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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, November 8, 2009
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, November 8, 2009
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Pharmacy and Medications |
Do Hydrocortisone and Fludrocortisone Affect Menstruation?08/29/2008 |
I actually have an interesting question. I was diagnosed with Addison`s Disease (Primary Adreanal Failure), and I began taking Hydrocortisone and Fludrocortisone Oral everyday which will be a lifetime event for me now. My question is in the first year on these medications my periods were normal but now that I have reached the 2-year mark they have dropped off to 1 every two months. I have no choice but to take these pills if I want to live but could taking both of these steroids which affect menstration be damaging my fertility?
There are many things that could cause menstrual irregularity. A few examples are stress, diet, too much exercise, emotions, age and sexual activity. If you are currently trying to get pregnant, the reduced number of menstrual cycles will translate into fewer days when you are fertile and likely decrease the chance of conception.
Addison’s disease is also known as primary adrenocortical insufficiency. Basically this means that for some reason (there are several), the adrenal glands stop producing cortisol, aldosterone and dehydroepiandrosterone (DHEA). The key is that in Addison’s disease, the problem is with the adrenal glands themselves.
Patients with Addison’s disease need replacement therapy for the hormones they are no longer capable of making. Normally cortisol and aldosterone are replaced, but the DHEA is not. That is why your doctor prescribed hydrocortisone and fludrocortisone. The idea is to provide patients with enough hydrocortisone and fludrocortisones to mimic what the body would normally produce. This sort of dosing is called physiological dosing and should not alter normal pituitary functioning significantly. Changes in menstrual cycle could be related to too much or too little of the replacement hormones. A dosage adjustment may restore some normalcy to your periods.
When the adrenal glands are functioning normally, they secrete a small basal amount of hormones every day. In case of need, for example, to help deal with stresses like injury, illness and even emotional stress, normally functioning adrenal glands can transiently produce large amounts of adrenal hormones. Physiologic dosing can roughly approximate baseline needs for hormones, but will not provide adequate replacement during stressful situations.
Some recent studies and case reports have reported using DHEA replacement for Addison’s disease patients. Improvements in general well-being and slight improvements in bone density, but no change in sexual function were observed in the study. In the case report, regulation of menstrual cycles was reported by the patient. However, the replacement of the other adrenal hormones was carefully adjusted so the actual role of DHEA in this patient is difficult to determine. DHEA is a precursor of both testosterone and estrogen. In the study, some women were able to attain low normal (for women) testosterone levels. The jury is still out on whether DHEA replacement is a true benefit for Addison’s disease patients. In addition, there is little information about its safety during long-term use. However, if replacment of hormones that the body can no longer produce is the goal of therapy, it seems reasonable that replacing DHEA might be useful. It is certainly worth asking your doctor about it.
What is actually causing your reduced cycling will require further workup and testing by an endocrinologist with possible input from an ob/gyn physician. We would advise developing a working relationship with these doctors to help you deal with your conditions as effectively as possible.
This response was prepared in part by Jessica Lytle and Lauren Abell, PharmD candidates at the University of Cincinnati College of Pharmacy.
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Robert James Goetz, PharmD, DABAT Assistant Professor of Pharmacy Practice Drug and Poison Information Center Cincinnati Children’s Hospital Medical Center University of Cincinnati |
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