My GYN started me on bio-identical progesterone when it became obvious I was in perimenopause, and we waited for me to get all the way into menopause before adding estrogen (also bio-identical). For me, menopause was surgical due to being diagnosed with endometrial cancer (very early stage). So I’m sure some here are already flipping out, that a GYN would prescribe hormones to someone with a history of gynecological cancer. However, I have a good friend in Texas who is a P.A. who practices a lot of integrative medicine, including hormone replacement therapy, so I ran things past her, and my GYN feels very comfortable prescribing these for me. The year or so prior to my cancer diagnosis, I’d been having some pretty severe hot flashes on and off (as my estrogen was rising and falling, trying to figure out what my body was going through with menopause), so I was terrified of what was going to happen after surgery, for good reason. Within a few days of surgery, I started having horrible hot flashes. My sleep became chronically interrupted - I think it played a part in my developing an internal abscess at the surgical site that then led to sepsis (five nights in the hospital - sepsis has a 30% mortality rate) at 7.5 weeks post-surgery. Around 5 weeks, I saw my GYN and he started me on a BHRT estrogen cream that I rubbed on my forearm. When I followed up with him 3 months later, my blood tests still showed very, very low estrogen, so he switched me to a BHRT estrogen cream, which was a bit stronger; again, six months later, my estrogen was still really low and I was still really struggling with hot flashes that were interrupting my sleep; I felt like I was really susceptible to picking up colds during this time, too. I just felt exhausted all the time because of poor sleep - I couldn’t push myself in my weight training or work outs like I wanted to. So it was a vicious cycle. Finally, around six months post-surgery, he put me on a BHRT estrogen patch. No kidding, within five nights, I was sleeping like a baby. My hot flashes disappeared within two weeks and I finally felt like I was getting my life back. When he started me on the estrogen patch, we started at the highest level - he described it as trying to refill a well that had gone dry. We have restested about every six month, and I’ve been able to come down twice on my estrogen prescription. After my last test in June, I was running a bit low - I could tell because I was having occasional mild hot flashes (to be fair, after I’d been on the highest dosage for about five months, I started having some headaches and breast tenderness), but he told me it was my call, if I was OK staying there or going back up again. The hot flashes I have now are very mild and rarely wake me up at night, so I’m comfortable staying at the estrogen level I’m at now.
When I last saw him in June, we had ‘the talk’ again - which I initiate anytime I start worrying about the risk of being on hormones with a cancer history. He has given me bibliographies of peer-reviewed journal articles that show BHRT after a gynecological cancer does not increase cancer recurrence like synthetic hormones do, as long as you’re taking progesterone with the estrogen - that’s the most important part. It’s unopposed estrogen that increases cancer risks; and all the studies that were done 15-20 years ago were done with women who were on estrogen only, and using synthetic estrogen (derived from pregnant mares). My GYN told me that he has cardiologists who are sending him patients now because studies are showing BHRT treatment protects the heart. My bone scan done two years ago was better than it was the two years before then (part of that also has to do with my lifting weights). My bladder has always been like a large iron vat, and I’ve never been one to have to use the restroom often, and that continues. I feel sorry for ladies who have to make pit stops every hour - it’s just a world I don’t understand.
I’m sorry if this gets to be TMI, but last spring when I was at my GYN-ONC and he did an internal exam - it’s really just a visual exam because I no longer have a uterus, ovaries or cervix - he says, “Hmmm.” And I’m thinking, “Dear God, WHAT?” He says, your muscle tone is remarkable considering you’re more than two years into menopause. And I reminded him I was on BHRT, and he says, “Yep, that’s it.” And I’ve never experienced any sort of painful intercourse like many women in menopause do.
There is a cluster of cousins on my mother’s side who have had breast cancer (although negative for BRCA gene), so I also have a breast surgeon I see annually. I had seen him a couple of weeks just prior to my cancer diagnosis, so it was about a year after the diagnosis when I saw him again and had to fill him in on everything that had happened a year ago. I was SO afraid he was going to tell me I had to stop taking the hormones, but he told me that was a decision between me and my GYN and GYN-ONC, and that he has breast cancer patients who are on BHRT - he feels its a quality of life issue and he’s in no place to tell women who suffer horribly after menopause what to do, so I was SO thankful.
There are some other non-hormone options that some women have luck with in regards to hot flashes, including some anti-depressants, but because of my history of treating life-long anxiety with psych meds, I was NOT willing to mess with some of those drugs. BHRT has been a life-saver for me - it made me functional again when I was so sleep-deprived, and I am grateful for the cardiovascular protection it provides as I also have a very strong history of cardiac disease in my family - mom with an MI in at my age now; older brother with a stent placed about my age now, and another brother with a massive MI at 69 years old.
So whatever you do, you have to take into consideration what are your risk factors and if you have some gynecological cancer risk factors, you will need to find a GYN (or integrative-type physician or practitioner) who is willing to prescribe them for you. My GYN is incredibly popular all across the northern suburbs of Chicago; he schedules out weeks/months in advance; he mostly treats BHRT and infertility; if his patients need treatment of other GYN issues, he usually refers them out to another GYN (such as when I had needed my endometrial ablation - he referred me out because he doesn’t do a lot of procedures anymore). He’s always attending conferences and sharing what he’s learned with me at our visits, and so I continue to trust he’s giving me the best advice he can based on the most recent studies out there. But if you decide to go that route, you will most likely have to look around to find someone willing to prescribe BHRT, such as @Busdriver 's physician. My cancer follow-up involved alternating seeing either my GYN-ONC or GYN every three months for the first two years; then I switched to every six months. So now I see each doctor once a year, but one of them every six months. I do that until I’m five years post-cancer diagnosis/surgery. Then I can go back to every year.
Oh, (sorry this is long) I have asked him how long he lets his patients stay on BHRT; he has women in their 70s and 80s on BHRT and claims their cognitive functions are generally higher than women who aren’t on BHRT (all other variables being as equal as possible), so for now, I don’t worry about him taking them away from me!!