HRT after total hysterectomy due to uterine cancer

Posted by sbryant @sbryant, 3 days ago

I was diagnosed with uterine cancer in March. I had a total hysterectomy on May 19. They took the uterus cervix ovaries and lymph nodes. I am now having major menopause symptoms once again. My doctor said she thinks it’s safe to use HRT again for 6 to 24 months has anyone done this?

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Hi Sbryant,
I'm sorry to hear that you have cancer and had to have a hysterectomy. That's a lot for your body to cope with! I didn't have anything like that but I'm 79 and when I started menopause they gave me a hormone replacement drug. I took one tablet and ended up in the emergency room! I never took anymore. I went through menopause naturally. I drank a lot of water and orange juice which seemed to help. I ate healthy and just coped with the hot flashes. I'd open the door and stand outside for a minute and then they'd subside. Many women went through menopause over the years without anything except water and healthy food. Since you have already had so much done to your body and you have cancer, I'd just not take the hormone replacement drugs. Your body already has a lot to cope with.

Prayer also helps. I prayed a lot through menopause and it helped. I'll say a prayer for you.
PML

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Thank you for your response. I was taking a hormone replacement patch prior to my hysterectomy. I’ve already dealt with menopause. Once this is my second time around due to the surgery. I already drink water and eat healthy. It’s to the point where I’m not sleeping at all, which is why I’ve turned back to HRT.

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@sbryant

Thank you for your response. I was taking a hormone replacement patch prior to my hysterectomy. I’ve already dealt with menopause. Once this is my second time around due to the surgery. I already drink water and eat healthy. It’s to the point where I’m not sleeping at all, which is why I’ve turned back to HRT.

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I've been miserable without estrogen for four and and half years since my hyst for UC. I think HRT is what led to it in the first place...Was on estrogen for way too long , with only topical OTC progesterone. So I'm scared to try even OTC estrogen.

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@sbryant This is a tough question. Did you share your misgivings about taking HRT? Is this your oncologist who told you she believes it is safe for you to take HRT?

Everyone is different and we have to enter into this conversations with our own oncologists. With this collaboration with our doctors we can figure out what feels like the right choice for ourselves.

I was using vaginal estradiol prior to my hysterectomy for endometrial cancer (endometroid adenocarcinoma, Stage 1 at diagnosis). There continues to be controversy about vaginal estradiol however at the time my doctors told me and the research literature was clear that the estrogen in this formulation used vaginal is safe. It’s a small amount of cream and very, very little enters the bloodstream since it’s basically being used “topically” as in on-the-skin and externally. The estradiol worked for vaginal atrophy for me.

After my hysterectomy my gyn-oncologist told me that I should not use vaginal estradiol anymore. I shouldn’t use any estrogen products. My cancer was ER+ (estrogen receptor positive). While the estradiol did not “cause” my endometrial cancer she did not think it safe to continue to use. The radiation oncologist told me the same thing.

I was post-menopausal when I had the hysterectomy. I’d had insomnia ever since peri-menopause. It hasn’t been any better and in fact my insomnia has been worse over time. What to do? I use OTC products like melatonin, I try to practice good sleep hygiene, and when I have difficulty falling asleep or staying asleep I get up and read. Yes, this insomnia is distressing but I have learned to accept it over time. And it isn’t every night.

I’ve shared a rather long explanation on my own experiences. I will say if I were in your place I’d ask my oncologist more questions and I might get another opinion from my gynecologist.

What do you think you might do?

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@naturegirl5

@sbryant This is a tough question. Did you share your misgivings about taking HRT? Is this your oncologist who told you she believes it is safe for you to take HRT?

Everyone is different and we have to enter into this conversations with our own oncologists. With this collaboration with our doctors we can figure out what feels like the right choice for ourselves.

I was using vaginal estradiol prior to my hysterectomy for endometrial cancer (endometroid adenocarcinoma, Stage 1 at diagnosis). There continues to be controversy about vaginal estradiol however at the time my doctors told me and the research literature was clear that the estrogen in this formulation used vaginal is safe. It’s a small amount of cream and very, very little enters the bloodstream since it’s basically being used “topically” as in on-the-skin and externally. The estradiol worked for vaginal atrophy for me.

After my hysterectomy my gyn-oncologist told me that I should not use vaginal estradiol anymore. I shouldn’t use any estrogen products. My cancer was ER+ (estrogen receptor positive). While the estradiol did not “cause” my endometrial cancer she did not think it safe to continue to use. The radiation oncologist told me the same thing.

I was post-menopausal when I had the hysterectomy. I’d had insomnia ever since peri-menopause. It hasn’t been any better and in fact my insomnia has been worse over time. What to do? I use OTC products like melatonin, I try to practice good sleep hygiene, and when I have difficulty falling asleep or staying asleep I get up and read. Yes, this insomnia is distressing but I have learned to accept it over time. And it isn’t every night.

I’ve shared a rather long explanation on my own experiences. I will say if I were in your place I’d ask my oncologist more questions and I might get another opinion from my gynecologist.

What do you think you might do?

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Thank you for your response and explanation of your experience. I started HRT in an estradiol patch form along with progesterone. I wasn’t completely through menopause as I still had random bleeding. I was on HRT for roughly a year when I started spotting I went to my gynecologist and had an ultrasound and they didn’t see anything alarming. I went off all HRT for seven days and restarted it with a higher dose of progesterone, which seemed to have stopped the bleeding for about a week I called the gynecologist back and explained to her the bleeding had returned. She said they wait six months to do a second ultrasound at the six month mark I went in and had the second ultrasound which they could see some spots in my uterus as well as some thickening. They scheduled me for a hysteroscopy and DNC, which is how they found the cancer eight weeks later I had a total hysterectomy test, confirmed there were no other signs of cancer even the uterus only had pre-cancerous cells left three weeks after the surgery. The menopause symptoms came back full force, and I haven’t slept since I reached out to the gynecologist and she discouraged me from using any estrogen. She called my oncologist and my oncologist said she thought it was safe for me to use the estradiol patch again for 6 to 24 months and then wean off of it. I’m so torn because of the cancer. I have my postop hysterectomy appointment on August 5, which will give me the opportunity to speak in more depth with the oncologist. Thanks again for reaching out. I really appreciate everybody and anybody’s input so that I can make a conscious well-thought-out decision.

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@esikora

I've been miserable without estrogen for four and and half years since my hyst for UC. I think HRT is what led to it in the first place...Was on estrogen for way too long , with only topical OTC progesterone. So I'm scared to try even OTC estrogen.

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I was on the estradiol patch for the progesterone pill. I too am miserable without it. I was only on it a year, though before my diagnosis it sucks we as women have to suffer with this once during regular menopause, and then again after the hysterectomy.

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I had a hysterectomy for a very “high grade abnormality” - I talked to 2 OBGYNs that I knew from my job (hospital RN) and it was the recommended treatment. I was told it would eventually become uterine cancer if I didn’t.
I have used HRT since 2014 as I was already menopausal and the hot flashes and night sweats were horrible.
I do see a GYN yearly.

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HRT comes in several forms. I had a total hysterectomy when I was 42. I did not have cancer but I had fibroid tumors that were causing excess bleeding and my gyn said ovaries are cancer magnets, as is the uterus; my mother had cervical cancer at 34. The sooner one is without both the uterus and the ovaries, the better: IF you can use an estrogen patch. One does not need progesterone if there is no uterus, either. I'm so happy I did get rid of all the baby plumbing 28 years ago and used an estrogen patch.

I wanted to have an estrogen patch on my tummy before even going into surgery because I didn't want my body to take a dip in estrogen when my ovaries were removed and experience all the side effects of lack of estrogen.

My doctor agreed with me and that was 28 years ago. I've used the estrogen patch ever since; it is my friend. I will be 70 in Sept and people think I am barely my early 60s. I have no heart disease, my hair is thick and shiny at 70 - and I am a blonde with little grey hair; my skin is supple and happy, and I don't have vaginal dryness, and have never had a hot flash. I don't have stress incontinence, I have lots of energy to stay fit and in shape, and weigh what I weighed as a teenager. I have four kids.

Having said all that: I also have a sister who had breast cancer at age 29. She was not put on estrogen therapy and sadly, her skin looks like she is 90 and her hair is brittle, as are her bones; she has had foot fractures and has bad lower back osteoarthritis.

It is a tragedy the panic regarding estrogen replacement caused her doctors and her to believe she could get through her life without estrogen. It is vital to a woman's health.

Estrogen can be an issue for a woman if she has breast cancer that is Estrogen receptor positive...but honestly, I'd rather take estrogen and take the risk, or remove my breasts because estrogen benefit of positive health effect on the rest of a woman's body.

Good luck and hope it all goes well for you either way you go. Hang in there!

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@wisco50

I had a hysterectomy for a very “high grade abnormality” - I talked to 2 OBGYNs that I knew from my job (hospital RN) and it was the recommended treatment. I was told it would eventually become uterine cancer if I didn’t.
I have used HRT since 2014 as I was already menopausal and the hot flashes and night sweats were horrible.
I do see a GYN yearly.

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Thank you!! This makes me feel hopeful

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