Originally posted on Women's Voices for Change.
Dear Dr. Pat,
I am 44 years old and six months ago I had a hysterectomy with removal of both ovaries because of endometriosis and severe pelvic pain that increased with menstruation. I tried all the drug treatments available to control the symptoms and either the side effects were too awful or the pain returned when I stopped these drugs.
Finally I went to an endometriosis surgical specialist to increase the chance that all of the endometriosis would be removed. The laparoscopic surgery went smoothly. I have been pain free since then. My local gynecologist did not want me to begin hormone therapy since I had this major surgery for endometriosis and he said that treatment with estrogen could cause the endometriosis to grow again. He also told me that hormone treatment could cause breast cancer, strokes, blood clots and heart attacks.
I cannot function. I have been depressed for the first time in my life. I have constant sweats day and night. I haven't had a good night's sleep since I left the hospital. I have no energy. I am trying really hard to stay focused at work but I am not the person I was before my ovaries were removed. I have to write everything down and check it off secretly at work because my memory and my performance are definitely worse. I have a good job and was always respected for my contributions but I am seriously worried that I could be fired for cause. Fortunately I am not in a relationship because my once healthy interest in sex is gone.
I have tried acupuncture and every natural remedy available. I saw a psychopharmacologist who prescribed Effexor. That did not help at all and when the dose was doubled, I felt drugged and dopey.
I don't drink alcohol, I am not overweight, I have no medical problems and no family history of early heart or stroke problems. There has been no breast cancer in my family either.
I don't care if the endometriosis returns. I need to function. What hormone therapy would you suggest?
Marci
Dear Marci,
Endometriosis is a disease that affects more than six million women in the United States alone. It results from the presence of tissue that lines the uterine cavity, the endometrium, in places where it should not be. It is often found in the wall of the uterus causing heavy and painful periods, in the ovaries causing painful and large cysts that are filled with old blood, on the bladder surface, on the surface of the bowel and involved in scars throughout the abdomen. The abnormally located tissue is presumed to increase in severity over the years due to the presence of cyclic hormones produced by the ovaries during the reproductive years that cause both regular menstrual bleeding and at the same time creates abnormal bleeding in the areas of endometriosis. Control of symptoms involves various drug regimens includes oral contraceptive pills, progestin therapies, and other drug regimens that stop all cyclic bleeding or block the production of all estrogen and progesterone from the ovaries. If these methods fail to control the symptoms, then surgical treatment is warranted. You had the most definitive surgical treatment available for endometriosis and it seems that your symptoms warranted this choice. Now you have no pain but you also seem to have lost a great deal with this early surgical menopause.
The recurrence rate for endometriosis after removal of both ovaries and the uterus along with all visible endometriosis is reported to be less than 10 percent in most studies over a seven-year period. Estrogen treatment may slightly increase the rate of recurrence but it is clear that your symptoms are significant and that you have tried all the usual remedies for menopausal syndrome associated with this early surgical menopause.
Your gynecologist has given you the facts, Marci, and you are fully informed of all the potential side effects of systemic hormone therapy. But you do want your "life" back.
Discuss the use of Menostar patch with your gynecologist. This form of estradiol (the same estrogen chemical compound that is produced by the ovaries) delivers 14 mcg of estradiol daily through the skin via a small patch that is changed once a week. I always suggest that a patient begin with the lowest dose possible and then assess how she responds in six weeks. You should have improved temperature control and sleep, enhanced energy and mood and cognitive function over time. If you find that you are still suffering and want an increase in estrogen dose, do remember that the lowest dose possible for the reasonable control of symptoms is ideal. Commit to daily vigorous exercise, and yearly breast imaging along with careful breast self exams.
When you get yourself back, find a way to give back. Volunteer to share the knowledge you have gained from this journey to other women. Join us here at womensvoicesforchange.org with your story of evolution or reinvention. At 44, you can rest assured that the best is yet to come.