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Concerns about estrogen (Endometriosis) Concerns about estrogen (Endometriosis)

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Unread 10-26-2010, 06:25 PM
Concerns about estrogen (Endometriosis)

Hi Ladies.

I am 6 years post-hyst (kept my ovaries) and I am almost 5 weeks post-op from having my ovaries removed due to grapefruit size chocolate cysts (surgery date was 9/24/2010). That said, my doctor gave me a prescription for Estradiol 0.075 mg/day 7-day patch. She said I need a low dose estrogen to protect my heart, breasts, vagina etc... I haven't tried the patch because I do not honestly understand why I need estrogen, especially if the reason I had chocolate cysts was due to all of my endo growing back. My surgery took 5 hours. My doc said it was a "spider web of endo inside of you." My hyst 6 years ago took 4 1/2 hours due to all the endo. This doctor said she removed most of the endo from my body, along with the cysts/ovaries.

My question is, if estrogen feeds endo, and clearly I have an issue with endo because as mentioned, it all grew back, is it a wise idea for me to use estrogen replacement therapy????

Additionally, I have had my post-op appt (last Friday, 10/22) and my doc said my vagina appears fine. She said she is able to tell when a woman is low on estrogen and so far I am not showing symptoms of estrogen loss (apparently the vaginal walls become thin). I have a funny feeling that before my surgery, I was "estrogen dominant". Based on what I have researched I seem to fit the profile but I am not an expert.

Anyway, would anyone be kind enough to educate me on HRT because I have been doing endless research on it and I am more confused now then when I started. I mean, if I use the estrogen patch, don't I need progesterone too????

So much to learn.

In closing sorry this message is so long. Any advice you can share would be sooooo wonderful.

Thank you.

All the best,
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Unread 10-26-2010, 07:02 PM
Re: Concerns about estrogen (Endometriosis)

The topic of endometriosis is quite complex and confusing and even medical professionals don't all agree! So, don't feel badly in the slightest if you are confused!

The key here is that estrogen can be essential for overall health as your doctor stated. The flip side for those with endometriosis is that the same estrogen that aids our health also fuels any remaining endometriosis, the whole reason we had surgery in the first place and even need to consider HRT!

Women with endometriosis have to carefully balance the pros and cons of estrogen replacement differently than those without our diagnosis. Our pros and cons will not be the same as many of our peers.

One thing that some doctors suggest is some type of progesterone along with any estrogen replacement. The theory is that that the progesterone (or progestin) will keep the endometriosis at bay while allowing you to benefit from the estrogen. On the other hand, some doctors assume that if there is no uterus, no progesterone is needed at all, endometriosis or not.

Here are a couple things to keep in mind:

It can take time for all of the residual hormones to leave your system. Thus, while all may be well right now, in time things might change for you as your stores of estrogen are depleted. So you may have a little bit of time now while you feel fairly well and you show no symptoms of low estrogen. You can use this time to research and determine what is right for you long term.

Not using estrogen replacement doesn't guarantee you will be endometriosis free, especially since your doctor stated she removed "most" of the endometriosis. Did you know that endometriosis can create its own supply of estrogen? While the estrogen it produces might not do much, or anything, for your overall body's need for estrogen, it is enough to allow the endometriosis to flourish whether you use any type of HRT or not!

To give you a little bit of perspective from a different angle, even with the stage IV endometriosis that led to my hysterectomy, I still have both of my ovaries. Why? My doctors (GYN, endo specialist, GP, neuro) and I all have felt that estrogen is important for my overall health, and my own estrogen is better for me than HRT. So, with each surgery, my ovaries have been cleaned up and retained. This means I have a lot more estrogen flowing through my body than you should ever get with estrogen replacement. But when weighing my pros and cons, the risk of no or too little estrogen were worse then the risk of endometriosis.

Your endometriosis risks may be higher than no or too little estrogen risks, the opposite of my risks. I simply don't know. You and your medical team will have to work through your specific pros and cons.

I would recommend finding a doctor who is thoroughly knowledgeable regarding both endometriosis and hormones to help you determine what is right for you. You can also talk to your GP about your overall health concerns with regard to estrogen. It is important that you and your doctor(s) are on the same page and understand each other's concerns.

As an FYI, it is likely you were estrogen dominate. Many of us with endometriosis are!

Unread 10-26-2010, 07:57 PM
Re: Concerns about estrogen (Endometriosis)

Dear Weiser,

Thank you so much. Your post is very helpful. I think I may reconsider using the patch if I start to experience symptoms of estrogen deficiency (which through research I have noticed are similar to the symptoms of estrogen dominance).

Do you happen to know, off hand, if my Estradiol patch contains progesterone? Just curious.

Back in 2004, when I had my hyst, like you, my doc felt keeping my ovaries was a good idea for my overall health but she did say, "I guarantee you, you will wind up having them out." Six years later and here I am BSO Post-op.

I really like my new/current doctor. She's very knowledgeable about endo, has lectured about it (most recently in Italy) and her speciality is women with reproductive issues (she does not; however, try and get women pregnant). But, no one knows my body like I know my body. And when I mentioned my concerns about the endo, like you, she said my concerns should lie with lack of estrogen, endo should be the least of my concerns.

Anyway, thanks so much, I feel so much better since reaching out and I am so grateful for this website.

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Unread 10-26-2010, 08:18 PM
Re: Concerns about estrogen (Endometriosis)

I am so glad to hear you have a knowledgeable doctor! That is definitely a plus!
Originally Posted by GurlGeek325 View Post
Do you happen to know, off hand, if my Estradiol patch contains progesterone? Just curious.
CombiPatch by Novartis has estradiol and norethindrone acetate (progestin) and might be an option to consider! Or, you could try a patch for the estrogen and another delivery method for progesterone such as natural progesterone cream.

Glad to have helped you! in there!


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