Questions about HRT - Very confused

Hi all,
I have been basically hanging out over at the Pre-OP support board but since I saw my Doc last night I now have this dilema. To keep the ovaries or have them out, if I have them out obviously I have to start HRT. I am 43 going on 44 so of course I am lying in that gray area. Doc says rule of thumb is under 40 keep the ovaries over 45 take them out. So its up to me. I have one healthy ovary and one with a small cyst. My doc suggests having them taken out but I'm not sure. What about Insurance? Do most companies cover HTR? What experience can any one give me as far as HRT and the side effects? Any info would be great as I am very confused and not sure what to do. Thanks so much!

Connie

I guess as far as whether to have your ovaries removed or not depends on what you are having your hysterectomy for, and family history, etc...as well as how healthy your ovaries are. I think I read in your previous posts that you have fibroids and adenomyosis? If I were in your shoes and did not have a strong family history of ovarian cancer, and my ovaries were even remotely healthy, I would keep them. Even in menopause they continue to excrete a small amount of hormones that are vital to our wellbeing. There are many long term consequences and risks of going into surgical menopause (which is far different than natural menopause and requires a different approach to deal with). Here are just a few studies that address this:
http://hyper.ahajournals.org/cgi/con...ract/47/6/1168
http://www.mayoclinic.org/news2006-rst/3642.html

And here is a hystersisters thread that addresses what hormones do for you:
https://www.hystersisters.com/vb2/sho...ormone+pellets

There is also a Hystersisters article here somewhere that addresses your very question about whether to keep ovaries or not (which is a common concern so you are not alone!), but I can't find it offhand. Hopefully one of the hostesses will come along with it.


As far as whether insurance covers hrt, that too varies with different hrts and insurances. My insurance for example will not cover any form of compounded hrt formula (such as Triest or Biest or testosterone cream). I have had to pay out of pocket for those and they were not cheap. On the other hand my insurance has covered most commercial hrts (bioidentical such as Femring or Vivelle Dot and synthetic such as Estratest). The copays for me vary with the different brands. Vivelle Dot has been fairly cheap for me but my copay for Femring was $99.

For some women, finding the right fit as far as hrt comes quickly and they do not have problems, but for many of us it can be a lengthy trial to find the right combination that works enough for us to feel like ourselves. I am over two years post op and still struggling to find balance. Being only 33 at the time of surgical menopause, this has been traumatic to say the least for me. Also, hormones are different than drugs per say in that you don't really think of side effects so much as the effects of not having the right balance. For example, too much testosterone can cause oily skin, aggressiveness, hoarse voice. Too little estrogen obviously means more hot flashes, dry skin, mood swings, etc..Too much estrogen in relation to low progesterone (but not too much estrogen in and of itself) can cause sore breasts and bloating. Confusing huh? Here is a list of too much/too little symptoms of the various hormones:

https://www.hystersisters.com/vb2/hsarticle.php?id=97238

There is just so much involved in surgical menopause and hrt or alternative methods of relief that I can't possibly begin to cover it all here. A good starting point is this article:
https://www.hystersisters.com/vb2/view_menopause.htm

I wish I had taken the time to research this ahead. I had absoulutely no idea what to expect. I thought you just took a pill and that was that. For me it has not been that simple. For some women it is. I guess it comes down to the benefits of losing your ovaries in your personal situation versus the risks of losing your ovaries. It is not an easy decision for certain. I wish you the best in figuring this all out. I hope I didn't completely scare or overwhelm you. That was not my intent at all. Good luck!

Connie,
If the ovaries are healthy I can't see a reason to remove them unless there is a history of ovarian cancer in your family. I have read many times where a doctor may say "you'll be going into menopause so let's just remove them." However, even if you were in menopause, those old ovaries still provide some hormones, just in lesser and lesser amounts.

Here's a thread that has some good discussions regarding this issue: Old Ovaries-Still of Value

My advice is to do some more research before just having them removed. I have seen many posts here where women have regretted having "healthy" ovaries removed just because they were nearing the age of menopause.

Best wishes on your upcoming surgery. Whatever your decision we are here to support that decision.

One book that might help you with your decision, and which I very highly recommend, is Dr. Susan Love's Menopause and Hormone Book. I chose to get rid of my ovaries because I'd become exhausted with decades of cancer scares. I am also 54 and sooner or later would have entered menopause. I've been fine (in fact, better in many respects) since my TAH/BSO three weeks ago, but if at some point in the future I need hrt I would certainly consider that, but only for the short-term. In your case, if your ovaries are healthy and there's no family history of ovarian cancer, it probably would be best to keep them for all the reasons listed by the other posters here. Everything is in your body for a very good reason and the only good reason to remove anything, as far as I am concerned, is if it's seriously impacting one's physical and/or mental health (as it was in my case).

I don't regret my decision at all "simply" for the peace of mind I now have regarding one very important aspect of my physical health, but every woman's decision to keep or not to keep her ovaries will be as unique as she is. Do as much research as possible, you still have time to decide. Just make sure that if you keep your ovaries you continue to be monitored throughout the years for possible ovarian cancer.

Good luck to you, and let us know what you decide!