Estrogen replacement while on Coumadin

[Kathy McCain]

Great news Colleen, good to hear you are doing much better!

I was on HRT for about eight yrs. I stopped taking it about three years before my AVR though. I have never needed to get back on it, but while I was, it was a Godsend! I really took it for mood swings more than hot flashes. I still get some flashes, but they are very mild.

Take care

 

[Protimenow]

Yeah, Suzanne's right up there with Kevin Trudeau :eek2::biggrin2:

I'm assuming that Cris is disparaging the fact that I mentioned Suzanne Somers. The books I'm referring to were mostly interviews with physicians who specialize in anti-aging, health, and hormone replacement. The opinions in the books I refer to aren't necessarily hers -- they're those of the health care professionals who she interviews.

I don't know much about Kevin Trudeau, but I don't think that the scholarship in his books can come anywhere close to what Suzanne brings to her books.

The idea of bioidenticals being better for the body than synthetically derived compounds taken from animals makes sense to me (but not necessarily others - and I'm not asking anyone to form an opinion or to have an opinion about bioidenticals).

Speaking only from personal experience, the experience of my wife, and the experience of friends on bioidentical therapy, I can only report positive results.

And, whether I learned about bioidenticals from Suzanne Somers (by virtue of the people she interviewed for her books), or from some prominent physician, my confidence in the superiority and safety of bioidentical over synthetic hormones would have probably been the same. I'm not telling anybody what they should or shouldn't do. I'm not even suggesting that you all should have open minds about these things. I wouldn't even be surprised if someone out there doesn't grab one of my sentences and quote me out of context. From my experience, and those of some people I'm close to, bioidenticals DO work. From my reading about the study that cast a bad light on hormone replacement therapy - the main problem was the source of the estrogens used - and shouldn't condemn ALL estrogen replacement therapy.

Please - don't negate the message because you don't like the messenger.

 

[pat45750]

Interesting thread. I wondered about estrogen and warfrin. Seems from reading, that even the creams are not recommend when on warfrin. Hum - we get new valves so our bodies work at top speed and then the rest of it doesn't work well! Pat

 

[Protimenow]

I'm not entirely sure about the effects of estrogens on people taking warfarin. There are some questions to ask: does the INR change vary based on the TYPE of estrogen being taken? (I'm talking about Premarin and other types available as pharmaceuticals that are based on animal sources, versus the bioidenticals). Does the INR change vary over time? (Would a person starting HRT have a larger change in INR than one who has been using it consistently for many months?). Are there any change differences based on the WAY the hormone is taken? (In other words, will the creams cause a different change than a pill?).

The answer to some of these questions would probably involve more frequent monitoring when starting HRT than may be your usual schedule, and regular testing once you've been using it for a while. If the INR goes out of range, again, more frequent testing and possible warfarin dosage adjustment may make sense.

I haven't seen a lot of literature about warfarin and bioidentical estrogens (Estrin, Estriol, Estradiol, etc.), but I get the sense that, since the bioidentical should be treated by the body as if it was the same hormone your body used to make in larger quantities, a bioidentical would probably be safer than the animal-derived types. I'm not convinced that bioidentical hormones are contraindicated as long as the INR is monitored for changes.

Again, the reported problems from HRT were from large doses of Premarin. There are questions about similar problems associated with bioidenticals - and I am not aware of research that shows this problem. It will be great, a few years from now, if actual studies can show the real effects of bioidentical HRT and warfarin (if such studies are being done).

 

[ShezaGirlie]

I don't have a lot of answers about estrogens and warfarin, but I can share my personal experience of taking warfarin for 11 years along with Estrace (estradiol tablets) which is a bioidentical form derived from soybeans and Mexican yams. I have no intentions of ever stopping taking estradiol along with warfarin. I take the lowest (.5mg) dose estradiol and it does wonders for me. Qualify of life is more important than quantity of life for me. That said, I don't intend to croak anytime soon since my Mom is 95 years old..:thumbup:

 

[Bina]

This is all very interesting info. A few years back when I had hot flashes the only HRT that I knew about was Premarin which I had read was derived from pregnant brood mares, so of course being a horse owner I ditched that idea. The bioidenticals that I have heard about more recently would have been something of great interest to me. So, hot flashes are gone, but osteoporosis is here big time. Bummer. Gals: eat your calcium !!

 

[Protimenow]

I'd be surprised if there's an association between estrogen creams and breast cancer. Other factors often come into play (how many children you have, family history, etc.), and the cancer often doesn't develop for many years after these statistically related events.

The problem reported by what may have been a conceptually flawed conclusion was one of heart attacks, if I recall correctly, and this was in women taking estrogens derived from animal sources.

Janie's quality of life statement is an important one here. She's taking bioidenticals and her quality has improved so much that she wouldn't want to stop using it. And she hasn't reported any problem because she also takes warfarin.

I don't work for any pharmaceutical companies. I don't sell bioidenticals. My wife and I use them, and they have provided benefits for both of us. I try to get my kids to have a hormone assay so that, when they become old farts like me, they'll know what levels to aim for so that they can stay feeling youthful.

As long as the hormone is biologically identical to the HUMAN hormone, and you perform standard INR monitoring, I believe that hormone replacement should be safe and the quality of life will be as good as possible.

 

[afraidofsurgery]

I have to debunk some untrue implications about bioidenticals. The FDA has not approved compounded bio-identical hormone replacement therapy (BHRT) drugs. Also, compounded "BHRT" drugs are not safer or more effective just because they are 'natural.

Prescription drug formulations go through a lengthy process of approval with the FDA where they have to show efficacy and safety, so when you take one of these pills you know exactly what you're getting.

Your body doesn't know or care where the estrogen came from, if it's a chemically pure compound it will have the same effect in the body whether it's from a plant or a horse or synthesized in the lab. So, by definition, ALL the prescription and bioidentical products are bio-identical! A drug is a drug is a drug.

I take Yaz BCP's continuously to prevent bleeding at all, I had the safety discussion with my OB/GYN and our conclusion is that the warfarin will neutralize the synthetic estrogen's clot forming risk. Personally it's totally worth the risk to me, I'm not into being miserable due to hormonal imbalances!

 

[ShezaGirlie]

I had the safety discussion with my OB/GYN and our conclusion is that the warfarin will neutralize the synthetic estrogen's clot forming risk. Personally it's totally worth the risk to me, I'm not into being miserable due to hormonal imbalances!

Thanks for your info and it's just one more reason and validation of why I favor quality of life over quantity of life..

 

[Protimenow]

Actually, all estrogens are NOT the same. That's why Premarin is called Premarin (pregnant mare urine) and not called Estrogen. It's not identical to the estrogen that the human body produces. Other related medications - estrin, estriole, estradiol, and probably others are also not identical to the forms that the human body makes. The body may metabolize these into other usable forms, but also metabolizes these drugs into other compounds - which may be where some of the reported problems arise from.

Bioidentical estrogen is supposed to be just that - identical to the form that the human body naturally makes. In theory, a sixty year old woman taking bioidentical estrogens in the right amount could then function in much the same way as she did when she was 20 years old - and her quality of life could be considerably improved. There are certainly other factors at play -- cycling the estrogen is usually recommended, the use of bioidentical progesterone is usually prescribed, and even a low dose of testosterone is used to make the body 'feel' as if it was much younger.

So - a drug is a drug is a drug - is a nice saying, but it's important to be certain when making such a statement that the drugs ARE equivalent. (It's probably safe to say that 'warfarin is coumadin' but not correct to say that 'premarin is estrin is bioidentical estrogen')