Ovaries? HRT?

TAH BSO scheduled for April 3rd.

OK - I've made it this far. The scheduler phoned today with the date - four weeks from next Monday. I do feel confident about the decision to have a hysterectomy - but I'm a little nervous about the ovary issue. I would love to hear other's opinions. I have a choice. At this point I asked my GYN to remove the ovaries. I've had surgery in the past for a ruptured cyst. The ultrasound didn't show a cyst today, but I know that feeling and it comes and goes each month. In addition, my DH's Aunt died at 55 of ovarian cancer. He was devastated by this. I know the odds are low - but I wouldn't want to risk this. My side of the family has no such cancer history and I'm aware that the risk of heart attack is greater - but my instinct tells me to remove them.

My concern is the hormone jungle afterward. Now that truly scares me. My doctor doesn't prescribe anything after surgery until/unless there is a problem. She assured me today that IF I need hormone therapy she always prescribes a natural combination - nothing like what was used in the WHI study.

What does everyone else think?

You are very lucky to have a doctor who will prescribe a natural combination. Most put you on the standard HRT without looking at you specifically. Mine wants to give me a patch or gel. I found another doctor....have yet to get an appointment with him....to get a natural combination prescribed. I'll visit him after my surgery. Talk to yours. She sounds likes she will look at what your needs are instead of pulling some HRT solution off the shelf for you. Good luck in your process and your surgery.

Best of luck to you! The waiting is the hardest part. I had a TAH/BSO on 2/14. We took the ovaries because of my endo and I didn't want him to have to go BACK in and get them at a later time! I started getting hot flashes 3 days post op and my doc prescribed me PremPro and it has been WONDERFUL. NO hotflashes, no crying spells like I had in the hospital! I am 2 1/2 weeks post op and am feeling better every day! Big hugs to you!

Hi MyMacey!

Many people recommend keeping ovaries if they are healthy, but if you have had problems with ovarian cysts in the past, maybe they aren't so healthy. I had healthy ovaries but still opted to get mine removed when I had my hyst at age 50. I, too, went with my instinct so I understand where you're coming from.

With regard to HRT, I don't know what you mean by the term "natural combination." Perhaps you are referring to compounded bio-identical hormones? At any rate, I recommend that you do some reading in the Hormone Jungle area of the site. You will discover that, no matter what type of HRT one chooses, some women experience success right off the bat, while others struggle for a long time to find an HRT regimen that works for them. There's no way to tell ahead of time whether HRT will be a breeze for you or the beginning of a long saga of trial and error.

Good luck in making the surgical decisions that are best for you!

Many s and Best Wishes,

What I mean by natural remedies are compound creams made up of estrogen and progesterone according to my specific needs. I have found another doctor (GYN) who prescribes the correct levels based on the patient's needs. They are then made up in cream formula's at a compound pharmacy. I will know more after I have an appt with him. I am NOT interested in the stuff off the shelf so to speak. My surgeon suggested skin gels and patches with estrogen only and that's not what I'm looking for.
So if compound bio-identical hormones is the term I should be using, I stand corrected, thankyou. I apologize as I do not mean to suggest anyone not use standard HRT that doctor's prescribe. It's just not for me. I saw my mother take that for years with numerous side afects. I am also an alternative health practioner and do not want those premade HRT combinations as I would prefer it made up to according to my specific needs. As someone who has suffered with migraines and other symptoms related to possibly of low progesterone since I was 16 years old (and I'm 50 now), it's time I took my own healing path into my own hands. I've listened to doctors my whole life telling me what the reasons were for my problems and now that it's coming down to all of this, I am going to explore all possibilities out there. This is a great forum for women to share knowledge in all areas and experiences and I'm sharing mine for what it's worth.

Yes - waiting is going to be harder than I thought. During the day, I feel like "I'm OK - I can deal with this." But this morning I woke up with a sore jaw! I feel like I gritted my teeth all night in my sleep! I have a few butterflies in my tummy as well. I guess they will go to the castle with me.

I agree with Duckie36. I DON'T want to have to go back later and take the ovaries out. Another reason for my decision. Then there is the issue of whether or not my ovaries will function correctly if I left them. From what I understand - it's more difficult to decide for women my age (almost 45) - 55 because most of us have begun having perimenopausal symptoms and the hormone jungle has already begun.

On the other hand - I understand the point of view that healthy tissue should never be removed unless absolutely necessary. Makes sense to me. Also, women who go through surgical menopause tend to have more symptoms than the ladies who go through a natural menopause. Yes - this concerns me!

Then there is the issue of androgen production. If I have healthy ovaries and they keep functioning for years, what impact would they really have? I have read that for women who have no ovaries, androgens are still produced by the adrenal glands.

As for my GYN's remarks about HRT. I really don't know what she meant by "natural". I will read the hormone jungle section as suggested and be prepared with questions during my pre-op appointment with her on March 28.

Here's hugs to all of you who answered my questions. Thank you!

	Quote:
Originally Posted by Avon Queen What I mean by natural remedies are compound creams made up of estrogen and progesterone according to my specific needs. I have found another doctor (GYN) who prescribes the correct levels based on the patient's needs. They are then made up in cream formula's at a compound pharmacy. I will know more after I have an appt with him. I am NOT interested in the stuff off the shelf so to speak. My surgeon suggested skin gels and patches with estrogen only and that's not what I'm looking for. So if compound bio-identical hormones is the term I should be using, I stand corrected, thankyou. I apologize as I do not mean to suggest anyone not use standard HRT that doctor's prescribe. It's just not for me. I saw my mother take that for years with numerous side afects. I am also an alternative health practioner and do not want those premade HRT combinations as I would prefer it made up to according to my specific needs. As someone who has suffered with migraines and other symptoms related to possibly of low progesterone since I was 16 years old (and I'm 50 now), it's time I took my own healing path into my own hands. I've listened to doctors my whole life telling me what the reasons were for my problems and now that it's coming down to all of this, I am going to explore all possibilities out there. This is a great forum for women to share knowledge in all areas and experiences and I'm sharing mine for what it's worth.

I am with you 100%. I will be looking for the same type of treatment as you describe. I've done some reading on it and intend to do a lot more. My GYN did say 1) No hormone treatment unless I need it and 2) She called the HRT therapy used in the WHI "Horse HRT". Not sure what she meant by that - but she frowned and didn't like it! She DID say she uses natural combinations when she prescribes hormones. I took that to mean what you describe above, but it will be good to make sure I'm hearing from her what I think I am. to you Avon Queen. Thanks for your support.

I'm starting to get a headache! OK - I must be stressing a little. I'm nervous.

MyMacey:

You sure do have your hands full! I can only speak from my own experience and that is if they're healthy, leave them in. I'm 30 yrs. post-op and been through just about every negative consequential experience -- virtually all the menopausal [or menoSTOPal as one author calls it] symptoms in spades, osteoporosis [having lost about 50%, total, of my bone mass], etc. I asked before surgery, to save even one of my ovaries, if possible (it wasn't) and wish I'd been able to.

My position is simply that in a "normal" menopause the ovaries don't just shut down business, they're viable long after your menses stop and work in tandem with the rest of your endocrine system. So I see removing them as I'd see taking the flutist out of an orchestra--the music goes on but there'll be gaps in the performance. <smile>

So saying, I'd side with whatever ~you~ know about your body and your health. If you really feel--despite your not having a family history to worry about--that your ovaries are not healthy or likely to be unhealthy later then I'd go with that. My only concern, personally, would be HRT and taking good care of your bones -- according to one report I read a while ago 25% of the bone we're going to lose we lose in the first 4 yrs. of menopause--and that's the natural variety, where we're creating our own estrogen, still (albeit in smaller amts. and chaotically! <s>)

Congratulations on having a good doctor who'll work with you to get the right bioidenticals for you. If you decide on the oopherectomy I'd suggest getting your levels tested, now, while you're feeling well, in hopes of maintaining those same levels, later.

Keep us posted? Take care.

Hi Yankee Lady,

You have excellent points. This is why I'm here. I want to know everyone's experience and opinion so that I can feel comfortable with the decisions I am making. 50% bone density loss is dramatic. Is that common? I'm so sorry to know that you have suffered for so long with these complications.

I love your analogy using an orchestra. What a wonderful way to "demonstrate" the missing ovary. I suppose the question then becomes how good is the orchestra and how bad is the flutist? grins... I think my flutist has been hitting some sour notes that have ruined the sound of the rest of the orchestra. Perhaps if she is no longer a part of the music - the rest will play beautifully? It could go either way - I know. That's why I want to make the most informed decision.

My worse nightmare is that I take the ovaries out and I become a monster - meaning I'm even more irritable, tired, etc... I saw my step-mother go through that and it was hard on her as well as the rest of the family. (me!!!!)

I wonder how much exercise - particular strength training - help with the osteoporosis issue?

Big thank you for recommending my getting hormone levels checked now. I like that idea. My only concern is that they are out of sync right now since I am currently anemic and experiencing menorrhagia. Still - it is something to compare with later.

Hi!

You're right--checking your hormone levels when they aren't optimum isn't going to be very useful. Even if they were tested at optimum levels, it still isn't helpful. Why? Because there is no set dose of hormones to prescribe to make any of us reach a particular level. We all react differently to dosing. My own experience has been to keep track of my symptoms and have my hormones prescribed accordingly. I know when I feel good, and I know when I feel lousy. It doesn't take hormone testing to figure that out.

Hormone therapy is largely a trial and error process. Doctors and compounding pharmacists can make an educated guess at a starting level and go from there, but even with testing they are going to ask about your symptoms. Also, the range of what is considered normal levels is very broad. You may be tested and told your levels are normal and feel anything but normal! I've had that happen. Ugh!

I do believe that it is important to have free and total testosterone levels done before starting testosterone therapy, but other than that I think hormone testing is not necessary, especially pre-op levels. I know I would never want to duplicate my pre-op levels.

If you are able to keep your ovaries, so much the better! You can always have them removed later if necessary, but you can never have them put back and there are many, many women on this site who wish they could do just that.

It's good you are weighing your options, asking questions and researching.

Best wishes to you!

s