ELIZABETH LEE VLIET MD #3

[Guest guest]

" HORMONAL BALANCE....

" If you are already on ERT or HRT and are still having

problems with bladder symptoms like I have described,

you may want to ask your doctor to check blood levels

of FSH and estradiol to determine whether you are

taking THE RIGHT AMOUNT of estrogen for YOUR body

needs. In continue to find that what we thought was an

adequate dose turns out to be less than what's needed

for many women. If you are still bother by symptoms,

it is especially important to determine if you are on

the right amount of estrogen, because you may not be

getting enought for estrogen's OTHER BENEFITS either.

" If serum estradiol levels drawn about 12 hours after

a dose of oral medication or on the last day of a

transdermal patch are below about 70-80 pg/ml, it is

likely that SUBOPTIMAL ESTRADIOL is a factor in the

persistaence of urinary symptoms. I typically aim for

estradiol blood levels of over 100 pg/ml, which is

what is typical for the first part of the menstrual

cycle. If your ERT/HRT regimen provides estradiol

blood levels over 100, the FSH will usually come back

down to 35 or less. A residual FSH greater than 20

with estradiol levels below 80 pg/ml confirm the

suboptimal estrogen replacement. "

" When viewing studies of estrogen effects on bladder

fucntion and incontinence, it is important to

determine WHICH FORM OF ESTROGEN has been used, since

potencies and receptor actions can be quite different.

In my clinical experience, optimal effects on bladder

are difficult to achieve without having optimal serum

levels of the premenopausal estrogen, 17-beta

estradiol. Clinical studies that do not measure serum

hormone levels, or that use predominately an estrone

form of estrogen therapy, may fail to show clinical

benefit on incontinence, more as a result of

suboptimal estradiol replacement than as a result of

lack of estrogen effect PER SE. "

E L Vliet page 327-329

__________________________________________________