Surgical Menopause!

Hi frazzle Kudos to you for looking into this before your surgery rather than after.

I had a TVH/BSO almost six years ago. My DR and I discussed it beforehand and we decided I would use estradiol patches. Everyone's different, but I woke up in the recovery room having a huge hot flash (might be because I was perimenopausal already so I was already short on estrogen pre-surgery); the nurse applied a patch and I've never looked back.

I've been diagnosed with breast cancer twice in the six years since then, once two years post hyst and once at four years post. I have chosen, with my DRs, to stay on bio-identical HRTs because for me, the benefits outweigh any perceived risks.

When the data from the WHI study first came out, they had not been fully analyzed. The media got ahold of the initial observations and ran with them. The result was that DRs panicked - they thought the data suggested that all HRT causes breast cancer. Since then, the data have been more closely examined and the initial statements reversed. It now appears that in the group of women on estrogen alone, there was no increase in breast cancer incidence at all; the women in the Prempro group (Prempro is a combination HRT consisting of Premarin (estrogens) plus a synthetic progestin called Provera) experienced a slight increase. So it is now thought that if anything, Provera use may contribute to an increased risk of breast cancer. (Coincidentally (?), I used depo Provera for a few years back in the 1990s, to which I attribute my cancer.)

That said, estrogen can cause existing breast cancers to grow. Mine was estrogen (and progesterone) receptor positive, meaning my HRTs were causing it to grow. They did not, however, cause it to originate. So, staying on HRT given my history is a choice I've made because I've tried to cut back on my HRTs and observed many immediate negative health effects (including very high blood pressure, migraine, severe bone pain, blurred vision and more); for me it's a quality of life issue.

Some women do just fine without using any HRT; again, it's an individual thing. And it's true that even if the ovaries are removed, our bodies can continue to make a limited amount of estrogen, which can be enough to make menopause bearable for some women. This estrogen is in the form of estrones that are made and stored in abdominal fat cells (not in the adrenals, which do make cortisol and aldosterone, a testosterone precursor, but do not make estrogen): http://en.wikipedia.org/wiki/Adrenal_cortex
That means that some women, for whom any estrogen could be a bad thing, need to take medications called aromatase inhibitors even after their ovaries are removed to prevent them from making more estrogen (aromatase is the enzyme that helps us convert testosterone to estrogen). You may want to discuss this with your DR; however, with just one family member with a history of breast cancer it's unlikely imho that your DR is going to feel you're in that category.

There are many good links to information about hormones and breast cancer in our Resources directory, in both the Breast Health and Hormone Jungle sections. You may want to browse through them and then talk with your DR about what you'd like to do. Do be prepared to change your mind, though - nothing is cast in stone - you may find that surgical menopause is either easier, or harder, than you had anticipated.

Good luck with your surgery!

s,
-Linda

Linda-thanks you so much for taking the time and sharing your knowledge and experience with me. You have given me much food for thought. You have been through so much, God bless you. Again, thank you...You rock!!!

I'm 45 and nearly 11 weeks post hyster. I am having the worst time with menopause symptoms and have been given anti depressants from my Dr.

You might like to look do a google search for the survivors guide to sugical menopause site which has a lot of info about surgical menopause and different hormones.

Everyone is different though, there's no knowing whether you will be badly affected or not.

Hi Frazzle -

I am 6 weeks post op today from a TAH BSO. I am not taking HRT because of breast cancer history in my family. So far I've had several warm moments each day but not a real hot flash. I've had some trouble falling asleep but it's getting better now that I'm up and doing more. I had one "weepy" evening about 9 days post op but I figure - hey, I can cry once over this whole thing right? I'm definitely fluffy so I may have some estrogen stored in my cells.

I saw my doctor on Monday. She said I could use some estrogen cream for vaginal dryness if needed. The estrogen is not absorbed into the system.

Susan