Jvy’s mother and sister had breast cancer, so she was reluctant to take HRT. She is 60 now, and when she was perimenopausal a decade ago, her doctor warned her against it because of her family history. Now, with serious bone loss in her spine as well as loss in her hip, but a low NTX score indicating slow progression, she faced a real dilemma.
As more evidence has come in about estrogen and breast cancer, the possible link seems ever shakier, and general medical opinion has shifted to include HRT even for women with a family history of breast cancer. So now that she faced an immediate problem with her bones, Ivy was willing to try it, and I recommended a standard dose of Premarin, with a plan to have a mammogram every six months for three years, then annually after that. But the side effects—everything from weight gain and breast sensitivity to mood swings and depression—soon made her stop. She then asked me to try her on Evista, which set her mind at ease about the breast cancer risk, but she felt anxious and shaky, and started experiencing allergic-type responses (rashes and blotching) to things that had never bothered her before, so she stopped that, too.
Ivy is very detail oriented, and a perfectionist to boot, so she wasn’t about to give up on finding a bone density treatment that would work for her. She knew her bones were fragile enough that she needed some intervention along with good diet and exercise. So I prescribed Fosamax, but she got terrible reflux from it. She started taking an additional medication to reduce acid, thereby cutting down on the reflux symptoms, but was then worried she wouldn’t have enough stomach acid to absorb the calcium supplements and all the nutrients in her food.
So although reflux no longer bothered her, and she had reason to believe the Fosamax was working for her bones, Ivy still wasn’t satisfied with that approach—or with doing nothing beyond lifestyle changes. A second bone scan just six months after the first showed no change, which wasn’t a surprise given the short amount of time and the switching of medications. It was a reality check, however, and motivated Ivy to try Premarin again. This time, 1 started her with a lower dose, .3 mg daily, less than half of what she had before, and it didn’t give her the side effects she had with the standard dose.
At the same time, I recommended she start taking selenium supplements to help reduce her cancer risk, along with the calcium and multivitamin she takes. She continued getting frequent mammograms. She has a sonogram of her breasts as part of her regular checkups, and does a monthly breast self-exam at home.
Ivy loves good food, but is mindful about what she eats, and is now careful to include some good nondairy sources of calcium in her diet every day. Her home is full of beautiful things, and she treats herself well, in general, but lives with a very high level of stress and currently has a lot of emotional turmoil in her life. She walks miles every day, and has for years, but is experimenting with adding a meditative element to the workout in an attempt to reduce her stress. I added trace minerals to the supplements she takes when she went off estrogen the first time, and now she’s also selected some additional nutritional supplements recommended for coping with stress. She also eats flaxseeds for the healthful omega-3 oils and bone-boosting phytoestrogens they contain.
She recently started taking the phytoestrogen ipriflavone. With its proven bone benefits, it should back up the synthetic estrogen, in case the lower dose doesn’t offer as complete protection. But ipriflavone has none of estrogen’s side effects, and Ivy didn’t get mood swings or sore breasts or an upset stomach with this combination.
With a solution finally in place, Ivy turned down my suggestion that she try estriol, a natural estrogen that generally has fewer side effects than Premarin, including no elevated risk of breast cancer. (In fact, some breast cancer patients even use it.) Unless her next bone scan reveals her strategy isn’t working as well as expected, Ivy is comfortable with the precautions she’s taken against breast cancer and satisfied with what she’s done for her bones, and doesn’t want to change anything.
This successful combination of the traditional (Premarin) and the nontraditional (ipriflavone) is what complementary medicine is all about. Neither avenue alone would have gotten Ivy the care she needed. The moral of the story is, with all the choices now out there for preventing and treating low bone density, if you look long enough, you’ll find an approach that works and is right for you.