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Measure hormone levels before surgery? Measure hormone levels before surgery?

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Unread 06-29-2007, 03:39 PM
Measure hormone levels before surgery?

I am having a hysterectomy and the ovaries removed also. I am confused about how to figure what kind of dose of HRT to get. Since blood tests can measure hormone levels, should I have my level checked before I undergo surgical menopause? The point being to see if my post-surgery HRT doses are keeping my levels at "normal" for me. It sounds like most doctors just fiddle with doses until symptoms go away, but the point of HRT for me would be to ward off osteoporosis which runs in my family. The plan is to take it until age 50, where it sounds like I'd expect menopause to start anyways. If I have end up having no symptoms to alleviate (like most women in my family), how else would the doctor know how much hormone to prescribe?
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Unread 06-29-2007, 03:48 PM
Measure hormone levels before surgery?

In theory testing before surgery may seem like a good idea, but in reality it's really not going to be that useful. For one, many of the conditions we're considering having a hysterectomy for are either caused or contributed to by hormone imbalance, and who wants to duplicate that afterwards?

Most doctors do prefer to prescribe HRT's according to the woman's symptoms rather than trying to target specific hormone levels. Not everyone will feel the same at the same level.

Unfortunately there is not one set way to know ahead of time what doseage you will do well on or what method of delivery is going to work out the best for you. It can be a matter of trial and error. I will say that that is usually better to start low and work your way up as necessary. It's sort of like cooking, you can always add seasoning, but it's difficult to take it away once you've added too much.

Best wishes on your upcoming surgery.
Unread 06-29-2007, 06:32 PM
Measure hormone levels before surgery?

There are other Dr's who disagree. They view serum testing as a holistic approach and the standard to follow in order to find out whether women have optimal levels of the sex hormones. They then work within individaul symptoms in order to gain the right fit as far as dosage is concerned. Studies show that 45% of women who do not have the major symptoms of hot flashes and night sweats, still have less than optimal levels of estradiol for the proper functionality of estrogen receptor cells. This can affect brain, eyes, heart, bones, and bladder function to name a few of the 400 areas in the body where estrogen plays a signficant role.

I say follow your own heart. If your inner self says that you need to be tested, insist on it. I personally don't think that women should have to accept the "I go by feel" apporach if they need some assurance that they are attaining near optimal ranges. Sure there has to be some flexibity based on symptoms, but where is the flexibility when a Dr says, "I don't test. I go by feel" If this were the case, mammograms would have never been invented and women would stil be suffering the fallout.
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Unread 06-29-2007, 09:11 PM
Measure hormone levels before surgery?

Here is another example of why I also believe there are good reasons to test hormone levels for hrt instead of just going by symptoms:

I do believe that a very important goal of using hrt is to relieve the symptoms of menopause, but for those of us who were pre menopausal and were very young before our hysterectomies, hrt is about more than relieving symptoms, it is about adequately replacing the hormones we used to produce naturally to protect our health as well as quality of life. We don't always know what symptoms mean low testosterone levels or progesterone or estrogen or even thyroid as they all overlap, have similarities, and work together.

However, hrt is much more complicated than just taking a pill and getting your hormones to optimal levels. Absorption rates vary with delivery methods, your body's tolerance to different hrts vary, other conditions like hypothyroidism affects levels, etc...And of course before your hysterectomy when you still cycle, your hormones are not static but rise and fall every day and throughout the day so you might need extensive hormone tests to average your levels out. I do wish I would have kept a monthly journal pre hyst of how I felt hormonally each day. I vaguely remember feeling better the second half of my cycle, between ovulation and my period, the opposite of most women, when progesterone levels are higher. Yet now I do terrible with progesterone. A mystery to me!

I really don't know about testing hormone levels before your hysterectomy. Some doctors believe in it, others do not. I personally have many days I wish I had done this. I now have osteoporosis and wonder if this is because I was deficient in estrogen, progesterone, or testosterone before my hysterectomy or as a result, or if other factors played a part. It would help me figure out an optimal way to treat it if I knew. I had serum calcium and vitamin D levels tested and they were fine. My estradiol was very low last year but with the Vivelle Dot it tested much higher this year. I can't tolerate progesterone or any of the forms of testosterone I have tried and wonder if I was efficient at making them before my hysterectomy or not. I probably didn't have perfect hormone levels before my hyst either but for peace of mind I would love to have had this info! I am still struggling big time with hrt and surgical menopause, and so far this guessing game has driven me crazy! I did not have obvious hormone problems before my hysterectomy and in fact had very regular normal periods...they were just excruciating with endometriosis. But like I said it would have taken extensive hormone tests throughout the day and at different times of my cycle to get an overall picture of what my hormones were doing and the various levels.

I am not sure how easy it would be for you to find a doctor to test your hormone levels (estradiol, progesterone, testosterone, dhea, all free levels as well as total) as it seems to be pretty rare for them to do it...especially if you aren't currently having any problems with hormones, but there are specialists out there who probably do. I don't think it is routine to do this though. It is not something you have to do.

It might also be helpful to have a baseline DEXA scan done either just before or just after your hysterectomy. I wish I had done this instead of waiting for a year afterward. If my scores had been so low before my hysterectomy, I would not have allowed my doctor to take my ovaries. To me osteoporosis is much more serious and life threatening than endometriosis. I have seen firsthand and recently what it can do to you as my Grandma sustained fractures in her spine and is now in a nursing home. Many women die within one year of fracturing a hip. This is the reality I face now. As debilitating as endometriosis is, I have yet to hear of anyone dying from it. Even if your DEXA scores were low and you still decide to have your ovaries removed, you can be better prepared to protect yourself and fight it from the start. The more bone you lose, the harder it is to gain back.

Good luck with everything! You are smart for asking questions now!
Unread 06-30-2007, 02:14 AM
Measure hormone levels before surgery?

Originally Posted by ChrisSPDX
Studies show that 45% of women who do not have the major symptoms of hot flashes and night sweats, still have less than optimal levels of estradiol for the proper functionality of estrogen receptor cells.
Do you have references or links to these studies? Did they specifically involve women who had had a BSO?

(((Naturebound))) thanks for that link. I read the full text of the study. It would seem that the problem with it is that compliance was a big issue in their test population, particularly in women with little or no menopausal symptoms, and that skewed the data towards lower bone density and lower serum levels. I would imagine that if they could repeat the study using only oophorectomized women who use their HRT as prescribed, they'd find a different story altogether.

(((jet914))) Hindsight, of course, is always 20/20... I do wish I'd had my hormones tested before my hysterectomy. Not right before, because as (((Kim))) said, that is rarely helpful; but rather a few years before, before I started into perimenopause. The reason is not so that I could duplicate the levels now, but rather so I could have monitored them and known to get on HRT when I was perimenopausal rather than waiting until after my ovaries were removed. You see, like many here, hormone imbalance was a contributing factor to the reason I had my surgery (severe prolapse) in that the lower hormone levels of perimenopause allowed the ligaments holding up my pelvic organs to relax to the point that everything dropped beyond repair before I realized what was happening.

I saw in another post of yours that you're having your hysterectomy because of hyperplasia. Often that is contributed to by estrogen dominance as well, so it may be that you wouldn't want to duplicate the levels you have now if you want to lower your risk of other "female" cancers in the future.

I've had my levels tested a few times since my hysterectomy; however, I've found symptoms a more reliable way to figure out which combination of HRTs works best for me. In addition, as (((Naturebound))) mentioned, regular DEXA scans are a better way to ensure that you're getting enough estrogen to help keep your bone density in a healthy range. Six months after my hysterectomy I had my first DEXA scan. At the time, I'd been trying to lower my estrogen dose, plus I'd spent a few years in perimenopause so my levels were a little low anyway even pre-hyst. My bone density showed borderline osteopenia. I raised my estrogen level back to where I felt better anyway, added a little testosterone and started working out regularly (weight bearing exercise helps build bone mass); two years later, a follow-up DEXA scan showed my bone density back up in the healthy range.

So, for me, it turned out that using the dosages of HRT that felt best for me in terms of symptom relief, combined with regular weight bearing exercise, did a great job of maintaining bone mass; and I still use the DEXA scan as a sanity check to make sure we're still on the right track. My DR is willing to order hormone testing if I request it, but since I'm not having any symptoms and my bone density is fine, she sees no need to require it. I agree.

Good luck with your upcoming surgery!

Unread 06-30-2007, 09:00 AM
Measure hormone levels before surgery?

Surferbabe, 1998, Vihtamaki and Tuimala. I find it interesting that this study and the one Naturebound cites found similar conclusions, that it is possilbe for women to be free of menopause symptoms yet not have adequate estradiol for protection against osteoporosis.

Your point regarding DEXA scans is one that can apply to the testing of hormone levels. Perhaps it is appropriate to do these tests, if nothing else to give reassurance that replacemnt therapy is within appropriate range.
Unread 06-30-2007, 09:11 AM
Measure hormone levels before surgery?

Yes, I had thought of the DEXA scan and just had that done (as well as a mammogram) so I'll have those results before my upcoming surgery. I've already dipped into osteopenia levels once already but two years of added calcium plus a weight-bearing regimen brought my density levels back up. That's PRE-menopause however. I seem to recall reading somewhere that it's not possible to get that kind of result after menopause. I have such a sensitive stomach that I'd prefer to avoid those osteoporosis drugs, which is why I'm already considering HRT. I'm hoping the hormones can be delivered transdermally.

Good points made about my pre-surgery levels not being optimum for me anyway. The advanced hyperplasia along with cyclical headaches that started the last couple of years and the fibroid they found in the ultrasound all point to estrogen dominance, which my doctor also pointed out.

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