Prinzmetal Angina and Estrogen Replacement

• By kwinner
• Posted August 30, 2008 at 1:33 pm

Hi Robin,

There's another post that talks about hysterectomy, but here's a bit about me. I had my LAVH/BSO on December 20th, I have prinzmetal's too, but it wasn't diagnosed at the time. On Janurary 3rd I had a heart attack. I was on low does HRT. As far as the menopausal symptoms, it was great, no hot flashes, no night wsweats, etc., as long as it wasn't the genrics but the real deal. Now, here's my thoery, I think the drastic drop in estrogen caused my spasm induced MI. I had been having attacks for about a year by then, but was being tested for other things, as most of us with this are. I wonder if we had started with a higher dose, one more to mimic my natural estrogen production and then tapered it down slowly if things would have been better. BUT, in my case we dind't know about the heart stuff yet. I do strongly feel estrogen played a part in it, but I have no medical confirmation on that.

I can say the hysto was the best thing I ever did, the monthly migraines are gone (also the prinz and estorgen playing together), I generally feel great. I stopped taking the HRT, they kept giving me generics and those were yucky, but I also decided to work on the HD and osteoperosis risks in other ways. Breast cancer is a big concern in my family, so I feel like I'm safer taking this road anyway. I'm managed really well on iso and CCB, and I finally, after months and months of trying to figure out the right combo of meds, feel like I have my life back!

I'll be thinking of you Tuesday, let me know what you decide!
Hugs,
K

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• By lkay
• Posted August 30, 2008 at 2:34 pm

Robin,
At 53 I am post-menopause (did that 8 years ago), have Prinzmetal and NO ONE has stopped to look at the relationship between the two. The nightly angina started well after the time my periods stopped.

You definitely have my attention. Please keep us posted on your decision as well as anything else you learn.

Be well,
Laura

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• By CJM3
• Posted August 31, 2008 at 10:02 am

Hi Robin- I have the same problem that you have. I see a Dr. Noel Bairey-Merz (a cardiologist) out at Cedar Sianai Medical Center in LA. I also see a Dr. Holly Thacker who is at the Cleveland Clinic. She specilizes in Women's Health. Both doctors believe as do I that Estrogen levels drops to its lowest level during / right before your menstrual cycle and this drop in the Estrogen level directly corresponds to the spasms (at least in my case it did). I was able document for my doctors that my spasms occured at the start of my period (this is also the same time my arteries dissected) and it helped them see that the estrogen was a big factor in my case. I tried several birth control methods to stabilize the cyclicity of my cycle. The only one that has worked has been YAZ and YAZMIN as they both have lower levels of progesterone. Progesterone can cause spasm (I have been told). I take it continuously- no inert pills. Even though I have a history of heart attack at age 39- resulting in a triple bypass (my arteries dissected) the benefits of the pill far outweigh the risks. I now have my life and family back instead of being debilitated for at least a week every month.

My spasms improved greatly but still persisted. We werre then able to determine that when certain foods were digested by my body I would get spasm. By documenting what I ate when etc. It was determined that my body could not handle the digestion process of meat. I have eliminated all meat and have not had a problem since.

I might however add that I do take calcium channel blockers- Norvasc and Cardizem (they are the gold standard for treating spasm) . I have been able to back off some of the high doses (I was on 20 mg of Norvasc- double text book reccomendations) with the elimination of meat.

I do hope that this helps. There are doctors out there that understand all this and I would be happy to give you some phone numbers if interested.

Take care and keep me posted.

Sharon

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• By vrolijk
• Posted August 31, 2008 at 11:20 am

Hi, rstep

It seems very strange to me that the physicians want you to have a hysterectomy?? Just, so that they that can make sure how much estrogen you are getting.

Before my heart attack I did have a hysterectomy about 10 years before my heart attack. I was then put on estrogen replacement therapy right away after the hysterectomy.

After my heart attack they told me I never could use estrogen again.

Being taken of estrogen was horrible experience, besides all the other medical adjustments you have to make.

I had night sweats and all kinds of problems and serious problems from taken of estrogen. It also made me moody for a long time. I also had horrible dryness of the vulva, and so had pain their also and could not have intercourse.

I have no clue what to say, besides that I believe hystrectomies are done way to much and basically like a castration. Many women do not feel like women anymore and the pleasure of sex seems to have gone away… In europe they hardly do any hystrectomies unless it is absolutly neccesary..

I seriously would recommened that you would have a second opnion about this problem…

Because estrogen hormone therapy is not usally not indicated for women with heart desease. Actually they had told me that the hormone therapy had made my heart attack more likely!! take care of yourself, Vrolijk

Estrogen Increases Heart Risk

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• By TexRose
• Posted August 31, 2008 at 4:52 pm

Hi Vrolijk and all, YES, too many unneccesary Hysterectomies are done. I did not need one. Mine was for Fibroids and they could of watched them as I had NO Symptoms but was given the scare tactics by a young and eager OB/GYN who needed to pay off his student loans. I was placed on Premarin for years. I got off with the Estrogen scare in 2002.
But, Estrogen cream helps with the dryness and using this just twice a week will not hurt the heart, I was told and really helps with the bladder issues. I am still getting on and off severe cyclic spasms and have wondered if there was a connection to what was in the past. This is mighty strange and also the food connection. I could not take CCB. My feet swelled terribly. I wear a Nitrate patch 12 hours on and 12 hours off. I would jump back on a low dose HRT patch today, if I knew it would not hinder the already known heart disease with MI's.
TR

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• By rstep
• Posted August 31, 2008 at 9:31 pm

Thanks all for the input - I have put off having the hysterectomy for many years. If I do have it done it will be because of the severe periods I suffer with once and sometimes twice a month. I do not take having this done lightly at all and opted to have the endometrial ablation in Jan instead. Unfortunately that did not work and at this point I just need relief!! My ultrasound on Tues will give us another look at what is going. My gyno only suggested that if we did the hysterectomy for relief of my periods, that we remove the ovaries in order to control my hormone levels. The little research I have been able to do states that some researchers believe that estrogen acts as a vasolator on the vessels, keeping them smooth and open. I also wonder if it makes a difference as to what type of estrogen is used and might would prefer bio identical hormones. I will keep you posted - Robin

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• By Yatchzee
• Posted September 30, 2008 at 11:33 pm

I am wondering if my Prinzmetal diagnosis from about 5 years ago came about because I had lowered my dose of estrogen ( no progesteron because of a hysterectomy) on my HRT when the big heart attack scare came about. I could not get totally off because of the hot flashes. The cardiologist wants me off of it and I would like to see if more would lessen the spasms. I take a cacium channel blocker, lisinipril, baby asprin, fish oil supplement and sometimes take L'arginine when I am having severe spasms and pain. I also carry the nitro quick but it does not help much and I don't usually need it. I wish there was more recent information on estrogen/prinzmetal.
Joyce

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• By rstep
• Posted October 4, 2008 at 9:32 am

My ultrasound showed no changes except that uterine lining has thinned. Fibroid still same size. Had appt. with different gyno who does laproscopic hysterectomies. She said leave ovaries in and we will use low dose estrogen patch only during shedding phase of cycle. Might be a little hard to keep track of when there is no bleeding. She seemed very informed on estrogen and spasms and uses this therapy for those that suffer monthly migraines. My surgery is scheduled for 11/19 and I CAN"T WAIT!!!! YEA!!! I have been using breathing control to help with the spasms and it seems to be helping. When I sense the pain coming on I try to control my breathing and breath deeper. The spasms have not been progressing to the crushing pain in arm phase. Before I completely gave in to the pain and my anxiety progressed. Much easier to breath than panic!! Robin

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• By Wendyz
• Posted October 5, 2008 at 11:59 am

Hi Robin,
I too have had a hysterectomy and after a while had to have both my ovaries removed due to large benign tumors. I was then put on low dose premarin and have been on it for 4 years. In Dec 07 I had my first heart attack and then another in March. I had never had any trouble with my heart until then, but have had high BP and high cholesterol (hereditery) and have a strong family history (mom & aunt both died 3 1/2 years ago from this-ages 64 & 67). Interestingly enough my mom was also on premerin when she died. She continued to have jaw pain, pain in the middle of her back and pain under her left arm (which I also have) although she did not have the angina & spasms like I do. I have been fighting with Dr's who keep trying to tell me I had "something else" going on other than spasms/angina because all the "tests" come back fine. It wasn't until after my 2nd heart attack that my EKG changed at all and it was only a very slight change, so I don't know how they can say that. Anyway, I was finally "tentatively" diagnosed with small vessel disease and the first thing my cardiologist from Swedish Hospital in Seattle did was take me off the premarin. That was only 1 1/2 weeks ago and my symptoms have decreased immensly. I still have the spasms, but have not had an angina attack and even the spasms are more easily dealt with. However, just to rule out other issues I was seen by a pain mgmt specialist (even though I kept telling them I have pressure like someone is sitting on me rather than actual "pain") and she diagnosed me with some nerve damage as a result of my last heart attack (blockage went undiagnosed for 8 days when I went to 4 different doctors during that time and since my EKG was fine, they sent me home each time...finally went to the hospital and found out I had a heart attack). Anyway, the pain mgmt doctor put me on Lyrica (low dose) to dull the nerve pain she said I was having. That was done at the exact same time I was taken off the premarin so I am still completely unsure of exactly which medication change is attributing to my feeling better. I too, will keep you posted (with smaller postings-sorry for the long letter here), but I truly believe that in my case, there was definitely a link between HRT and my heart trouble. By the way, I am 41 and was 40 when I had my 1st heart attack. I hope this helps someone out there because I firmly believe now that we have to be strong advocates for ourselves and our health and we need to keep going until we find someone who will actually "hear" what we are saying. Thanks for letting me ramble, take care and I really hope all works out for you :)
Wendy

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