Estrogen Story Is Confusing

Q. I took hormones for four years and then discontinued for a year. Now I have started again, at the urging of my doctor. While I was not taking hormones, I had hot flashes, night sweats and vaginal dryness.
I stopped taking hormones because the progesterone component made me irritable and depressed. (I was taking Premarin and Provera.) My doctor put me on Estrace and Prometrium this time, but I still feel prickly and sad.
I’m convinced progesterone is the problem, so I wonder if I can take the estrogen alone. I recently read that estrogen has heart benefits.
A. The hormone controversy has heated up again. A study showed that women between 50 and 59 taking estrogen alone were not at increased risk of heart attacks (Archives of Internal Medicine, Feb. 13, 2006). These women had previously undergone hysterectomies, so they did not need progesterone.
Estrogen alone is not safe for a woman who still has her uterus since it increases the risk of endometrial cancer. Progestins like Provera protect against this kind of cancer. When added to estrogen, however, they may increase the risk of heart attacks and strokes and possibly breast cancer as well. For some women, progesterone lowers libido and leads to depression.
We are sending you our Guide to Estrogen: Benefits, Risks and Interactions. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons’ The People’s Pharmacy®, No. W-49, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from www.peoplespharmacy.com.

Q. Is there any adverse interaction between Lipitor and pomegranate juice? I know there is a problem with grapefruit juice and Lipitor and wondered if there could be a similar problem with other tart juices.
I have been reading that pomegranate juice is very beneficial, but I take Lipitor so I thought I should check it out first.
A. Grapefruit affects drug metabolism and leads to higher levels of many medicines, including Lipitor. As a result, Lipitor may be more likely to cause side effects.
A study in Japan found that pomegranate juice was comparable to grapefruit juice in this activity (Drug Metabolism and Disposition, May 2005). A more recent study suggests, however, that pomegranate may not affect Zocor (Clinical Pharmacology & Therapeutics, Feb. 2006). Since Zocor and Lipitor are similar, there may not be as much risk of pomegranate juice interacting with Lipitor as we originally thought.

Q. I have always been very sensitive to cold medicines. Even nighttime cold medicines make me hyper. I can’t take any cold medicine after about 5 pm if I want to get some sleep at night.

I always take half the recommended dosage (usually that means one pill instead of two), and even then, I experience strong reactions. Why do some people get drowsy when they take these remedies?
A. Cold remedies often contain antihistamines and decongestants. Many people find that drugs like the decongestant pseudoephedrine are very stimulating. Any cold or cough medicine with “D��? in the name could pose problems, especially at night.
Antihistamines like diphenhydramine (Benadryl) or chlorpheniramine (Alka-Seltzer Plus Flu tablets) normally make people drowsy. But many children and some adults react differently. Such drugs stimulate them. Taking antihistamines at night could be counterproductive for such individuals.