Menopause Symptoms & Treatment: A Patient's Experience with Prometrium & Enjuvia

Question
I'm a 52 year old female smoker (trying my best to quit). My periods were very regular up until last Aug when they stopped. My Gyn put me on Prometrium 200mg 12 days per month. Since that time I have only had one period which was in Jan. It was very heavy and lasted 18 days.

This month my Gyn prescribed Enjuvia 0.625 and instructed me to continue taking the Prometrium 12 days a month. He said the Prometrium protects against uterine cancer and the Enjuvia protects against bone loss.

However, I also visited my primary doctor this month and he told me I should not take either of those meds because I am a smoker. He also said that with my large frame, bone loss should not be a problem and if it occurred there were meds for that.

He included an Estrogen, total, serum test with my regular blood work and my level was 177 pg/ml. No reference range was given. His nurse who called me with the results did not know if that number meant I was in menopause or not. My other blood work was normal.

At this point I am totally confused and not sure what to do. Aside from the lack of periods, I am not experiencing any menopausal symptoms. I would very much appreciate your opinion.

Thank you for your time.

Answer
Since you haven't had a period since January, that usually means that your estrogen level is quite low, since if the uterine lining receives enough estrogen, it will bleed after progesterone.  Total serum estrogen of 177 is normal, but if you were taking the Enjuvia, that would explain why it's not low.  If you weren't, my guess is that you're close around menopause, when your ovaries can sometimes make estrogen and other times not.

As to smoking and estrogen, I don't agree with your primary doctor.  We don't advise women over 40 who smoke to take birth control pills, because of increased heart disease.  That doesn't apply to taking HRT, and I've never seen evidence that women who smoke shouldn't take either estrogen or progesterone.

Your large frame may help to protect you from osteoporosis, but I wouldn't count on it, and bone loss is extremely common after menopause is estrogen is not taken.

I would believe your GYN.  Smoking is a significant risk to your health, but taking HRT is not (and in fact women that take HRT live longer than women who don't).