women in peri-menopause - age 45 to 55 or so

I just found out I had ITP a little less than 1 year ago. I am 53. For about the past seven years, I have had every horrible symptom of peri-menopause in the book, including super heavy bleeding. Three years ago I had an ablation and the monthly menstrual bleeding stopped almost immediately. I also have a fibroid in my uterus but the doctor was unable to remove that during the ablation and said not to worry about it. I still have irregular light periods to nothing and the latest ob-gyn told me i was near menopause. But also for three years I have been taking estrogen and progesterone for hormone replacement therapy to help with all the anxiety, mood swings, depression, headaches, insomnia, night sweats, daytime hot flashes, general weakness, etc. The hormone therapy has helped.

But when I took prednisone when i had first found out about ITP, I think everything got so out of wack and now my hormone therapy doesn't seem to be working anymore. I have been off prednisone for almost three months, I have tried different dosing of hormone therapy, but I am finding no relief.

My latest ob-gyn said it would be good if I could get off the hormone therapy because it could have an effect on my platelet levels. Has anyone experienced or know about a correlation between hormone therapy and low platelet levels? I can't imagine giving up hormone therapy - actually i think i need something stronger! My platelet level early this week had dropped down to 22,000 and this is low for me. I am trying to figure out what to do next!

I don't know that HRT has a direct affect on platelet counts, but hormones can play a big part in autoimmune disorders in general. I have Lupus and will not even consider HRT. I've been in menopause for about 7 years and it is miserable. I know how you feel, I sweat constantly and have all of the other symptoms as well. I have to keep the air conditioner around 70 and have even had it on in the winter.

I saw my GYN about two months ago and she suggested Black Cohosh and Primrose Oil which are two more natural ways to help with symptoms. I bought them but didn't take any because I was afraid they would interfere with all of my other medications. I can't vouch for it's efficacy, but I've read many reviews that claim that they help.

HRT can be dangerous for several reasons...raised risks of certain cancers and exacerbation of autoimmune disorders. The following article states that HRT can raise the risk of blood clots in APS patients (Antiphospholipid Antibodies). Approximately 1/3 of ITP patients have APS antibodies. I am one of them.

Sex hormones, including estrogens, influence the immune system in a complex manner, playing an important role in the pathophysiology of autoimmune diseases. Estrogen receptors can be found in almost all cells, including those of the adaptive and innate immune systems. Depending on the relative preponderance and stimulation of different receptors in various tissues, estrogens may demonstrate pro-inflammatory or anti-inflammatory properties. Traditionally, exogenous estrogens were considered to have the potential of worsening the autoimmune processes and hence were avoided in patients with rheumatic diseases. Recent studies have demonstrated the efficacy of exogenous hormone therapies, either in the form of oral contraceptives or post-menopausal hormonal replacement therapy, in the majority of patients with rheumatic diseases. However, caution needs to be exercised as a higher incidence of mild to moderate flares of systemic lupus erythematosus was noted with hormonal replacement therapy in the large randomized controlled trial, HRT-SELENA. Exogenous estrogens can also increase the risk of thrombosis in patients with positive antiphospholipid antibodies and should be avoided in this subgroup. This review will discuss the current evidence on the efficacy, safety and impact of exogenous sex hormone therapies in patients with autoimmune rheumatic diseases.

Copyright © 2011 Elsevier Ltd. All rights reserved.

www.ncbi.nlm.nih.gov/pubmed/22261500

I found this article also. Platelet microparticles are usually elevated in ITP patients which can lead to thrombic risks.

www.bioportfolio.com/resources/pmarticle/239899/Hormone-Replacement-Therapy-Leads-To-Increased-Plasma-Levels-Of-Platelet-Derived-Microparticles.html

Thank you Sandi! I will do some more research and read the articles you have included in your post.

Please contact PDSA by calling 440-746-9003 or emailing Carol at rchoxie@pdsa.org. She has more information for you about this issue.