8th June 2008
I am not an expert when it comes to hormones believe me! lol. It's all a guessing game when you lose your ovaries. I have learned to really listen to the subtle and not so subtle messages me body gives me and sometimes I still have no idea.
As far as your own hrt dilemma, that's something we all have to figure out for ourselves since we are all so different with different risks and symptoms and backgrounds etc...I am a 36 year old woman with no history of any estrogen dependent cancers in my family and my needs will probably be a bit different than yours. Do you have a history of estrogen dependent cancer or does it run in your family? Or are you simply worried about the long term risks? I too worry about long term risks but for me the benefits outweigh those risks, especially since upping my estrogen has really helped improve my bone density (I have osteoporosis) and keeps the uncontrollable crying to a minimum. I know other women that feel so much better off hormones after giving their bodies time to adjust and have found other ways to cope but either way we all have risks and problems to deal with. I am on a .075mg Vivelle Dot patch by the way and at one time tried .1mg but gained too much weight and felt horrible. Below .075 mg and I have too many symptoms of low estrogen. But I also take compounded testosterone and have been on other hormones from time to time like progesterone for added support. I will tell you that changing your patch only once a week when it is designed for twice a week will cause you some major flucuations (sudden drop in estrogen followed by a sudden upswing when you finally do change the patch) and those fluctuations in hormones can be worse than a consistent low or high estrogen level. I had horrific migraines, chest pain, calf cramps and other symptoms that sent me to the ER numerous times on some forms of estrogen (troches, pills) because the levels did not stay consistent for me and the fluctuations caused drastic symptoms. If you really want to decrease or discontinue your hrt you are better off going to the .025mg patch and then off eventually over time. However you may find in the coming months that your symptoms may increase as your body continues to change and "realize" it no longer has ovaries and you may need a higher dose. Leaving it alone for now wouldn't be a bad idea unless you have serious risks for taking hrt like cancer, blood clots, smoking etc..
From my own experience I can tell you that for a surgically menopausal woman (which by the way is sooo different than natural menopause when a woman has years to adjust to a lower output of hormones, but still makes a small amount of hormones over a lifetime to protect her overall health) a .0375mg patch is an extremely low dose that most likely will not meet your hormonal needs over time, although it can help with the more immediate problems like hotflashes. Not all women have hotflashes or nightsweats in surgical menopause believe it or not. Those are just a few of the many many symptoms of surgical menopause that can occur. Also, it took me over a month after my hysterectomy to really begin to notice any major severity of symptoms. I learned that although some symptoms of surgical menopause are instant (unless you are given hrt immediately), most women will still have some naturally circulating levels of their own ovarian hormones stored for a period of time post hysterectomy/oopherectomy before they are completely depleted. Also how much body fat you have can make a difference since estrogen in the form of estrone is stored there too. I am fairly small and thin so it took me less time to feel the effects. This is why a lot of women dont complain of symptoms right away and wonder what all the fuss is about. Also keep in mind that after major surgery it takes a while to rid our bodies of all the drugs and anesthesia put into them. It took me four weeks before I really crashed and began to feel the effects (even with hrt). It was another year or two before some of the longer term effects began to make themselves known (urinary incontinence, vaginal atrophy, osteoporosis, muscle loss, lack of libido, fibromyalgia, etc.).
Even if I had kept my ovaries though I still have vaginal scarring and shortening to deal with (I can't wear vaginal rings for hrt because they wont fit in there properly), pelvic pain and bladder problems, and loss of the intense orgasms I had before.
My story is long and complicated but yes I do feel misled by my ob/gyn. I never had a chance to have a simple laparoscopy to just remove the endometriosis and leave my organs intact (only a diagnostic lap one year before my hysterectomy to diagnose the pain I was having and a trial of Lupron and birth control pills). I was told the endometrisois was too advanced. I had asked for another one. I was told a hysterectomy would be the ultimate "cure" for endometriosis and that that was my only option left since I didnt tolerate birth control pills or Lupron. My insurance would not cover me to see a gynecologist or endo specialist outside of my network and my choices here were slim. I did see one other gyn in my network and was told the same thing. (after reviewing my surgical and pathology reports post hysterectomy it is obvious to me that a hysterectomy was totally unnecessary and that my disease could have been removed by a skilled doctor). It is unfortunate that there are so few doctors out there with the skill, expertise, and willingness to remove disease and leave organs intact. It's easier for them and requires less training to just take it all out. A woman's reproductive organs are just not viewed as that important unless she is trying to conceive (I had told these doctors I did not desire children even at my age). At any rate I am no longer angry at my gynecologist in particular. I wrote him a letter stating how I felt and the consequences of what was done to me and have done some healing on that part. I still blame myself as much although I was not nearly as well informed as I should have been. Forgiving myself is much harder for me. My anger is more generally directed at the whole medical establishment and business of over prescribing hysterectomy. That it is more commonly done than tonsillectomy is disturbing in light of the complications that can occur and the long term consequences.
Sorry for going off on a tangent again. I wish you the best in figuring everything out and hope that everything works out for you. I am so sorry your hysterectomy was an emergency and that you didnt have time to prepare. Doesnt leave much time to take it all in does it? Good luck with everything!
