38 and doctors won't talk to me about HRT because I'm "too young"

I'm having a TAH BSO for endometriosis and possible cancer which will be tested for during surgery late next month/early October.

Today I had another consultation with my surgeon and I asked about HRT. I've had four hospital appointments with consultants in the last six weeks. When I ask questions about likely outcomes and surgical menopause all they will say is wait and see.

I've asked about HRT and been told that at thirty-eight I'm too young for it to be a consideration unless the symptoms of menopause are "life-changing".

However from what I've read it seems like HRT would be a good thing and lowers risk for osteoporosis and I'd rather be on it then wait and have to let any symptoms become horrible before anything is done.

I'm in England so healthcare is free but, and this is my first ever surgery, first time I've been to hospital and spoken to consultants, had scans and tests etc, it seems like there isn't much in the way of patient choice.

I feel dictated to. I know what I require of the surgeon especially is that he be very good with a scapel but I do find the men I've spoken to lacking in empathy and unwilling to discuss things and answer questions properly. Today I asked the surgeon to stop talking to me in patronising euphemisms which he didn't like but I don't like being spoken to as if I'm a child and my body is some mysterious entity that can't be discussed. I'm a woman, not Cthulhu.

Thanks to anyone who's still here at the end of this rant, much appreciated And I'd value all opinions/experiences on to HRT or not to HRT. Thank you.

My personal theory re: surgeons is that they choose this field of medicine because they find it easier to deal with *unconscious* patients than conscious ones. I'd suggest talking to your GP about this instead.

The problem is that the reason your ovaries are being removed is that estrogen can cause of recurrence of both endometriosis and endometrial cancer. The ovaries are being removed so that they don't continue producing estrogen. For the same reason, the estrogen in HRT could also lead to recurrences. If your primary goal is to avoid recurrences, you don't want HRT.

I'm assuming, however, that your *real* primary goal is good overall health and good quality of life. That means you're going to have to do a balancing act between the effects of surgical menopause and the risk of recurrence. Talk to your GP. If your GP's not informed on this subject, see if they can refer you to someone who *is* but who's not primarily a surgeon.

For what it's worth, the trend in endometrial cancer treatment is towards keeping the ovaries in pre-menopausal women with early stage cancer. I don't know about endometriosis, though.

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Originally Posted by Rackrent I'm having a TAH BSO for endometriosis and possible cancer which will be tested for during surgery late next month/early October. Today I had another consultation with my surgeon and I asked about HRT. I've had four hospital appointments with consultants in the last six weeks. When I ask questions about likely outcomes and surgical menopause all they will say is wait and see. I've asked about HRT and been told that at thirty-eight I'm too young for it to be a consideration unless the symptoms of menopause are "life-changing". However from what I've read it seems like HRT would be a good thing and lowers risk for osteoporosis and I'd rather be on it then wait and have to let any symptoms become horrible before anything is done. I'm in England so healthcare is free but, and this is my first ever surgery, first time I've been to hospital and spoken to consultants, had scans and tests etc, it seems like there isn't much in the way of patient choice. I feel dictated to. I know what I require of the surgeon especially is that he be very good with a scapel but I do find the men I've spoken to lacking in empathy and unwilling to discuss things and answer questions properly. Today I asked the surgeon to stop talking to me in patronising euphemisms which he didn't like but I don't like being spoken to as if I'm a child and my body is some mysterious entity that can't be discussed. I'm a woman, not Cthulhu. Thanks to anyone who's still here at the end of this rant, much appreciated And I'd value all opinions/experiences on to HRT or not to HRT. Thank you.

Hi. It's sort of strange that they told you no HRT because you're too young; they told me no HRT because I'm too old (49)!

My doc's plan was to wait and see how I did without it. That made me very nervous. I have a history of pretty serious depression and when I shared that with her she agreed to start it immediately. I'm on a low dose of estradiol and prometrium. I'm 2 weeks postop and feeling really good. Hopefully that continues (I have heard that the body has some stored estrogen for a while).

And good for you for speaking up to your doc! I know many love their male gyns but I would never entrust that part of my body to a male (and especially one with a condescending attitude)!

Good luck on your journey and I wish you peace during your wait. I had to wait until surgery to find out if a large ovarian mass was cancerous and it was a difficult time.

Wishes for your wellness!

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Originally Posted by Rackrent I've asked about HRT and been told that at thirty-eight I'm too young for it to be a consideration unless the symptoms of menopause are "life-changing". However from what I've read it seems like HRT would be a good thing and lowers risk for osteoporosis and I'd rather be on it then wait and have to let any symptoms become horrible before anything is done.

I'm at risk for osteo since my mother has it. At age 54 I'm not on HRT (yet) because I work out including weight bearing exercise which helps bone strength. Doc has suggested it, but knows my workout routine and has revised his suggestion to "We'll do a bone scan next year for a baseline and see where you stand." That I'm all for. Then if I need it at some point in the future for bone strength or whatever reason, I'll start. Not having HRT right away doesn't sentence you to a dowager's hump or make your bones immediately brittle.

Truth is estrogen is needed by our bodies, and younger women will notice it's absence more. There are reasons, though, women might opt out of HRT - some of it is clear cut, but other reasons need more study. Here are two good summary articles outlining those who might benefit and those who might be at risk from it, Hormone Replacement Therapy and Should I Use HRT?

As an aside, the relationship between HRT & Heart Disease is not definitive - the studies are usually conducted with older women as subjects who have more propensity to heart disease.

(Awright ladies, don't go throwin' all male doctors under the bus ! I've got a male doctor - he is an excellent doctor-surgeon, listens to his patients and considers their preferences. I wouldn't trade him for any doctor, male or female .)

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Originally Posted by Cussette ...(Awright ladies, don't go throwin' all male doctors under the bus ! I've got a male doctor - he is an excellent doctor-surgeon, listens to his patients and considers their preferences. I wouldn't trade him for any doctor, male or female .)

I'm seeing three different oncologists. My med onc and rad onc are women, my gyn onc is a man. The one with the most blatant, "Me doctor, you patient," attitude is... my rad onc!

I can speak to the endo issues. If you have endometriosis, then a hyst/BSO won't be a cure. Neither will going without estrogen because endometriosis can make its own estrogen or get it from the foods you eat. Our best bet at staying endo symptom free is to visit with a specialist who is trained to recognize and excise (not scrape or burn) each implant. Most ob/gyns don't have the training to excise the implants from the delicate tissues of the bowels (where endo is commonly found) or the bladder or other body parts. Any that is left behind can cause problems. By not taking HRT, you aren't feeding them a steady flow of estrogen, but you aren't preventing them from getting it either. We have members who have had excision surgery and have been able to keep their ovaries and remain symptom-free. As for talk about your being too young for HRT, it sounds backwards. It may be that there was a misunderstanding and the specialist thought you were requesting HRT right away, not for after your ovaries are removed - that's the only way that comment would make sense. I would advise trying to keep your ovaries if you do not have cancer. I had to have mine removed because they were covered in scar tissue and basically filled with endometriomas. My gyn/onc knew to excise all the endometrial implants and I have used HRT for over 3.5 years with no return of endo symptoms. I was utterly miserable without HRT waiting for pathology to come back. I was 45. I hope that helps a bit.

(((Rackrent))) First, I'm sorry you're dealing with all of this. I was about your age when I had my radical hysterectomy for cervical adenocarcinoma. We did remove ovaries as well, and my gynecological oncologist did prescribe HRT (which I opted not to do due to other concerns). So, I do find it a peculiar statement that you are "too young" as you obviously will be losing ovarian function entirely once they're removed. That logic would seem to make more sense not to prescribe HRT if you were older and nearer to natural menopause. Your survey states possible ovarian cancer, so perhaps the reason for no HRT is somehow related to that or to your endometriosis? Either way, it definitely sounds like things warrant further discussion. Speaking of cancer, we do have a Cancer Concerns forum you're welcome to check out, if you'd like. There's lots of great information there and experienced ladies glad to help.

All that being said, it is possible to manage without HRT. Of course, we're all different in this regard, and there are pros and cons to both approaches. My worst immediate symptoms were mild hot flashes and being overly emotional about things, both of which resolved over time. Now, a decade beyond, my most noticeable issues are dry skin, thinning hair and mild cognitive issues (like that tip of the tongue feeling when you can't find the word you want). Nothing much out of the ordinary that other women in my age group report experiencing to some degree.

As for those doctors, well, some certainly have better bedside manners than others, and specialists generally tend to skew to the lesser side (not all, of course). But, you absolutely should understand and feel comfortable with your treatment plans. So, keep advocating for yourself until you do!

I actually had the opposite reaction from my doctor. I was 35 at the time of my Hysterectomy (I'm now 36), so I was three years younger than you. My doctor insisted that I use HRT because of my young age, in spite of my reservations. I had my Hysterectomy for Endometriosis and severe pelvic pain. I have a family history of breast cancer. I've had five surgical breast biopsies and three core needle breast biopsies myself. There was no question that I wanted to have my ovaries removed.

I was concerned about the increased cancer risk associated with HRT. I talked to my primary care doctor. He felt that in my case, the benefits of using HRT outweighed the risks. In his opinion, the media tends to over blow the HRT and cancer risk connection. I am taking the lowest dose possible of HRT to meet my needs. I'm on 5.5 mg of Estradiol tablets daily and I use 1 gram of Estrace vaginal cream 2-3 times a week. I haven't had any unbearable menopause symptoms. I have had times where I get pretty warm, but it's hard to tell if it's because it's hot outside or hormones!

In your case, I imagine the cancer concern plays a role in whether or not you can use HRT. Since Endometrial Cancer (and other types of cancer) can be fed by Estrogen, I can see where there is some resistance on the part of your doctors to discuss HRT. Doctors are also on the fence about prescribing HRT to Endometriosis patients. If the Endometriosis is not completely excised, Estrogen can make matters worse.

Are any of the consultants you spoke with willing to wait to see what your pathology results indicate before prescribing HRT? Some antidepressants can also be helpful with treating menopause symptoms. This could be a possible option for you if it turns out that you are unable to use HRT. Get as many opinions as you can and make a decision based on what you feel comfortable. Good luck!