GYN says I need HRT (again), I'm still concerned about risks Options

[robin07]

Last week I went to see my GYN as I've noticed once again that the night flushes have returned and the lack of sleep is just getting to me. I can't carry on losing sleep. Also around the time of my period the fatigue is worse than before.

Well, I walked in to my GYN's consulting room and he asked what he could do for me. (Last time I saw him I was so sore with external dryness). I said that the hot flushes had returned and he looked back through my notes and said 'HRT'

He had recommended this last year and I reminded him of my concerns because my mother had breast cancer and he said, well the risk to you is small.

He said if my mother, aunt, grandmother had all had breast cancer that would be different but as it was only my mother and it was postmenopausal breast cancer then the risk to me is small. He then proceeded to give me the hard sell for ten minutes.

Thing is, other people have said they would advice against me taking HRT. The nurse practitioner I spoke to about HRT, the endo I saw last year both advised against it.

MY GYN said it's about 'quality of life'. I tried to stay calm and not say that I've been dealing with this peri stuff for 6 years on and off.

I've been looking in to bios, but it is proving difficult to find someone over here.

GYN has recommended that I take HRT in patch form for TWO years which will mean that I'll only be 49. He feels that that will get me over the worst. This doesn't make any sense to me at all as I think I could be weaning myself of HRT at age 49 just at the time I may start to need it most.

Last week I just had a good cry as I'm so fed up with feeling like this. I've even thought that I may go to my GP and ask for Prozac as a potential non hormonal solution to the night flushes. I took this a few years ago for a few months before I knew much about peri and my GP was telling me I was too young for menopause and I didn't have a sinlge flush the whole time I was on it. This would also buy me some time to decide about HRT and look in to possible BHRT here in the UK.

Any thoughts or help apreciated.
robin

[oncourse]

I think there is a national menopause society with a list of BHRT doctors on it you could check, maybe someone in your area is on the list. My gyn won't even talk about HRT...I had to seek out a gyn who does only HRT stuff.

[robin07]

thanks for your reply oncourse. I'm having troube finding the National Menopause Society. Googling brings up the British Menopause Society which says it's for medical professionals.

Your gyn won't talk about HRT? Are you in the UK?

[EveningPrimrose]

thanks for your reply oncourse. I'm having troube finding the National Menopause Society. Googling brings up the British Menopause Society which says it's for medical professionals.

Your gyn won't talk about HRT? Are you in the UK?

Robin -

Maybe the following link will help --- This is a list of doctors who will prescribe progesterone, not sure about oestrogen but it's worth calling those on the list as a first guide. Maybe you could have a telephone consultation first ---

http://www.npis.info/consultadoctor.htm

[robin07]

EP hi, thanks for this info, I've not seen this site before and I've done a fair bit of googling.

[skiergirl]

Robin,
What kind of patch was you gyn recommending? In the U.S., all of the patches (as far as I know) contain bioidentical estrogen. There are some that also contain a synthetic progestin (like Combipatch). I think you'd be safe in using a low dose patch with bioidentical estrogen and some form of bioidentical progesterone for awhile. I agree with your gyn that quality of life is important, and low estrogen can cause health problems too.

[Lady E]

I think you should try the patch.HRT has gotten such a bad reputation when really it can help.I am on low dose birth control pills and have so many more better days than bad now.If your Dr thinks it will help why not give it a try?GOD-bless

[robin07]

Skiergirl and LadyE thanks both of you for your replies.

Okay I'm confused. Or at least I think I was/maybe still am. Stop babbling robin.

I'd better explain. When I went to see my GYN he didn't recommend any particular brand of patch.

I phoned the other day to speak to him to find out which kind of patch he had in mind and he has gone on holiday. So his secretary read out to me on the phone his written recommendations. Although he recommends the patch he didn't mention a particular one.

So his secretary said she would check the info that she has and according to her there is one called Evoril Conti and one called Estra Combi.

Looking at the Estra Combi patch it says that it is made from estradiol and northisterone. Does this mean that my GYN has been talking to me about bios all along and I have assumed because he says HRT he means pregnant mares urine. Is estradiol bioidentical? What questions should I be asking?

I have spoken to three GPs, two nurse practitioners, one endo and one GYN and not one of them has ever used the word 'bioidentical' hence my confusion.

Thanks again for your advice on this.

robin

[NiteOwl]

I couldn't find any info on the Evoril Conti but the Estra Combi contains bioidentical estradiol for the estrogen part, and norethisterone, which is a synthetic progestin for the progesterone part.

I don't know why your doc is saying you can only take hormones for 2 years, but when 2 years is up if you are not ready then you just tell him you can't come off yet...period. If he won't renew the script then find a new doctor who will!

[robin07]

Nitey thanks for your reply, yes that's what I thought. The oestrogen part is bioidentical. So the northisterone is synthetic.

When I spoke to my GYN and told him about my mother having breast cancer. He made a point to me that she had it when she was post menopausal.

So what he is saying is,in HIS opinion the risk to me from taking HRT PREmenopause is small and he would advice me to take it, BUT because he has only recommended HRT from now (age 47) to age 50 he would NOT recommend it post menopause.

Of course, that's assuming I go through the menopause at age 50. Unfortunately without a crystal ball I don't know when I will actually go through the menopause and neither does my GYN. Age 50 is purely a guesstimate on his part.

There are ladies on PS telling of their symptoms starting at or around that age.

So I have to make a decision if it's worth taking HRT for about 2 years, to age 50.

Alternatively I am wondering if I should go the low dose AD route for a few months, at least to give me a break, to enable me to get some sleep and rest from the night flushes. Plus if I do that I can still see what my cycle is doing and if I start to skip periods I will know. My periods have been staedily getting lighter and shorter and they used to be heavy.

So I need some time to think this all over.

robin

[robin07]

oops I forgot to say that I spoke to my GP last week and he was surprisingly sympathetic.

He knows my family and knows that both my parents had cancer and that this is a decision that only I can take. He appreciates that I need to think about this and that at 47 I could be several years from actual menopause.

He will be happy to consider serotonin supplementation as an alternative to oestrogen supplementation for a couple of months if that's the way I choose to go initially.

Well I'm going away for a break with hubby. I don't want to think about this while we're away but hopefully all the pieces will fall in to some kind of place.

robin

[Lady E]

My mother had a stroke,but it was due to her weight,and the fact that she did not live a healthy lifestyle.I still take birth control pills.Sometimes a family members illness is not reason enough to not take hormones.I was suffering so much,and I have three school age children.To me I had to weigh the pros and cons.My doctor knows my history and said I should be fine taking the bcp untill I am around 40,that is my idea-I want to raise my kids without being a major you know what to them.I truly hope you can find relief safely.pray about it,and give it a chance.Oh and remember all hormonal madicines take around two to three months to get into your system fully,and it may take trying several different kinds to find one that is right for you.I am on the third bcp I have tried and it seems to work wonderfully.GOD-bless

[joyceveronica]

Nitey thanks for your reply, yes that's what I thought. The oestrogen part is bioidentical. So the northisterone is synthetic.

When I spoke to my GYN and told him about my mother having breast cancer. He made a point to me that she had it when she was post menopausal.

So what he is saying is,in HIS opinion the risk to me from taking HRT PREmenopause is small and he would advice me to take it, BUT because he has only recommended HRT from now (age 47) to age 50 he would NOT recommend it post menopause.

Of course, that's assuming I go through the menopause at age 50. Unfortunately without a crystal ball I don't know when I will actually go through the menopause and neither does my GYN. Age 50 is purely a guesstimate on his part.

There are ladies on PS telling of their symptoms starting at or around that age.

So I have to make a decision if it's worth taking HRT for about 2 years, to age 50.

Alternatively I am wondering if I should go the low dose AD route for a few months, at least to give me a break, to enable me to get some sleep and rest from the night flushes. Plus if I do that I can still see what my cycle is doing and if I start to skip periods I will know. My periods have been staedily getting lighter and shorter and they used to be heavy.

So I need some time to think this all over.

robin

Hi Robin
Really appreciate your concerns but definitely for me it's quality over quantity as far as this life is concerned.Was Menopausal at age 39 and have been on Prozac plus synthetic HRT.Tried to wean off but hell! so got back on and am slowly feeling better.My mother has had two bouts with cancer but doing fairly well at 86.Get six monthly check ups and so far so good.
Live in the hot dusty Middle East where bio-identicals are not even heard off and depression and Menopause are considered to be severe mental illnesses.Most of the women here age very quickly and the only ones with life quality are the monied and educated who are obviously well medicated but too higly perfumed and manicured to ever discuss such tawdry subjects.Don't know whether to laugh or cry!
I wish you luck in whatever decision you make.I always read your posts and you do sound very level headed.Please enjoy your trip with your husband and keep us posted.
Just to make you laugh,my husband runs a Club hosted by girls from various countries but the Arabs swear there is no prostitution in this part of the World and Gays do not exist.Although know for a fact that one of the "Girls" was a beautiful young man in full drag.Talk about Hypocrisy.
All the best my friend
Elizabeth

[robin07]

Elizabeth and Lady E

Thank you so much for your replies, how are you doing?

I was almost at the point of thinking I'd wait a bit longer before deciding but then I woke up at 5.00am thinking that I was on fire. I was soooohot that I thought I was going to pass out and instinctively headed for the back door to get some cooler air. I just felt awful and literally lay down on the floor next to the open door. It's a long long time since I had such a bad flush at night. After only a few minutes of cooling 5.00am air it eased and I went back to bed but felt awful.

I was due to drive 100 miles along the motorway that morning fortunately we delayed our journey a little and then hubby did his driving and mine because I felt like a limp rag.

So I went to my GP and have decided to try the non hormonal approach. I am going to try Prozac. GP has given me two months. So I'll see if it helps. It has only been a week or so, so still early days yet. I did take Prozac before for a few months following what I now realise was depression caused by lack of sleep at the begining of peri and had no side effects or problems that time so I'm optimistic this time.

But, if that doesn't work then I'll have to think again.

It seems strange to take an AD when I don't feel depressed but I know that if I continue to lose my sleep my health will suffer anyway and my body WILL get depressed. Cos, I love my sleep. I'm not one of those people who can manage on little sleep.

Thanks for your replies it means a lot.

robin

[zen]

have you not thought of the many different meno symptom pills that are available? or have you tried them already? things like Phytolife, Promensil etc.. i have had great results with Blackmore's Phytolife and Evening Primrose Oil (with fish oil) - my flashes are almost gone, maybe one or two sneak through.. i sleep through the night, i feel much better in myself, i do not have a problem with dryness... i am 55, last period was February last year..

[FoxyRoxy]

Live in the hot dusty Middle East where bio-identicals are not even heard off and depression and Menopause are considered to be severe mental illnesses.Most of the women here age very quickly and the only ones with life quality are the monied and educated who are obviously well medicated but too higly perfumed and manicured to ever discuss such tawdry subjects.Don't know whether to laugh or cry!

Just to make you laugh,my husband runs a Club hosted by girls from various countries but the Arabs swear there is no prostitution in this part of the World and Gays do not exist.Although know for a fact that one of the "Girls" was a beautiful young man in full drag.Talk about Hypocrisy.
Elizabeth

WOW Elizabeth you must live a very interesting life there in the Middle East (is this part of the world where the women are veiled??) and I bet your hubby has many interesting funny stories to relate to you at times. Sorry for my ignorance but I live clean down the other end of the world in little old New Zealand so I am fascinated by the lives of other women around the world.

Rox

[joyceveronica]

WOW Elizabeth you must live a very interesting life there in the Middle East (is this part of the world where the women are veiled??) and I bet your hubby has many interesting funny stories to relate to you at times. Sorry for my ignorance but I live clean down the other end of the world in little old New Zealand so I am fascinated by the lives of other women around the world.

Rox

Dear Rox
Interesting being the operative word!Got married at twenty and have now been here 37 years.On the whole it has been a good life but the truth of the matter is that I honestly would advise young people to marry with in their own culture.I know this will ruffle a few feathers but the amount of wonderful ladies who have tried to really adapt to the way of life here and the Culture and have ended up divorced is really very high.
I think ,on reflection,that as one gets older we become more aware of our own roots and traditions and long to return.Of course,this is probably to some extent unrealistic nnostalgia,but I know how much I am now irritated by Arabic Music that my husband loves playing loudly.This did not bother me up till about ten years ago
The heat is unbearably intense and would love to have some rain.We do have air conditioning but long for a refreshing walk around a park in London.
Some stories are funny Roxursox but the reality is that these young ladies running this Club are from Eastern countries and desperately need the money.They are supposed to be cocktail waitresses,some have dgrees,but unfortunately fall into the world of prostitution and alcoholism.Wealthy Arabs befriend them then discard after getting bored.Some of these poor girls really believe these men will marry them and will not be persuaded otherwise but the fact of the matter is that they regard these girls in a poor light,use and abuse them then marry locally or return to long suffering wife or wives!
On the plus side worked in a good School for many years ,had an active social life before retreating into Menopausal hibernation.Also have three lovely grown up children and three cute grandchildren so this country has been very good to me.But would I do it again,my friend?I honestly think not.
Keep in touch and ask any questions you like
Stay well.
Love
Elizabeth

[joyceveronica]

Elizabeth and Lady E

Thank you so much for your replies, how are you doing?

I was almost at the point of thinking I'd wait a bit longer before deciding but then I woke up at 5.00am thinking that I was on fire. I was soooohot that I thought I was going to pass out and instinctively headed for the back door to get some cooler air. I just felt awful and literally lay down on the floor next to the open door. It's a long long time since I had such a bad flush at night. After only a few minutes of cooling 5.00am air it eased and I went back to bed but felt awful.

I was due to drive 100 miles along the motorway that morning fortunately we delayed our journey a little and then hubby did his driving and mine because I felt like a limp rag.

So I went to my GP and have decided to try the non hormonal approach. I am going to try Prozac. GP has given me two months. So I'll see if it helps. It has only been a week or so, so still early days yet. I did take Prozac before for a few months following what I now realise was depression caused by lack of sleep at the begining of peri and had no side effects or problems that time so I'm optimistic this time.

But, if that doesn't work then I'll have to think again.

It seems strange to take an AD when I don't feel depressed but I know that if I continue to lose my sleep my health will suffer anyway and my body WILL get depressed. Cos, I love my sleep. I'm not one of those people who can manage on little sleep.

Thanks for your replies it means a lot.

robin

Dear Robin
I think Iam doing fairly well!I love my sleep too Honey and just can't function without my 8 hours so will be in Prozac and HRT Hell or Heaven for a while to come.
Don't feel as anxious anymore,can cope much bettwr so am slowly tapering anti anxiety meds down and so far-Touch Wood-so good.I honestly now believe Robin that I can almost monitor my own mental and physical condition as well,or if not better,than some Doctors especially when it comes to Menopause issues.
As i think I mentioned Middle Eastern women mysteriously never get Menopausal and the few who did admit they are Menopausal say its a breeze as they hop to London for Estrogen implants and supply of ADs.The rest age really quickly,which is a shame as they have no one to discuss this with.
We have a few Psychiatrists but only "The Severely Mentally Ill!" go there.There is so much shame attached to anyone who is either mentally or physically challenged.Many poor folks are literally hidden away for the rest of their lives.Things are slowly improving but we have a long way to go.
You rarely see a child or adult being taken out in their wheelchair on the streets or in the Mall.It is heartbreaking.That is why I have decided to do voluntary work with the mentally challenged.

Stay well,dear Robin
Keep us posted on your choices and outcomes
Love
Elizabeth

[robin07]

have you not thought of the many different meno symptom pills that are available? or have you tried them already? things like Phytolife, Promensil etc.. i have had great results with Blackmore's Phytolife and Evening Primrose Oil (with fish oil) - my flashes are almost gone, maybe one or two sneak through.. i sleep through the night, i feel much better in myself, i do not have a problem with dryness... i am 55, last period was February last year..

((zen)), thanks for your reply yes, I've tried several things over the years. Last year Feb march and April the hot flushes and insomnia were pretty horrible and I ended up having acupuncture. Which seemed to work. But I spent a lot of money, about £300 in total. I'm only 47, started having regular periods only in my forties, and I've been having hot flushes/problems on and off with this for about six or seven years since my periods became 'regular' and like everyone here I don't how much longer it will last. From puberty to 40 I had no more than 3 or 4 periods a year.

I do take supplemets. Evening Promrose Oil for about three years now. 1000mg a day and 3000mg the week before my periods and it has really helped with horrid cramps. Also at the moment I take Calc/Mag, B-complex, acidophilus,flaxseeds and at times vit e, and vit c.

At the first consultation with my GYN I told him that I was trying supplements and he said 'I can recommend a psycho-analyst to help you reduce the number of supplements you're taking' Then guess what? He turned around and recommended a supplement to help with my hot flushes If he'd taken the time to ask I could have explained how I'm trying each supplement to help with a particular problem. EPO for cramps, Magnesium for constipation, vit e for dryness etc.

Glad things are getting better for you, Zen. There's hope then.

[robin07]

Dear Robin
I think Iam doing fairly well!I love my sleep too Honey and just can't function without my 8 hours so will be in Prozac and HRT Hell or Heaven for a while to come.
Don't feel as anxious anymore,can cope much bettwr so am slowly tapering anti anxiety meds down and so far-Touch Wood-so good.I honestly now believe Robin that I can almost monitor my own mental and physical condition as well,or if not better,than some Doctors especially when it comes to Menopause issues.
As i think I mentioned Middle Eastern women mysteriously never get Menopausal and the few who did admit they are Menopausal say its a breeze as they hop to London for Estrogen implants and supply of ADs.The rest age really quickly,which is a shame as they have no one to discuss this with.
We have a few Psychiatrists but only "The Severely Mentally Ill!" go there.There is so much shame attached to anyone who is either mentally or physically challenged.Many poor folks are literally hidden away for the rest of their lives.Things are slowly improving but we have a long way to go.
You rarely see a child or adult being taken out in their wheelchair on the streets or in the Mall.It is heartbreaking.That is why I have decided to do voluntary work with the mentally challenged.

Stay well,dear Robin
Keep us posted on your choices and outcomes
Love
Elizabeth

Elizabeth, oh yes, I love my bed when I read that some ladies on PS have managed on a few hours sleep a night through all of this I'm amazed. The last time I tried to do that I just got anxious and ill and exhausted. So now I take this sleep business pretty seriously.

I lived in the Middle East for a short time. You've lived there for 37 years. There must be some changes there then. Although perhaps some things haven't changed at all.

I remember when I lived there going to buy a lipstick. This was a long time ago. I was served by a man. Now today there are men here on cosmetics/perfume counters in large stores but back then there weren't and being advised about a lipstick by a man was a strange experience for me at the time.

hugs
robin

[joyceveronica]

Elizabeth, oh yes, I love my bed when I read that some ladies on PS have managed on a few hours sleep a night through all of this I'm amazed. The last time I tried to do that I just got anxious and ill and exhausted. So now I take this sleep business pretty seriously.

I lived in the Middle East for a short time. You've lived there for 37 years. There must be some changes there then. Although perhaps some things haven't changed at all.

I remember when I lived there going to buy a lipstick. This was a long time ago. I was served by a man. Now today there are men here on cosmetics/perfume counters in large stores but back then there weren't and being advised about a lipstick by a man was a strange experience for me at the time.

hugs
robin

Dear Robin
Thanks for those hugs.You and my little granddaughter give the best!
What part of the Middle East did you live in?I am in Amman Jordan.Yes there have been many changes but they are mostly cosmetic.Lots of big Malls,more Theatres etc and from the outside looks like any other large city but the truth is so different!
Please send me your e-mail so I can send you the real Truth!
Otherwise The Secret Police might take me away !
Love
Elizabeth

[joyceveronica]

Elizabeth and Lady E

Thank you so much for your replies, how are you doing?

I was almost at the point of thinking I'd wait a bit longer before deciding but then I woke up at 5.00am thinking that I was on fire. I was soooohot that I thought I was going to pass out and instinctively headed for the back door to get some cooler air. I just felt awful and literally lay down on the floor next to the open door. It's a long long time since I had such a bad flush at night. After only a few minutes of cooling 5.00am air it eased and I went back to bed but felt awful.

I was due to drive 100 miles along the motorway that morning fortunately we delayed our journey a little and then hubby did his driving and mine because I felt like a limp rag.

So I went to my GP and have decided to try the non hormonal approach. I am going to try Prozac. GP has given me two months. So I'll see if it helps. It has only been a week or so, so still early days yet. I did take Prozac before for a few months following what I now realise was depression caused by lack of sleep at the begining of peri and had no side effects or problems that time so I'm optimistic this time.

But, if that doesn't work then I'll have to think again.

It seems strange to take an AD when I don't feel depressed but I know that if I continue to lose my sleep my health will suffer anyway and my body WILL get depressed. Cos, I love my sleep. I'm not one of those people who can manage on little sleep.

Thanks for your replies it means a lot.

robin

Robin
Keep in mind honey that it takes at least 5 to six weeks for Prozac to kick in.Although you may not feel actively depressed,continued insomnia can drive you slightly crazy!Give them a fair shot and hopefully you will start getting some sleep.

just reading a book by David.D.Burns,M.D calling Feeling Good and it is very helpful with lots of information on dealing and coping with Mood Swings etc. and he also has a lot of useful info.on Prozac and other ADs.According to him Prozac is not addictive and one can wean off quite easily if done slowly when both patient and M.D. feel there has been a significant improvement.Unfortunately,it looks as though I will have to stay on idefinitely as when weaned off on two occassions it was very bad but each person responds differently to Meds and if you start off with lowest dose possible you should do ver well!
Lots of luck
God Bless
Elizabeth

[robin07]

Hi Elizabeth, funnily enough after 3 weeks I've just noticed that I seem to be sleeping more deeply than befoer so I'm getting a more restful sleep.

I've been wanting to email you some details of my time in the Middle east but thing have been busy around here recently so please bear with me.

Well even though I wondered about the taking the non hormonal approach the last week has been interesting. My period started on Friday and it has been the lightest EVER. At least this way I know exactly when I'm having a period and how long it's lasting.

How do you cope with the incredibly high temperatures over there? I can't imagine going through menopause and living with such high temperatures. I know the other night when I was flushing badly I just headed for the cool air outside.