HOW HORMONE INJECTIONS TRANSFORMED TWO WOMENS' LIVES

Miranda, aged 51 years, came to see me in a very distressed state. She had been on a standard dose of hormone tablets for two years but still complained of a dry itchy vagina, poor libido, headaches, mood changes, insomnia, loss of confidence and black depression. She was very frightened by these uncharacteristic changes in herself and felt she was becoming dependent upon sedatives. Her male psychiatrist told her that it was not her hormones playing up as she was on oestrogen tablets and that she should give up working and concentrate more on her husband's needs. He prescribed a large dose of anti-depressant drugs and told her she would need them to lead a normal life.
Miranda had scratched her vagina and vulva to the point of it developing dry cracks (fissures) and it would often bleed after attempted intercourse. Her blood tests revealed lowest levels of oestrogen so I asked her to double her dose of oestrogen tablets and use a vaginal oestrogen cream. After three months on this increased dosage she returned complaining of a worsening of her migraines and slight improvement only in her itchy, dry vagina. Her fits of deep depression persisted and her marital situation had deteriorated. I then suggested that her liver was probably very active in breaking down the oestrogen tablets and that only small amounts of oestrogen were getting past the liver to the rest of her body which was still crying out for oestrogen. We decided to try a course of natural oestrogen and testosterone injections called Primodian Depot. This was injected every four weeks and a course of progesterone tablets for ten days every month was also given to ensure that a regular menstrual bleed occurred. One month after the first Primodian injection Miranda returned asking for another injection. She was delighted with the first injection that had given her a 90% improvement in all her symptoms. Her vagina had become moist and responsive, her libido was fantastic, her depression had lifted and her husband had been relieved to rediscover the girl he had married. She had felt like socializing again, rejoining her exercise classes and her mental efficiency at work had improved in leaps and bounds. Miranda received a course of three Primodian injections and then we decided to insert an implant of natural oestrogen and testosterone into the fat of her buttocks. She requires an implant every nine to twelve months and has never looked back. Her marriage has been saved; she has thrown out her sedatives and anti-depressants and continues to enjoy her high-powered job. Yes, this is one of many success stories demonstrating that time, patience and confidence in using the correct type of HRT for each individual woman will usually work.
Miranda was one of the significant percentages of women who do not find relief from oestrogen deficiency symptoms with oestrogen tablets. These women should not be patronized and told they have a mental or emotional problem or made to feel inadequate. Rather, they should be offered alternative forms of HRT such as injections, implants or patches of oestrogen. If their doctor is not confident in this area, appropriate referral to a Women's Health Centre or Menopause Clinic should be given.
Another interesting story is that of 43-year-old Selina who came to see me because of increasing pre-menstrual syndrome and a total loss of interest in sex. Selina craved more emotional and romantic attention from her 58-year-old husband who was unable to give her this because he resented her inability to fulfill his sexual appetite. They had been married when Selina was 32 and things had been perfect until she had her tubes clipped (a surgical sterilization) at the age of 35 after the birth of her second child. From that point on, Selina began to experience symptoms of gradually increasing oestrogen and testosterone deficiency noting sudden mood changes, loss of sexuality and a reduction in the amount and frequency of her menstrual bleeding. A sample of Selina's blood revealed low pre-menopausal oestrogen and very low testosterone levels. Tb worsen matters, the amount of sex hormone binding globulin (SHBG) she produced from her liver was very high. Sex-hormone binding globulin is a protein in the blood that carries and binds the sex hormones, oestrogen, progesterone and testosterone. Sex hormones are inactive when they are bound to sex hormone binding globulin (SHBG) and so large amounts of SHBG reduces the active role that sex hormones can play in your body. So this was Selina's dilemma, low amounts of sex hormones and a high amount of sex hormone binding globulin circulating around in her body; she did not stand a chance and things would only get worse as she got closer to the menopause.
Selina and I designed a six-month programme of oestrogen and progesterone tablets but she returned after four months saying that her pre-menstrual irritability and sexual disinterest persisted. We then began a six-month course of monthly natural hormone depot injections. Selina received an injection of Primodian Depot (oestrogen and testosterone) at the end of every menstrual bleed and one Primogyn (oestrogen) and one Proluton Depot (progesterone) injection on day 16 of every menstrual cycle. This produced a dramatic improvement in her mental, physical and sexual wellbeing and her husband could hardly keep up with this new energetic and sexual woman. The combination of these three types of injections containing natural oestrogen, testosterone and progesterone had provided Selina's brain, genital organs and other sexually responsive body cells with sex hormones that
Her own pre-menopausal ovaries could not provide. After six months Selina found a slight increase in facial hair so we stopped the Primodian injections which contain testosterone. She eventually opted for an implant of natural oestrogen without any testosterone as her libido had returned to normal and she did not want any increase in facial hair. Selina's case illustrates one of the many flexible programmes of' 'designer HRT'' that can be tried for women with hormonal imbalances in the pre-menopausal years.
The injectable forms of natural hormones are very useful for what I call a "hormonal crisis". A hormone crisis is a severe and/or sudden deficiency in hormones that may sometimes occur after a hysterectomy, surgical removal of the ovaries, tubal ligation (surgical sterilization), sudden onset of the menopause, premature menopause, severe medical illness, severe stress, chemotherapy for cancer or after childbirth. Natural hormone injections can truly work wonders and can prevent a hormone crisis leading you into a deep, dark pit; indeed they usually take you quickly and smartly out of the pit. You may only need them for three to six months after which time your own hormones may recover or you will probably find it more convenient to have either an oestrogen implant, oestrogen patch or the more conventional tablet forms of HRT.
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