HRT
Dr. Robert Rebar's POF FAQ

21. HRT - what are the alternatives?

Women with POF clearly benefit from estrogen. You are at increased risk of losing bone rapidly and of cardiovascular disease. If you have a uterus, you should take a progestin as well. Estrogen replacement is warranted because of the bone loss that occurs and because of the other problems associated with estrogen deficiency. Estrogen does not seem to preclude pregnancy, though once the diagnosis is made the likelihood of a spontaneous pregnancy appears to be in the neighborhood of 6-8%. For appropriate dosing you should work with your physician. Nothing replaces a face to face chat with your asking the questions you have.

22. Can you recommend a lower HRT replacement? My MD made a comment that she "would hope that I would not get pregnant" while taking HRT. What are the odds in your opinion?

Our experience with POF indicates that we cannot predict the 6-8 % who spontaneously will conceive after the diagnosis is made. Women with this disorder may conceive while using OCs or replacement estrogen, so birth control pills may not be contraceptive in this disorder for unclear reasons. Any woman taking estrogen who has POF and misses a withdrawal period should have a pregnancy test. Our experience indicates that the FSH level should not be used to determine how much estrogen any woman with POF should take. They should take enough to treat any symptoms and not worry about the FSH level.

23. How long should it take for BCP/HRT to eliminate Hot Flashes?

I always tell patients that relief commonly occurs in a few days but may take up to 3-4 weeks for the hot flashes to disappear. If they don't, you should be reevaluated.

24. HRT- are these hormones safe for lengths of time?

This is a complicated question and I would urge you to discuss it face to face with a reproductive endocrinologist. Having said that, most of us believe that currently available data supports the conclusion that in women like you the benefits of HRT far outweighs the risks. There is some evidence to suggest that the risk of breast ca is increased with long term use of estrogen but the increase is modest and not believed by everyone. To put it in perspective, remember that the risk of breast cancer increases with age. In the decade from age 50 to age 60, about 4 out of 100 women can expect to be diagnosed with breast ca. In the worst scenario (given today's data), that number would be 6 out of 100 if estrogen was used for the 10 years -- that's a 50% increase in risk. But 94 out of 100 women would still be cancer free.

25. Can estrace stop ovulation?

I would suggest that you discuss this with your RE. Estrogen can both cause
and block ovulation, depending on the dose and timing. Generally 0.5 mg
estrace is probably not sufficient to reliably block ovulation. In the appropriate setting it may well stimulate ovulation. You see how complicated this can be? Your own RE can best have a on-on-one discussion with you.