Oral Contraceptives and Hormone Replacement Therapy. Part 2

This reactive process continues until there are no more functional eggs present in the ovaries and a woman, by definition, is menopausal. This is really a beautifully intricate system that causes a virtual roller coaster of estrogen levels. In order to turn off this roller coaster, or hypothalamic pituitary axis, and provide more steady levels of estrogen, healthcare providers may prescribe very low-dose oral contraceptive pills to healthy, nonsmoking perimenopausal women who don??™t have medical reasons to avoid this therapy.

This is in contrast to a post-menopausal woman whose ovaries are no longer functioning to produce estrogen. For this woman, her hypothalamic pituitary ovarian axis cannot create the estrogen roller coaster of the perimenopause. In menopause, the ovaries (part of that intricate system) are not able to grow follicles that contain eggs that can produce estrogen.? Therefore, a postmenopausal woman needs only that estrogen needed to provide relief of symptoms and help prevent osteoporosis — and not enough estrogen to suppress the hypothalamic pituitary axis.

Q: My doctor recently switched me from oral contraceptives to hormone replacement. I have noticed that monthly, my breasts become quite tender — maybe even worse than when I was still menstruating. What??™s happening?

A: It??™s possible that you actually are not yet menopausal. You may still have functional eggs remaining in your ovaries and you may actually be ovulating, and your breast tenderness may be related to cyclic changes in estrogen and progesterone, just like when you were still menstruating. Make sure to discuss this with your healthcare provider. This may not be the reason but must be investigated. If you are still ovulating, then it is possible that you may become pregnant. Remember, hormone replacement does not necessarily suppress ovulation.

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