“CATHY,” 56 Years Old

The following story has been taken from an actual case in Dr. Vliet’s practice. All names are fictitious to protect patient confidentiality.

Medical condition: Six years earlier, “Cathy” had a hysterectomy and her ovaries were removed.

Although her daytime hot flashes had improved with hormone replacement therapy, Cathy still had night sweats that woke her up several times during the night. Extreme fatigue was making it hard for her to get through her daily activities. She also complained that her breasts felt full and tender most of the time. She couldn’t remember things well and felt like she had “brain fog” that she had never experienced before. Her complete loss of interest in sex was affecting her marriage.

Former Hormone Replacement Therapy

• Premarin - (horse-derived mixed estrogens) 0.625 mg daily for 6 years

Lab Data on Former Hormone Replacement Therapy

• N-telopeptide (a marker of bone breakdown) = 65, too high (indicating more rapid bone breakdown)
• Estradiol level = less than 30 pg/ml (too low)
• Testosterone level = less than 10 ng/dl (too low)
• A bone density test showed osteoporosis

New Hormone Replacement Therapy (bioidentical hormones)

• 17-beta estradiol (Brand name: Climara patch)- 0.1 mg
• micronized bioidentical Testosterone - 2.5 mg sustained release tablet
• Actonel - 5 mg

New Lab Data (at one year after change in hormone therapy and after adding Actonel)

• Bone Density Test showed improvement, now Osteopenia
• N-telopeptide = 35 (now normal, indicating no excess bone breakdown)
• Estradiol = 85 pg/ml (desired target range)
• Testosterone = 45 ng/dl (desired target range)

Cathy’s Comment

“I am so excited to see how much better my bones are now — I was shocked to think I had been taking Premarin all those years and still losing bone. And I am really amazed how much better I feel on the estadiol patch, it is like night and day difference! My breast don’t hurt, I don’t have those drenching night sweats and I sleep well now. I don’t have that awful brain fog, and I feel like I have my mind back again! I feel like the old me! And since you added the testosterone, my energy is so much better, I feel stronger, and best of all, my sex drive is back. My husband thanks you too!”