Surgical Menopause - coping with no HRT

[tinysleepy]

I had a total abdominal hysterectomy & BSO around 9 months ago. Massive complex ovarian cyst - there was strong suspicion of ovarian cancer but thankfully no malignancy.
My discharge meeting with gynaecologist was clear; no HRT due to extensive endometriosis found during hysterectomy.

I have been managing so far - pretty well. Hot flushes, disturbed sleep and very tired, but feel better without pain.

Issue now is my mood. I don't know whether I'm depressed or the moods are just part of menopause. Feel teary & I struggle to be interested in work etc. Feel foggy headed & forgetful. Overall, each day is a bit like walking through treacle.

Complications include fibromyalgia & B12 & folate deficiency. I am taking prescribed tablets for vitamin deficiency.

I am not sure what I am asking really...has anyone managed menopause naturally & had success with addressing symptoms without HRT? Thanks

How old are younow?

TBH this is something your gynae who did the op should discuss with you! Pretty careless treatment of you to not offer solutions- the RCOG has a leaflet on alternatives to HRT which is linked to here if you so an advances search.

The other thing is, there are mixed opinions on HRT when there is endo; different gynaes have different views on it.

I'd go back and ask how they expect you to manage symptoms.

I am 46 - I was 45 at point of hysterectomy.
Not peri-menopausal.
Looooong history of fertility intervention & ablation.
Endo was never even mentioned before hysterectomy.
Anyway, I'll look at that leaflet, thanks.

I have been doing a quick bit of digging and found this medical research. It shows that the situation is not black and white.

academic.oup.com/humupd/article/23/4/481/3814217

It's a very long article but if you go right to the end this is what it says in the Conclusion - see the bullet points.

It says it's something decided on an individual basis and that risks such as osteoporosis have to be balanced with the lack of HRT, that different types such as Tibolone may be okay, and you need to discuss it all very carefully.

I'm worried for you that you are without estrogen at 45 which may increase your risk of other diseases long term. How would you feel about seeking another opinion from another consultant?

Thanks Polly! I love disappearing down a research black hole, so will read that!

I had no time to prepare & consider the whole HRT v No HRT decision because was all a bit emergency.

I am worried about the osteoporosis risk + heart disease etc. I was just clearly told NO HRT!
I need to dig a bit don't I?

Does HRT help with the mood-issues & emotional rollercoaster?

Ok why no hrt? I had a hysterectomy at the same age & im on hrt

I have endo and effectively had a medical menopause by starting GNRH treatment at 44, which I've stayed on long term. I have managed without HRT, though I use an oestrogen vaginal cream. The idea is to give me enough to prevent the skin becoming thin and dry (I was getting a lot of yeast infections because of this) but not enough to reignite the endo.

I have to say the first three months were awful as I had no pain reduction and struggled with effects of full-on menopause symptoms. (I had surgery for the endo but due to late diagnosis have scar tissue behind my cervix that couldn't be removed.) I was on the point of giving up then suddenly things clicked into place and the symptoms diminished greatly. So if you are in the early stages hang in there!

I do still have some overheating issues (not really full on flushes) and some brain fog but I think some of that is down to my meds.

I do have regular dexa scans to check for osteoporosis, and take calcium and vitamin D.

Sorry I just re-read and saw that you are 9 months in. Did they remove all the endo when they did the hysterectomy? It's important to do this, ideally by excision rather than laser as it's less likely to regrow. If they did remove it all there is a low chance of it returning and you might be OK with a low dose of HRT. If they didn't remove it I would be asking for an op with an endo specialist to have it treated.

I don't think they removed all the endo. The gynaecologist said 'lots & lots of adhesions' but to be honest I was so happy that it wasn't cancer that I just didn't hear anything but no HRT (I had high CA125 & cyst looked dodgy - I was being referred to MDT & local cancer centre to make decision about whether chemo or hysterectomy first).
Cyst was endometrioma in the end - hence high CA125.

My reading suggests that endo can grow back on HRT, but without ovaries & no HRT, it's less likely. Is that broadly right?
I have had the whole lot removed including ovaries & cervix, due to cancer concern.

I have virtually no pain or absolutely no bleeding...well, so far...

One thing I have found through my own research, talking to drs and reading this forum is that there are almost as many opinions as there are consultants! Ok some things are black and white but there are even women who have had breast cancer using HRT - certain types and certain doses. (A consultant told me this.)

That link I posted - only quickly read some of it- seemed to say that estrogen only HRT is more likely to cause re activation of endo but if you use combo HRT with a progestogen, it's less likely. But the downside is that estrogen only HRT carries no breast cancer risk whereas combined HRT may. so it says these risks and benefits have to be balanced for each woman.

Can I ask if you’ve had any counselling/therapy?

I know some of the symptoms you describe could be hormonal but the tears/foggy/running through treacle sound very familiar to me.

I’d put them down to being peri-menopausal, but my fabulous gp gently suggested it might be worth me chatting to someone, and I can’t tell you the difference it’s made to my quality of life.

She actually diagnosed PTSD from something that happened years ago (which seems very obvious to me now but I didn’t realise at the time).

The peri-menopausal symptoms were sort of the straw that broke the camels back- so although they are still there they are much more manageable.

This is some recent news from Menopause Matters on mood / depression and hormones- written by doctors.

ps:menopausematters.co.uk/newsitem.php?recordID=188/Menopausal-depression-may-be-prevented-by-hormone-therapy

Oreos: thanks for your post; it's so difficult to try & separate the traumas associated with sudden hysterectomy & menopause v life's other stresses.
I don't know if talking therapy would help...or is it all hormonal?
Does my post sound as confused as I feel?

I guess you wouldn’t know unless you tried it!

My GP was able to offer me sessions on the NHS, but they would have been group counselling sessions...as an introvert I did not feel it would have been the right thing for me!

She also recommended a someone private - at £70 a session it was not cheap, but definitely worth every penny. I had about 8 sessions, which helped me to deal with a specific issue, and move forward.

The way it was described to me was that something happens and you just cope with it rather than deal with it. Other things (minor stresses, hormones etc. add to it, and you’re still ‘coping’, until one day you’re just not and it all just seems too much (not in a suicidal way, more of just an I can’t stop crying way).

I no longer feel foggy, constantly on the edge of bursting into tears, and I feel positive again for the first time in years. I still feel emotionally hormonal sometimes, but I’m able to recognise it much more clearly.

I obviously don’t know everything about your situation, but it would seem to be a pretty traumatic experience to me, so might be worth you giving it a go if it’s something you’re open to.

I’ve just stumbled across this. I’ve been in similar circumstances. A history of endo means you need dual HRT. I tried estrogel with natural progesterone but the endo returned. I’m now on Tibolone and would highly recommend it. My mood was so low without HRT (contemplating jumping off a bridge low) but feel much better now.

I can recommend a private HRT gynae if appropriate. PM me if you need details.