug and in all truth I can understand why. My doctor prescribed estriadol but after only one pill I was up half the night itching. Can you please help?
Brief Answer:
All estrogen products have a risk for clotting and are not advised
Detailed Answer:
Hello, and I hope I can help you today.
First, I want to emphasize that, in terms of safety, any estrogen containing product increases the risk of clotting and with your history of blood clots many practitioners would not feel comfortable prescribing it at all.
Your insurance company's choice of product to cover has nothing to do with safety. On the Premarin website, a history of blood clots is viewed as a contraindication to taking the drug. Taking estrogen for longer than 5 years increases these risks even further, and also can increase your risk for breast cancer.
In your case, if you developed itching from synthetic estradiol, you are likely allergic to some ingredient in the pills (it may not be the type of estrogen, but even the inert ingredients that give the pills their shape and color). Even a different brand of estradiol may not have the same effect.
So, from a medical safety standpoint, I personally would recommend trying to discontinue estrogen supplementation completely, unless there are no other products that can treat your menopausal symptoms.
There are many non-hormonal treatments that work for hot flashes that are recommended over estrogen in people who have medical risk factors. For vaginal dryness, vaginal estrogen is safer than a pill because less estrogen is absorbed by your body. Any other "benefits" of HRT were largely debunked by the WHI study which was conducted in the '90s when the popularity of HRT was at it's peak. Here is a reference where you can look at these study results: https://www.YYYY.nih.gov/YYY/whi_faq.htm
So in summary, there is really no "safe" estrogen product. I would not continue to take the specific Estradiol you were given as you are likely allergic to one of the ingredients. If you want to discuss this further, I would be happy to make suggestions you can discuss with your doctor if you just let me know what specific symptoms you are treating with HRT, as there are safer substitutes for estrogen that can treat a lot of menopausal symptoms.
I hope I was adequately able to answer your question today and that my advice was helpful.
Please do not hesitate to contact me further if you would like additional information, or if I can clarify anything else for you.
Best regards,
Dr. Brown
All estrogen products have a risk for clotting and are not advised
Detailed Answer:
Hello, and I hope I can help you today.
First, I want to emphasize that, in terms of safety, any estrogen containing product increases the risk of clotting and with your history of blood clots many practitioners would not feel comfortable prescribing it at all.
Your insurance company's choice of product to cover has nothing to do with safety. On the Premarin website, a history of blood clots is viewed as a contraindication to taking the drug. Taking estrogen for longer than 5 years increases these risks even further, and also can increase your risk for breast cancer.
In your case, if you developed itching from synthetic estradiol, you are likely allergic to some ingredient in the pills (it may not be the type of estrogen, but even the inert ingredients that give the pills their shape and color). Even a different brand of estradiol may not have the same effect.
So, from a medical safety standpoint, I personally would recommend trying to discontinue estrogen supplementation completely, unless there are no other products that can treat your menopausal symptoms.
There are many non-hormonal treatments that work for hot flashes that are recommended over estrogen in people who have medical risk factors. For vaginal dryness, vaginal estrogen is safer than a pill because less estrogen is absorbed by your body. Any other "benefits" of HRT were largely debunked by the WHI study which was conducted in the '90s when the popularity of HRT was at it's peak. Here is a reference where you can look at these study results: https://www.YYYY.nih.gov/YYY/whi_faq.htm
So in summary, there is really no "safe" estrogen product. I would not continue to take the specific Estradiol you were given as you are likely allergic to one of the ingredients. If you want to discuss this further, I would be happy to make suggestions you can discuss with your doctor if you just let me know what specific symptoms you are treating with HRT, as there are safer substitutes for estrogen that can treat a lot of menopausal symptoms.
I hope I was adequately able to answer your question today and that my advice was helpful.
Please do not hesitate to contact me further if you would like additional information, or if I can clarify anything else for you.
Best regards,
Dr. Brown
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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