estradiol withdrawal

Hi,
I am a 48 year old woman. I had a hysterectomy when I was 40, with one ovary left intact. When I was 46, I had a large Sertoli-Leydig tumor removed, along with the remaining ovary. I have been on .05 mg Estradiol patches since then to alleviate menopausal symtoms (symptoms). I have been kind of worried about the side effects of the patch, and have not worn one for about 2 weeks now. Now I am experiencing heart palipitations, lethargy, moodiness, etc. I also have subaortic stenosis, which worries me because of the heart palipitations. I have an appt. with my gynocologist next month, and I haven't told him I discontinued the patch yet. What is your opinion, should I go back on the patch? I'm not sure which would be worse; the long term risks of side effects or the symptoms I am experiencing now.

[Elaine Brown, MD]

Hi!
Unfortunately, that is a question that all women must ask themselves, and the answer is not clear cut.  The patch (hormone replacement in general) was originally developed to help alleviate the symptoms of menopause.  This is the main indication for which it is used today.  The American College of Ob/Gyn recommends using the lowest dose of estrogen necessary for the shortest period of time necessary.  It may be that you just need to use it for a few more months/years.  The question is really about quality of life.  If you are miserable without it, then it probably IS worth the small risk of using it.
Good luck!
Dr B