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HRT after a cancer diagnosis HRT after a cancer diagnosis

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Unread 10-16-2011, 07:22 PM
HRT after a cancer diagnosis

A cancer diagnosis that leads to hysterectomy can really help steer the direction of HRT after hysterectomy.

I was on Bio-identical HRT before hysterectomy. My pre-cancer diagnosis was caused by estrogen dominance.

Regular pharmaceutical products only use estradiol in their bio-identical hormones. You have to get compounded Rx to get estriol through your doctor. Estradiol is the strongest of all 3 main estrogens and it builds up in the tissue. The build up can lead to uterus and breast cancer problems.

Progesterone is the pre-cursor hormone to all the other hormones. There are many progesterone receptors throughout the body (not just the uterus). Although estrogen seems to have the greatest effect on hot flashes, bone density and vaginal dryness, progesterone also helps with a sense of well-being, brain fogginess, sleep and can convert to needed hormones (if it is bioidentical).

For me, because estradiol is the identified culprit for my endometrial cancer (discovered in surgery), I don't want to risk breast cancer next. Some breast cancers are also fed by estrogen. But... my hot flashes have gotten considerably worse.

I will be considering the effexor, low dose anti-depressant for the hot flashes, choosing estriol (weakest estrogen and it has no build up in the tissues) to potentially help with vaginal dryness and bone issues, plus increasing my dosage of progesterone to help protect my breasts from environmental estrogens as I slowly add back some foods and herbs that have estrogen effect on the body (I stripped all environmental estrogens during the last 3 months including personal care products, household products, foods, herbs, etc).

My goal is to keep the estrogen from becoming dominant again in my body. Progesterone is necessary to prevent this imbalance. At this point, I'm not sure if the weak estrogen (estriol) will actually help with hot flashes. We'll see on that issue as well.

Everyone's progesterone levels are different. Mine is potentially non-existent and vital to keep estrogen in balance.

I'm learning to remember that doctors are simply Practitioners and they are practicing on us.

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Unread 10-18-2011, 03:03 PM
Re: need help deciding about hrt

I used bioidentical progesterone in large dose for one year starting on the third year after surgery...when I had hormone level checked all that showed up was progesterone (I was told the progesterone would convert to other hormones, but I guess it didn't in me). I am going tomorrow to see the doctor again. Can I ask which order you are planning to start the effexor, estriol, and progesterone. That is still my dilemma.
Unread 10-18-2011, 08:13 PM
Re: need help deciding about hrt

(((goldenlife))) my situation is both similar to and different from yours.

I had my hysterectomy almost ten years ago for non-cancer reasons. I immediately went on bioidentical HRT (estradiol patches primarily, though I used testosterone cream for a while and also use a small amount of natural progesterone cream).

Since then I have had breast cancer twice, though it's thought that the second instance was just leftovers from the first and not a new cancer. My breast cancer was BOTH ER+ and PR+; that is, either estrogen (of any kind, not just estradiol) or progesterone would accelerate its growth. However, it's important to understand the distinction - estradiol and/or progesterone did not *cause* my breast cancer, which had its origins about a decade earlier (my DRs and I associate it with use of depo Provera for several years).

There is no evidence that estradiol, or in fact any estrogen-only HRT, causes breast cancer in any way. While it's true that unopposed estrogen in a woman with a uterus can cause endometrial proliferation which might ultimately result in uterine cancer, the same direct relationship doesn't necessarily hold with breast tissue.

ALL estrogens can build up in certain tissues, it depends on the type of tissue and whether the estrogen is balanced by other hormones and how much is used.

While it is true that progesterone can convert to the other hormones, women without ovaries don't do this as effectively as women with ovaries, so relying on progesterone as a source of estrogen may not work. In fact, in reality, in women who already have very low estrogen levels, adding progesterone does not help but rather makes their symptoms worse. It's all about moderation.

Most women in surgical menopause do not find that, in the long run, estriol is enough to deal with their systemic symptoms; it is, however, quite effective in treating vaginal dryness when used locally. I hope you have better luck with it than most if that's the way you choose to go and if your DR is willing to prescribe it for you.

I know, as you do, that it is very hard, once the "C" word has entered your daily vocabulary, to keep an open mind about the future, but I urge you to try. Don't shut out the advice of all doctors; there are some excellent ones out there. Don't eschew all estradiol when it may be the only thing that can help you. Or Premarin, for that matter - there are women for whom that is the only thing that can relieve their symptoms. You are early in the game yet, and how you feel now is not necessarily anything like how you'll feel six months or a year from now, or five years from now. Things happen, and we learn to adapt with the times and experiences we have.


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