“SHELLY,” 34 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: Premature menopause

“I’ve been on Premphase since my doctor told me I was in premature menopause. I’m not sleeping, I can’t concentrate in school, I can’t remember things, I’m gaining weight around the middle of my body, I have NO energy, my sex drive is totally gone, my joints ache… and this is all getting worse. My family doctor said I’m stressed with school and I’m depressed…. He prescribed Zoloft. But I don’t want to take it unless I know that’s what I really need. He did not do any blood tests to check my hormones.”

Former Hormone Replacement Therapy

• Premphase - 0.625mg/5mg (horse-derived mixed estrogens and cyclic synthetic progestin, medroxyprogesterone acetate or Provera)

Lab Data on Former Hormone Replacement Therapy

• Estradiol - 38 pg/ml (too low)
• NTx 65 - (too high, indicating more rapid bone breakdown)
• Cortisol - 17.7 (high, a stress effect from low estradiol, etc.; this contributes to weight gain)

New Hormone Replacement Therapy (bioidentical hormones)

• 17-beta estradiol (Brand name: Estrace) - 0.5 mg AM & PM
• micronized progesterone (Brand name: Prometrium) - 200 mg for 10 days/mo.

New Lab Data

• Estradiol - 112 pg/ml (goal range)
• NTx16 (now normal, indicating no excess bone breakdown)  Cortisol 9.7 (normal)

Shelly’s Comment

“Being off the Premphase has really helped. I feel lots better – have more energy, my sex drive is back, I am not as moody as I was, my memory is definitely better, and I am doing better in school.”

Physician’s Comment

In addition, Shelly did not need antidepressants.