total hysterectomy 16 mos, on premarin digital mammograms showing problems

I had a total hysterectomy 16 mos ago. huge fibroids... and tried several types of hrt and settled for premarin.. I am going for my third trip this month for a digital mammogram and ultrasound because they found a cyst of some sort and some other things that need a closer look. I had read somewhere that if I go off hrt now and have this digi mam now but hold off on treatment and repeat the digi in 6 mos, it could actually show or not show the cysts and other problem area. I am just curious as to whether or not anyone has encountered such an idea or experience. Cysts, Breast cancer, breast problems do not run in my family for generations back, so unless this appears to be truly suspicious or they recommend moree than a needle/and or biopsy I want to consider putting off anything more, but need some support with this idea. My doctor has not heard of this. Of course, he never heard of a vaginal cuff or doing blood tests for hormonal levels either.. He was however, an excellent surgeon.
Any feedback?
Thank you.

Is this your first digital mammogram by chance? The reason I ask is that I had perfectly normal mammograms from my baseline at age 35 through my annual ones at age 40, 41 and 42. At 43 I go into early menopause (no known reason) and also, within a month of starting HRT, have a "call back" mammogram. Coincidentally, this was my first digital mammogram as the facility had upgraded in the previous year. All of a sudden the density of my breasts has increased from 50-75% to over 75%, which is apparently the highest level. I had not been on the HRT long enough to cause this. It takes over a month to get into the breast center, where they do a spot compression on one breast and an ultrasound on both. The spot compression was clear - just overlapping tissue - but they note a small cyst in each of my breasts. They say that I can either have a biopsy then and there until I told them that I had the Mirena IUD for about 5 months the previous year (after I had it removed, no more periods, instant menopause). The radiologist said 99% that the hormonal imbalance was the cause and said that I was fine to wait 6 months and repeat the ultrasound. I had that repeat ultrasound in Nov and everything was fine...the cysts were still there but not changed at all...so the radiologist felt that they had been there all along but were not visible until I had the digital mammogram. I am, however, still on a 6 month rotation for a while, where I will get a diagnostic mammogram and an ultrasound. Not sure when/if that will change back to annual. I see my OB/GYN for my annual next month and will ask him then.

I am just wondering if you might be in a similar situation, where the cysts may have been there all along but not noticed until the digital mammogram?

Thank you for your note back.
I have always had the xray type mammograms until this year. This will be the 4th time I have had the digital mammogram this month, and the 1st ultrasound. I have never had anyone say anything except that I had "clumpy" or lumpy breast.. I think mostly meaning hard or dense... I never asked because no one ever seemed to care, always had a mammogram for the past umpteen years, I just turned 52..
I am wondering if the trouble started with the premarin.. and if I do ask for a "stay" of 6 months if I go off the hormones.. if the pictures might change or at least stay the same. I did not want to go on the hormones in the first place, but I just hit a brick wall after my surgery.. really I needed some help NOW. My hair started falling out in clumps, dark spots were jumping out on my hands and face, white spots too, my skin was turning reptilian, and the hot flashes were intense.. but I think I might be more apt to endure some of them or at least try...

You have given me a bit of encouragement, at least some thoughts to approach the radiologist and doctors with. Courage... I am just a nervous nervous person when it comes to docs and hospitals...
Thank you much... Just Enough

Sounds like you may very well be in the same situation as me in that the real change here is the technology upgrade. Because I had to go to a breast center for my spot compression and ultrasound, I had to go to my regular mammogram place and get the films to take with me, along with copies of the reports that they had been sending to my Dr all these years -- which were NOT the same as the "your boobs are fine, see you next year" letters that we normally (thankfully) get. I was STUNNED to see that my breasts were categorized as dense to begin with because no one had EVER mentioned this to me during or after any of my previous mammograms. I always thought that only younger (20s, 30s) women had dense breasts, not older women. I had to joke with my Dr that it was a cruel joke that I am barely a 34A and now I hear that I have more breast tissue/dense breasts??? Anyway, now I know, but I kind of got onto my Dr for not telling me. He also told me that in the past year, the guidelines have changed in terms of breast density -- that they now recommend an ultrasound for denser breasts -- and I have been reading about these changes in the news.

I'm glad that we seem to be getting the right care in terms of follow up ultrasounds. Let's hope things stay the same....I understand that if the cysts stay the same, generally things are ok. I did note that the staff at the breast center was very, very anti-HRT. They obviously didn't have to do without estrogen at a premature age.

Take care.

There are probably a couple of things going on. First, digital mammograms are much more sensitive than traditional mammography and can see much smaller features. The downside of that is that they can be over-sensitive and flag things that really aren't anything to be concerned about. The first digital mammogram is really like a brand new baseline; what matters more is the comparison of the next one to this first one.

That said, any unopposed estrogen, Premarin included, can increase the density of your breasts and aggravate fibrocystic breast condition. Using natural progesterone to oppose the estrogen can help reverse the increased density. Dr. John Lee writes about this in his book "What Your Doctor May Not Tell You About Breast Cancer" (which is not just about cancer). Remember that fibrocystic breasts are not cancer, nor do they increase the likelihood of getting breast cancer.

I hope this helps.

s,
-Linda

You know, I didn't even think to ask the OP if she was using any progestin/progesterone in conjunction with the Premarin. I am using the Vivelle Dot .075 and taking 200 mg Prometrium 10 days per month. I have not had a hysterectomy but I went into menopause early/prematurely and it happened over the course of 5 months -- went from thinking that I still needed birth control to menopause!

I was never ever told that I had fibrocystic breasts (and still haven't been told that) although I was certainly aware of what it is. One of my aunts has terrible trouble with it. I think you are right that the digital is so much more sensitive, which is good, but like you said, brings to light many things that perhaps aren't really a problem. Since my 6 month check was clear, we'll see if I get to go back to an annual schedule after my next one in May.

This board has really helped me in my decisions regarding HRT. I really appreciate everyone's input.

(((Red1964))), do be careful about extrapolating information you find here to your own situation. We are a hysterectomy support website. Women without a uterus don't generally need to use any form of progesterone or synthetic progestin, with the possible exception of some women with a history of endometriosis. DRs often will tell women without a uterus that they shouldn't use progesterone, which is not the case at all - it's just that we may not need to. So, for some of us, it can be a struggle to get a DR to prescribe it, so we end up using an OTC product (some of which are great). Also, we do not cycle our HRTs since we have no need to bleed regularly and no uterus to build up, and cycling only contributes to an increase in hot flashes and other menopausal symptoms.

Also, synthetic progestins and natural progesterone are very different. They act differently on breast tissue. Natural progesterone can help with fibrocystic breasts; synthetic progestins have been found to be associated with an increased incidence of breast cancer in the women in the WHI study.

I have found that, for me, a tiny dab of a really good OTC natural progesterone cream completely stopped the soreness I was getting from cysts. I still get them occasionally, but don't notice them, and my breast density in mammograms has decreased a bit since I started using the progesterone, meaning that the mammograms are a little easier to read.


-Linda

It is not uncommon for women to develop fibrocystic breasts during perimenopause as the hormones start to change. I got cysts for the first time during the years preceding menopause in my forties. Any hormone change/imbalance could bring them on, I guess. I still have the cysts, a number of them, but they change, come and go. I have to have breast ultrasounds because of it, and the cysts are pretty easy to spot on ultrasound.

I'm familiar with where mine are, the lumps I know from self-exams, so I just keep up with noticing if there is another lump aside from those. The cysts may increase and decrease in size as if they go through cycles. Mine don't cause me any pain or trouble, and some have disappeared over time. However, the pressure from mammograms causes me intense pain, probably because of the cysts -- I've had severe, shooting pain for 2 weeks after a mammo -- so I no longer get mammos very often, because I felt they were causing me breast tissue damage and setting up a precancerous condition in itself along with the radiation. I know for fact that mammo pressure popped a couple of my cysts. I don't recommend that anyone copy my action. And be aware that ultrasound is not a substitute for mammograms. Stuff can be found on mammo that does not show up on ultrasound, and vice versa. That's what the doctors say.

Also, be aware that if you ask for less pressure with mammo, the technician may do it that way but may not tell you till afterward, if at all, that you get more radiation with less pressure. That is not good.

As for Premarin, I have a close friend fighting breast cancer who was on Premarin for years. I tried to get her to go onto human-identical estrogen instead of horse-identical estrogen, which is what Premarin is, but she wouldn't. We will never know if her cancer is related to the Premarin, but I say why not stick with the estrogen your body knows.

I'd just like to add that the WHI study data were pretty clear that the women on Premarin alone did not have any increase in breast cancer rates over women not on HRT - in fact, their rate of breast cancer was slightly LESS (though not statistically significantly so). There is absolutely no evidence that Premarin OR bio-identical estradiol increase one's risk of getting breast cancer, though they can cause it to grow faster if it's already there.

Also, in the WHI study, the women on Premarin who did get breast cancer during the study period had higher survival rates than women in the study who got breast cancer who were not on estrogen. There are two explanations for this: (1) that the women on Premarin who got breast cancer got types that were more survivable, ie less invasive (mostly DCIS); and (2) that being on estrogen kept their bodies stronger and more able to fight the cancer.

At Hystersisters, we don't try to influence women towards or away from any particular form of estrogen. Not everyone does well on the same HRTs, and women should use whatever provides the best symptom relief for them as long as there is no compelling reason not to use it - and that includes Premarin. I'm a fan of bio-identical HRTs myself, but that doesn't mean I have any business telling anyone else they should use them.

I would absolutely recommend AGAINST skipping mammograms because they are uncomfortable, because of the radiation exposure (which, these days, is pretty low), or for any other reason unless your DR specifically instructs you to. The compression used during mammography does not cause tissue damage that in any way leads to breast cancer -- breast cancer begins down at the cellular level, not the tissue level. And if you are afraid of the discomfort (which really shouldn't be bad, as the newer machines aren't nearly as tortuous as the older ones), you could ask that they use one of the new cushions that are available to go between your breast and the paddle. There may be a small extra charge, but for those who find mammograms painful it may be worth it.

I have mammograms every six months because I'm a two time breast cancer survivor, both times in the same breast. The non-affected breast doesn't hurt a bit; however, the other one still has a seroma from the last surgery and radiation two years ago and it hurts like crazy when they compress the area. But you know what? I hold my breath, grit my teeth and count my lucky stars that I'm able to have mammograms that help detect the problem before it becomes untreatable.

s,
-Linda

Thermography is a substitute for mammograms if you can get it. Supposed to be more accurate, too, I believe.

I have to follow my own intuition on the mammo. It's a risk, maybe, but I walked out of the last one with a very strong and dark gut feeling I was being harmed by it, and the pain I had for 2 weeks after was scary. I talked with my doctor about it and went for ultrasounds only for a while. I am debating whether to get a mammo next time.

And when you look into it, you read stuff like this:

"Moreover, international studies have shown that routine premenopausal mammography is associated with increased breast cancer death rates at older ages. Factors involved include: the high sensitivity of the premenopausal breast to the cumulative carcinogenic effects of mammographic X-radiation; the still higher sensitivity to radiation of women who carry the A-T gene; and the danger that forceful and often painful compression of the breast during mammography may rupture small blood vessels and encourage distant spread of undetected cancers."
-- The Politics Of Cancer by Samuel S Epstein MD, page 540