Surgical Menopause

Hi everyone. I am 32 and scheduled for "total" Da Vinci hysterectomy in August.

History- PCOS, Endo, Infertility, Cervical cancer cells. I am married (10 yrs) and have twins who will be 7 soon. We did IVF to conceive the kids. Ever since I've had the kids I had very heavy bleeds and chronic pelvic pain. Sex is painful too. Last year I went for a laparoscopy to remove endo. The doctor could not burn anything off due to stage 4 and I was a "web inside". We treated with birth control pills and it helped a bit. Last fall my annual exam came back abnormal and after several months of testing, I have cervical cancer. It's very very very early so I am very lucky. The decision was made to remove all reproductive organs and I agree.

The doctor is holding off on estrogen replacement until 6 months post op. This is due to the endo and the hopes of it not growing back by starving it from the hormone. I also agree with this.

My major concern is not the surgery or healing process. It's the surgical menopause I am stressed about. How bad will it be? Will I be a complete monster for 6 months? I would like suggestions to cope during my hormonal imbalance. Thanks

It can be hard. (i was 33 at the time of my hyster/oopherectomy, have had a birthday since)
But some women have been able to take alternatives to help out with symptoms. Such as antidepressants, serotonin sneaks into estrogen receptors in the brain so it helps balance symptoms such as any mood swings, depression, anxiety, and even hot flashes.
Vitamin e supplements can help with hot flashes.
Black cohosh can help, its debatable whether it has estrogen properties but it does have a component like aspirin.
Always be sure to talk to your doctor about herbs and such and what you can take after a surgery.
Good multivitamin will help with energy also after surgery.
And omega 3 and co q10 supplements will help certain symptoms.
That being said, you could take a combo of estrogen and progesterone to get the hormones but with the progesterone, it helps make sure endo implants don't grow. Since if you have microscopic implants, they can produce their own estrogen so even if you starve your body from estrogen, there is a slight possibility that some can grow.
So definitely keep the idea of taking progesterone after or having a combo of estrogen and progesterone after. And the natural progesterone is easier on your system than synthetic progestins.
And it would be good to be seeing an endometriosis specialist, if you aren't all ready seeing one. And also if you do want to try hormones, be sure its ok because of the cervical cancer, not sure if those can be hormone dependent or not.
Take great care

(((aetco08)))

I'm so sorry to hear you have so many problems all at once I have a couple thoughts. First, do you have gynecological oncologist who will be doing the surgery? Is there any reason to suspect cancer anywhere other than the cervix? I ask because of the endomtriosis issues you talk about. Just removing all the reproductive organs and taking no estrogen is NOT a cure for endometriosis. Check out this Does an Oophorectomy and no estrogen cure endometriosis? Another thing that concerns me is that your doctor wanted to "burn of" the endo. It turns out that the best way to stay endo symptom free is to have excision surgery done by an endometriosis specialist. My surgery was done by a gynecological oncologist because my doctors thought I had a good chance of having ovarian cancer. I was glad that the gynecological oncologist had the skills to do endo excision. He excised implants from my bowel, bladder, and body cavity. Most ob/gyns do not. They is why we encourage women to see an endometriosis specialist. If you just have all your reproductive organs removed, any endo left on any other surfaces can still cause you endo pain. Many doctors differ in their advice regarding HRT after endo excision. Some studies indicate that waiting a few months help, others contradict it. My doctor believed he was able to excise all the endo, and I have been on HRT since day 10 (when my pathology came back negative for cancer). So far I have had no return of endo. We even have women who have had endo excision, retained their ovaries and have remained endo symptom free. Another issue is the cervical cancer. Does an oncologist believe it will be safe for you to take estrogen? If you don't already have a gynecological oncologist, I strongly suggest you consult with one. Ask the gyn/onc if he or she is able to excise endometrial implants. It may be that they can save your ovaries (if you are allowed to have estrogen in light of your cervical cancer). Mine were too far gone to save. I'll be honest. I had a horrible 10 days waiting for pathology. And even then when I started HRT after the first year, it has been a struggle keeping my estrogen levels balanced with HRT. If you haven't done so, get second that third opinions, preferably with a gyn/onc and an endo specialist. I wish you the very best of luck.

Thanks for the replies!

I am educated that the hysterectomy doesn't "cure" the disease. I'm not getting it done for that specific reason but am hopeful it will help elevate the symptoms. The main reason is the cervical cancer cells and my family history.

I have three doctors who are actively treating me- my regular gyno, the specialist, and the oncologist. I am lucky to live in a large city with so many options.

HRT is estrogen and progesterone. I will only be given estrogen replacement after the first six months. The doctors believe I am less likely to experience issues with the estrogen only. Progesterone is not recommended due to my age and specific condition.

The specialist has done over 9000 procedures. He said in 1999 he started withholding estrogen for the first six months after a national conference he attended. Doctors who practice this typically have a low re-growth rate. My doctor averages 4-6% re growth since 1999. I am confident I have made the right choice.

Like I previously said, the cells haven't morphed-its very very early. It's basically stage 0 or pre-cancer to oncologists. The cells are only at the surface and haven't gone into the deeper layers, thankfully. It wouldn't have been found if I didn't pursue the abnormal pap. By the time it would have been found it would have been too late. I been to several different doctors and had many tests over the last 6 months. After the surgery, I will continue testing for a year. One positive test and I will be treated accordingly.

Burning off the endo are my words based on how the procedure was explained to me. Not being in the medical profession it's the best way to comprehend the procedure at that time.

I have no desire to keep my ovaries. They have never worked (in my opinion) and I would rather remove everything in case ovarian cancer is lurking or would occur later in life. My mother and older sister have died from ovarian cancer. My material grandmother died of cervical cancer. They are silent killers and I am blessed I have the chance to live past 40 by being proactive now. Neither my mother or sister made it past 40. Actually I think endo saved my life. If I didn't have the endo pain I wouldn't have gone deeper to find a solution.

I would really like to hear what others have done regarding the surgical menopause. Coping skills, how to control emotions, and how to live a healthy life.

I agree it is like burning. With the DiV they use heat to cauterize then a laser like instrument to cut it. I watched the video of one and that is what it shows.

I went through natural menopause with no more than light hot flashes in the wee hours of the morning. Surgical has been a whole other story. I had night sweats the first two weeks and thankfully they went away. I had my surgery at the beginning of summer. The hot flashes made my summer miserable because I was wet from sweating all day long when outside in the heat, going from hot/cold or cold/hot. My little fan because my best friend!! Winter was much better but as the warm weather comes back seems my summer nightmare from last year is still here. I had so hoped my body would adjust by now but seems that is not to be.

My older sister had a hyster when she was about 35 for fibroids. She was on HRT until she was 55, had to go off due to cancerous fibroids in her breast. At 75 she is still have soaking hot flashes. I so do not want that.

Every one is different. There are many women who have little to no symptoms. You may be lucky and be one of them.

The negative I have found with ovary removal is my lipids are wacky. Also, because we have PCOS which is insulin resistance caused, we have to keep a closer eye on our glucose especially if there has been a problem in the past. Fortunately for me, my glucose has always been fine, but I am still watching it. Diabetes is the last thing I want now.

(((aetco08)))

I'm sorry you're facing all of this but as far as the cervical cancer, I am very glad you're catching things early when they are most treatable.

I didn't do HRT due to a previous cancer history. Surgical menopause certainly wasn't a walk in the park, but it was doable. The worst symptoms I experienced were being overly sensitive to things and mild hot flashes for which I took vitamin E as needed. In your case, there will be light at the end of the six month tunnel which hopefully will be mild and go quickly.

I know you're catching things early, but I did want to invite you to check out our Cancer Concerns forum for anything related to that diagnosis. There's lots of good information as well as ladies who've been there/done that.

Wishing nothing but the best for you, (((sister)))!