Tuesday, April 2, 2013

Babesia and menopause

I recently started treating a 53 year old woman with a clear history of Lyme disease; and she had also tested positive for B.duncani  at the lowest cut-off point of 1:256 via Labcorp. She was perimenopausal and  had hot flashes and night sweats.  She thought the night sweats were due to menopause. A single 3 day course of  Coartem did not make any difference. We discussed a strategy for sorting things out. I suggested she go on estrogen therapy for 1-2 months to see if the sweats would abate. If the sweats went away then the likely cause was menopause; if they did not active Babesia infection was more likely.

She went to her GYN to try HRT. She did not like straight estrogen and started bio-identical HRT. Almost immediately she started feeling much better.

Her energy level increased, her mood improved -  as did  her overall sense of well-being. The hot flashes went away. The night sweats got better but persisted. At this point she decided to stay on HRT.

A rule of thumb with Lyme patients is to treat all the other stuff and  see what remains.

The same patient had a history of borderline hypothyroidism on no replacement therapy at the time.  A TSH level was 3.4: low dose of Cytomel, T3 thyroid was started and this perhaps also helped with mood and energy.

This patient had clear other evidence of Lyme disease, with a CDC positive test. Psychological symptoms including depression, severe, with  hopeless were described. Luckily, the depression quickly resolved. Her Lyme had only been treated with a low dose of doxycycline.  It seemed treating thyroid dysfunction and menopause made the biggest difference.

Of course I did recommend further treatment for Babesia: not urgently.

I will veer off the usual topics  for a moment.

Is hormone replacement safe for menopausal women?

When I was a medical resident you were almost committing malpractice if you didn't prescribe it: it lowered the risk of heart disease, decreased the likelihood of osteoporosis - all without increasing the risk of breast cancer.

Things have changed. Now if you prescribe it you are almost committing malpractice. Perhaps the pendulum has swung too far. HRT was found to increase heart attacks in women with known heart disease. This should have been expected since estrogen increases blot clots. Estrogen is associated with a tiny increase in the incidence of breast cancer, but not mortality. Maybe HRT isn't so bad after all.

I have previously discussed the controversy regarding an optimal TSH level.

Beating Lyme is always easier when one's general state of health is better. Optimal management of hormonal issues may make treatment easier and more effective (or not). Anyway, she is very grateful because she feels a lot better.


Little Ron said...

have you any insights regarding bio-identical hormones. Are they safer?

Lymie Mame said...

Thank you for this post! I started getting sick at the age of 39 and struggled for YEARS trying to get a doc to help me figure out if I was dealing with peri-menopausal symptoms or lyme.
It turns out I have lyme and babesia and deteriorated to such a state from misdiagnosis that my menstrual cycle stopped and now, at the age of 44, am in full blown menopause.
It is so frustrating dealing with tick borne diseases and hormonal issues all at the same time and trying to differentiate what is what. More education is needed on this, please educate other docs about what you have learned! Thank you for your blog and your wisdom.