Question: My sister is 50 yrs. old and had a total hysterectomy, including oophorectomy, about 2 years ago. She was put on estrogen therapy (not sure of name, but was on 9 mg. per day). Her dose has recently been decreased to 3 mg. per day because she was forgetting to take her med half the time and was okay. My question is, does she need to be on anything at all, and if so, I suspect she only needs some progesterone cream?

Answer from Dr. Prior: The answer to the question you asked about whether or not she needed hormone therapy depends on whether she was still menstruating when she had the surgery, whether it was performed for a non-malignant reason, and whether she now has disturbing hot flushes or osteoporosis.

I've tried to summarize the good reasons for menopausal hormone therapy on the Centre for Menstrual Cycle and Ovulation Research website www.cemcor.ubc.ca . Briefly they are: menopause too early (doesn't apply to your sister); severe hot flushes not helped by other therapies and osteoporosis with hot flushes. There is also an article called "Stopping Estrogen Therapy."

Since the Women's Health Initiative study (the estrogen arm was recently stopped because of increased strokes and no benefit for heart) we know that otherwise healthy menopausal women do not need hormone treatment. In fact those studies are quite clear about risks, especially that of blood clots with pill forms of estrogen. I never, any more, prescribe estrogen except as a patch, gel or cream.

Women who have their ovaries removed almost always lose bone rapidly following the surgery. That would be ok if their initial bone health was good. If your sister has no risk factors I would still urge her to look at the ABCs of Bone Health for Menopausal Women on the website. If she has risk factors she needs a bone density and if it is low the ABCs of Osteoporosis Treatment would be more appropriate.

One of the treatments that has been shown to treat hot flushes is progesterone cream in a dose of 20 mg twice a day. That would be useful if she has mild hot flushes/night sweats.

Otherwise, she may need to take no treatment at all! After all, menopause is not a disease!

Question: I am 46 years of age and I knew there would come a day when the "hot flushes" would start and I find it is now that I am in perimenopause (premenopause?). I just refuse to believe that I must suffer through my body's inability to control its heating system.

I have been doing as much research as a layman possibly can regarding premenopause and menopause and interestingly, the name of Dr. Prior came up in my doctor's office today. With much excitement I asked for a referral to Dr. Prior but did not know if she accepts patients. This is why I am emailing now. I am keenly interested in Progesterone treatment or any cutting edge information and tools for relief of these symptoms I am experiencing. I just don't believe I have to wait it out. Can you please help?

Answer from Dr. Prior: Although I'm still following women I've ever seen, I am not taking new patients. However I would be happy to speak with your doctor about your situation.

In the meantime, I'd suggest you look at the material we have on the Centre for Menstrual Cycle and Ovulation Research website www.cemcor.ubc.ca. There are articles, in particular "Perimenopause--the Ovary's Frustrating Grand Finale" and the Daily Perimenopause Diary and instructions so that you can track what you are experiencing.

We know a lot about treatment of hot flushes in menopause. Currently no randomized trial has tested perimenopausal women and identified an effective treatment of hot flushes. However, our clinical experience suggests that cyclic natural progesterone (Prometrium) is both effective and a safe therapy in women with hot flushes and periods. There is a handout about Cyclic Progesterone Therapy also on the website.

Question: I would like advice on assembling a team for diagnosing and treating my perimenopausal symptoms and other conditions, as well as providing me with support and access to services.

At the moment I am feeling pretty well. Since I have not had a period for many months I may be approaching menopause, which may partly explain the reduction of my symptoms. Certainly I have used (extreme) lifestyle modifications to assist myself in coping. I have suffered symptoms which have been debilitating to me, which have caused me to live in a condition of disordered thought for several years and significant pain for the better part of one year. This has disrupted my life and nearly bankrupted me.

I have not been diagnosed as perimenopausal. I have been variously diagnosed as having Post Traumatic Stress Disorder (which is probably also true), having anxiety starting several years ago, and as having had anemia and gastrointestinal bleeding within the last year. I also believe I had symptoms of Mild Traumatic Brain Injury (from a motor vehicle accident several years ago ), and may have had health effects from removing around 12 mercury amalgams from my mouth about five years ago.

I would like to provide some information, but hope my letter doesn't sound bleak. I am feeling better and therefore am writing this letter. I would like to be tested, to know what is going on with my body and mind as a basis for treatment. Some questions which I have follow: What pertinent tests (including endocrinological) are available in BC, in Canada, or elsewhere, to examine me? What practitioners or clinics could help me? What insurance plans could help or could have helped me to afford alternative medical treatments, counseling, and to provide money to support me during an extended (though temporary) illness?