Kept ovaries--7 weeks post op, hormonal symptoms--when do I try HRT?

7 weeks ago I had an SAH and kept both ovaries. My recovery has been very smooth and painless physically, but my hormonal symptoms aren't really stabilizing. For 9 or 10 days after surgery, I had terrible night sweats, memory loss, emotional volatility, etc, but I hoped that would calm down. It did for a little while, but the night sweats have come back, along with bad insomnia, vaginal dryness, and complete lack of clitoral sensitivity. I hate taking ambien, but right now I need it to function at work, and the sleepiness is driving me crazy (I'm not physically fatigued; I have no trouble getting a lot of walking in, at least when I've gotten some sleep).

Tomorrow I'm going to see my internist, and I hope she won't brush me off the way the surgeon did when I first mentioned these symptoms (he said the usual: you kept your ovaries, this must all be completely unrelated).

Before I see her, I hope you all can help me with some questions for her, so I know how to proceed if her first response is--you kept your ovaries, this must be something unrelated...:

At what point do you stop waiting for your ovaries to come back to normal? When you're exhausted by insomnia and night sweats?

Is an estradiol patch a reasonable first try? I'm 44, no history of endo, no family history of any reproductive cancer, and in great health otherwise.

Which hormone tests, if any, should I ask her to give me? LSH levels? Should we wait for the results before trying something, or just jump right in, because I'd rather go on an estradiol patch than take ambien every night?

Thanks!

Sorry you are experiencing all that you are, but glad you feel okay physically..!

Boy, you are still SO early post-op, there's a chance that even if you start hrt, you'll still be all over the map for awhile as your body adjusts to surgery...And at that point, tweaking of your hrt may be needed...

I kept my ovaries also, and didnt start hrt until 7mos post-op, but the only real complaints I had was insomnia, and,..umm I've forgotten! (Maybe memory loss!?:-) Anyway, 2-1/2 yrs later, I still have insomnia, do take 5mg Ambien nightly (which I hate also) but no sleep is waay worse for me I've learned the hard way!

Oh yeah! My other symptoms were heart palps and fatigue.. Estrogen quickly took care of the palps. Wish I could figure out the insomnia, and I have tried EVERYthing known to man. I'm sure there are other factors involved, but it began with my TVH.

Bottom line is, your symptoms ARE related, and don't let her brush you off. You may need to start with some estrogen to see if gives you some relief. Just know that as you get further down the road in your recovery, you will most likely need to re-adjust your dosage. If it were me, I'd start with estradiol only, and see what symptoms it helps (or not) before adding the others.

Good Luck! You are fortunate not to have had much pain afterward. I was lucky too.. I had to go back to work 2-1/2 weeks after surgery, which I found was too early. I suffered with fatigue for months after that. Dhea helped greatly with that a year or so later...

Hang in there, hopefully she will allow you some sort of relief....Keep us posted!

{{{Tiva}}} ask for an FSH level ,that is a starting point anyway to see how your ovaries are functioning...it is NOT uncommon at all to have your ovaries "go to sleep " right after a hyster.............I too kept my ovaries ,and my FSH level came back FINE;but I still was having sypmtoms of menopause ...........Night sweats,insomnia, emotional instability and NO libido ..I aslo had my testosterone level checked because I too had almost no clitoral feeling............that level was VERY low ,as was my estrogen level.....I`m on a compounded testosterone cream and a low dose of the Climara patch.........I`ve seen slight improvement in my symptoms.......having a recheck in July.I agree with compassionate1 ;you are EARLY in recovery ,but I believe your symptoms bear investingating..........I would insist on a complete hormone panel and go from there......... `s Renee

Hi tiva!

I think asking for a FSH (Follicle Stimulating Hormone) test would be sufficient at this early point in your recovery. Hormone levels fluctuate post-op with or without ovaries, on or off hormone therapy. There's not really much point in having all of your levels checked at this point.

That said, your symptoms are what they are and if you aren't comfortable with them, discussing the use of estrogen with your doctor is not unreasonable. Ovaries sometimes don't function as well as they should post-op and it can take time for them to recover. It's not unusual for women to need some hormone therapy to help level things out post-op. I hope your doctor will be receptive to the idea.

Articles #10 - 13 will give you an idea of what your estrogen choices are. My personal preference is to use transdermal bio-identical hormones, so I'm using Vivelle Dot for my systemic estrogen along with Vagifem for vaginal dryness and also progesterone and testosterone creams. I think starting out on estrogen only is the way to go. Things get complicated in a hurry if working with multiple hormones. By introducing one at a time we have the benefit of seeing how we are going to react to each. I think an estradiol patch is a very reasonable choice. Climara comes in the following doses: 0.025, 0.0375, 0.05, 0.06, 0.075 and 0.1, and Vivelle comes in the same doses except they don't have a 0.06 dose. Climara is changed once a week and Vivelle is changed twice a week. Generally it's best to start on a low dose and see how that goes before considering a higher dose. Changes should be made gradually, giving each a couple of weeks before considering another. You might want to keep a journal of your symptoms so you have a clear picture and record of the process.

I hope this helps! Let us know what your doctor says, okay?

s

Hi Tiva,
Even though I didnt keep my ovaries, I thought I would give you my take. I started the perimenopause symptoms over a year before my surgery. I chose to go on HRT immeadiatly following surgery-estradiol-and have found that it works great for me. I did forget for a few days and then started having sleep issues, crying, etc. Once I got back on for a couple of days, I can say that I have noticed a big improvement. When I was going thru the night sweats, ambien did not work for me. Couldnt figure that one out. Anyway, I think it is perfectly reasonable to talk about your symptoms. And, at 44 you could very well be starting the change, or the ovaries could still just be sleeping. Also bear in mind that your FSH levels are constantly changing. Good luck to you!

Thanks for all the advice. I had been having a little trouble sleeping for a year before surgery (with very occassional night sweats), and ambien could sometimes help. But while it helps put me to sleep now, it only lasts for about 5 hours, and taking another half dose later just makes me groggy all day. Part of me thinks I should just give this another few months, but part of me wonders why--if I still had my uterus, a doctor probably wouldn't hesitate to put me on a very low dose minipill to get through perimenopause, so why would this be so different?

Thanks for all the advice. From reading the hormone jungle articles, I had figured that transdermal (either patch or cream) bioidentical estradiol might be a good bet. We'll see what she says this afternoon.

My poor grad students are so puzzled by my inability to remember anything, and by my irritability. It finally occured to me that these also might be related to hormones. Feeling so good physically after surgery has made it hard to remember that my body still has to adjust. My surgeon released me for everything at 4 weeks, and luckily my DH hasn't put the slightest bit of pressure on me to be sexually active with him. He also thinks it's awfully early for me to expect to want to be sexy. But it would be nice not to feel quite so dead down there.

Hi Tiva:
I hope your internist visit went well. At my 6+ week visit with gyne I was sleeping well, 9.5 hrs/night. By 8 weeks I was sleeping 5 hours per night and waking up 3-5 times. I've read that the body stores of hormones (mostly estrone from fat, if I recall correctly) decrease over the first few months after surgery and I think that happened to me. I needed to increase my HRT from 1.5 mg of Estrace to 2 mg just to survive. I haven't had to try ambien yet but that may be in my future. I've been taking melatonin for quite a while for sleep troubles caused by my fibromyalgia. It only lasts about 5 hours and I don't feel groggy in the morning.You might be able to take that mid-way through the night and still function the next day. I've been suffering at work too. Summer student #1 asks me a question, then the phone rings, #2 asks a question and someone comes in the lab. I then have to ask #1 what I was doing when she asked me a question! I can't remember much for long!!!

About the lack of feeling- I had laparoscopy and one ovary removed in '98 and lost some nerve sensation from belly button to clitoris. Luckily other nerves remained and the bikini cut I had didn't make things worse. But nerves do regrow so maybe things will get better with time for you. Getting a good night's sleep would help too! I tried Lupron in '99 to see if the pain was less and how I would manage menopause. I never slept for 3 months. That is why I waited until the last possible minute to have a hysterectomy. Fortunately I only needed 6-7 hours of sleep before surgery so functioning with 5 isn't as bad as it is for most people. Good luck with your HRT etc.
Kendo

Hi everyone--

Back from my internist, who it turns out is now opposed to HRT for ALL women, ovaries or not. (She's not an obnoxious doctor at all--she talked about how hard it's been to interpret the recent studies, since for much of her career, she was urging HRT onto women because of the supposed cardiovascular benefits, and now she's warning women away because of cardio risks).

But she's happy to prescribe bioidentical estradiol patches for women who want them to relieve symptoms. She simply thinks the blood clot data is frightening enough to make it a significant risk, even though no one has done long term studies with bioidentical hormones yet. She feels that vaginal estradiol is quite safe, however, since its systemic effects seem very low. She prefers to start women with symptoms on megavitamins and herbs and vaginal estradiol, then add the estradiol patch (and other hormones possibly) if symptoms don't improve.

So here's what we're trying for 2 months, then re-evaluating: a vaginal estradiol ring (estring) right now for the vaginal dryness. PLus 800 mg of vitamin E, 200 mg of B6, and 40 mg of black cohosh for the night sweats (along with the usual exercise, stress reduction techniques, sleep hygiene rules..). If those don't work, then she's happy to prescribe whatever form of bioidentical hormones I want, even though she is not happy with their potential risks.

My doctor felt that things are still so early after my hysterectomy that my symptoms may settle down soon (especially since I'm in a very stressful time at work, which will calm down in exactly 6 days). I hope so.

Good luck to everyone else going through this!

Hi , I would try fish oil,I am 45 kept my ovarys too.It has helped me with hot flashes. I am sleeping well with the help of xanax..Small dose...at night only. Please share what your dr, says you are too young to suffer..