Pros / Cons Estrogen Replacement

I am 4 weeks post- op from my complete hysterectomy due to bleeding and exposure to DES in utero. I have no motivation to do much of anything ! I was adiment with my doctor in the hospital that I did not want hormone replacement, but I am now having second thoughts. Hot flashes are returning, I am waking up every 30-45 minutes at night, tossing and turning etc.

I am condisering estrogen replacement only.

Advice?

Janet

Hi Janet,

I do not have an answer to your question and I thought it was a very good question. Decided to reply so your question could be pushed up on the board.

Best wishes,

Mary

Thanks,

I am going to call my doctor tomorow. My brother is an ER doc and he says the literature is difficult to interpret, but seems to think that estrogen alone will not increase my risks for breast cancer.

Janet

Hi Janet,

Here is a Web MD link that might help. One link might lead to another for some information.

http://www.webmd.com/hw/womens_condi...13-medinfo.asp

Mary

(((Janet))) Well, you're finding out that, despite whatever you had decided you wanted to do, your body may end up telling you otherwise. I think starting out on estrogen only (if you didn't have endo) is a smart idea, because it can let you focus on getting the estrogen dosage right before you throw in other hormones to complicate things. Some women do fine on estrogen alone. Others end up having to add either progesterone or testosterone, or both. The only way to find out is to "experiment".

I'd suggest starting a journal, in which you list dates, which vitamins, supplements (yes, those things matter too), HRT's and other meds you're on, and what symptoms you have. This list of symptoms of too much or too little hormones can be your guide:

http://www.hystersisters.com/vb2/article_97238.htm

When you start estrogen, give it some time to have the full effect. Initially when you start or adjust HRT's, you may have some increased hot flashes just from the change in levels... but if you're going in the right direction, they should taper off within a few weeks (sometimes much faster). When you've gotten as close as you feel you can on estrogen alone, then you can take another look at the symptoms list and decide whether you want to stay where you are, or try adding progesterone (I suggest leaving testosterone for last). If you add progesterone, don't change your estrogen dose at the same time or you won't know which change made the difference. Always change only one thing at a time, and always give each change time... hormone balance can take a long time. I didn't get around to adding testosterone until six months post op, and only after my DR had tested my serum levels of free and total testosterone and determined my free testosterone level to be very low. She also checked my liver function and lipids (cholesterol), as testosterone can adversely affect both of those. Other than the testosterone level testing, many DRs feel that hormone tests are a waste of money (lots of it), because each of us feels best at different hormone levels. Ultimately how you feel is more important than what the numbers are. The reason it's different with testosterone is because if you already have a lot of testosterone and you add more, you risk symptoms of too much, which can be unpleasant and hard to get rid of.

As far as which type of estrogen to try first, there are tons of choices. My recommendation would be to try the Vivelle dot 0.5mg/day patch first. That patch is the hands down favorite because it sticks best, and tends to cause the least skin irritation of all the patches. The 0.5mg/day is an average dose so it's a good place to start -- you can go up or down from there (most go up eventually). Your DR may have free samples you can try.

I hope this helps!
s,
-Linda