Surgical/Early Menopause

[GilbertMarkham]

I'm looking at surgical menopause within a couple of months; not what I expected but ....

Had anyone any experience of being thrown into menopause instantly this way?

The gynaecologist says I could have a patch (estrogen I'm presuming) fir a year or two if I struggle with the symptoms.

(She mentioned before that she's reluctant to give women with a family history of breast cancer patches etc.)

I'm 44, and since I've stopped the mini pill a couple ofontgs ago; am back to what seems like regular ovulation and periods. This is obviously going to end abruptly with surgery.

Has anyone used alternative supplements?

What do you do to prevent the heart, bone, brain etc issues?

*couple of months ago

I had everything out 9 weeks ago, it’s really hard to find info I found, I’m 39. I started on estrogen gel last week and I think it’s helping a bit already. I took natural supplements before then but probably not for long enough to help. My consultant told me that the risk is linked to progesterone, which you won’t need if they remove your womb - but obviously listen to your gynae and if you have a family history of breast cancer you might need to be more careful. Having your ovaries removed can reduce your risk of breast cancer.

I was so worried about bone density etc... but was really reassured when I spoke to him. Diet, exercise and supplements can help protect you against those things. Feel free to ask me anything x

Thanks so much for your reply.

The consultant is reluctant to give me gel/patch - doesn't like giving estrogen to women with family history of estrogen positive breast cancer, understably. Said she might for a limited period if I struggle.

Yes, I think I read elsewhere what you've said about ovary removal reducing breast cancer risk .. that's a positive.

What natural things did you try before you started on the gel? I've read about red clover, black cohosh, sage, evening primrose etc.

Not sure if all aimed at natural menopause though and if it makes a difference when it's sudden and not natural, as such.

The consultant mentioned exercise and maybe calcium/vit d for bone density. Not sure if she mentioned it fir heart issues too. Are there things they recommend for those issues (altzeimers was mentioned too in something I read).

*Alzheimer's

@GilbertMarkham There is a HUGE amount of info you need to be aware of and I'm not sure your consultant is right :(

(For the record I am a health writer, writing for Patient etc and have to interview top drs for information.) I've also been having menopause care myself from a UK top consultant for years.

A family history of breast cancer means a mother or sister with BC before the age of 45- ie young. If that applies to you, ok, maybe use caution BUT you can still use estrogen to age 51 anyway, regardless.

Few points- unless you have breast cancer yourself, you can have HRT at least to the average age of menopause- all informed drs agree on this. Using estrogen at 44 up to 51 (age of average menopause) is putting back what you oght to have to that age. This is non-negotiable and every single meno expert will tell you that- have a read around online.

The risks of NOT using estrogen (at a young age) are heart disease, loss of bone density, and dementia. Osteoporosis kills around 100K women a year through fractures and then complications. All combined cancer deaths in women are way below that number.

Obviously, if your mum or sisters have had BC young, that's something I am not aware of.

But if it's great aunts who died at 80, that's not relevant.

You really need another opinion. There are a handful of excellent meno specialists in the UK (and this is where I'm coming from with this info) but not all gynaes are menopause experts.

This video is well worth watching.

www.menopausedoctor.co.uk/menopause/early-menopause-and-poi-explained

@GilbertMarkham Your dr does sound behind the times.

As the PP said, the risk of estrogen only hrt is almost zero AND there is research showing women using estrogen only hrt have less breast cancer than women NOT using any kind of HRT.

The risk is with the synthetic progesterones in HRT and you won't need those.

@JinglingHellsBells

Thanks v much for your post, I'd noticed you posting on other threads and hoped you'd post in mine.

My family history is odd in that no brca gene has been found and the ages at which my mum, aunt, and sister were diagnosed with breast cancer was not under 40 (58,63, 49). Another aunt had ovarian cancer at around 43. This week I found out, as a result of risk reduction surgery (which my family members and even I had doubts about being necessary but did anyway) that I had precancerous cells in fallopian tubes.

(I had had fallopian tubes and one ovary removed because of a cyst in it which the surgeon couldn't easily biopsy (if that's the right word) and decided to remove as a precaution. It turned out to be ok, it was the fallopian tubes that showed the above).

As a result the consultant has understandably decided to remove the remaining ovary (and said there's no point in me retaining my womb) asap.

The consultant said that the ages of my mum and sister (58 and 59)
were suspicious to her. This did fly in the face of what my sister was told by her consultant (that's BC is common around menopause) and the 40 bench mark you've mentioned. However with another aunt having had ovarian cancer and is this, I can understand why she would be even more suspicious.

A different aunt on the paternal side actually had, and passed away from ovarian cancer. I don't know if that is a factor at all.

*that should be 58 and 49

*Sorry, i see you wrote 45, not 40 regarding "early breast cancer".

My consultant said that if I really struggle, I could have a patch for a couple of years (not ongoing).

Ive been reading a bit on the worrying health issues around surgical menopause that you've highlighted; and while it's still v concerning, I see one of the main studies has 45/46 as the benchmark age before which ovary removal etc is associated with most impact.

Maybe the consultant thinks I'm only 6 months to eighteen months off that age so ....

I'm not sure if that study mentioned whether any of those women had HT or not. I'll have to look at it again.

I can see it's a concern and obviously I can only pass on info which I've been told and you need to do what feels right for you.
However, having been talking to experts for over 10 years I do know that they do not all agree! :)

Most drs agree that round 47 is the 'safe' lower age limit for menopause without using hrt.

My consultant is one of the top 2-3 in the UK on menopause and runs education training for other drs. He says he does not believe estrogen causes cancer. They think the risk of BC comes from progesterone and mainly the synthetic types.

There is also no conclusive study showing estrogen causes BC. There are associations but no proof that it causes or does not cause BC. This is on the website of Dr Newson.

Here is a link to many articles on her website.
www.menopausedoctor.co.uk/search?query=hrt%20breast%20cancer
There is from a research paper on her site

d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/394/Menopausal%20hormone%20therapy%20and%20breast%20cancer%20what%20is%20the%20evidence%20from%20randomized%20trials.pdf

^For women and health-care providers alike, fear of breast
cancer with perceived risk of HT can be confidently replaced
with current knowledge of risk determined from the totality
of the literature. As such, it is more than reasonable to conclude that the current state of the science indicates that HT
may or may not cause breast cancer, but the totality of data
neither establish nor refute this possibility; and women
should be so counseled. However, it is very clear that any
potential breast cancer risk (especially for the typical population of women near the time of menopause who are HT
naïve when initiating HT) is rare and no greater than other
factors as reviewed. As such, HT can be used with the
reassurance that, in addition to the rarity of potential risk
when initiated near the time of menopause, 50 years of study
has failed to conclusively prove cause-and-effect between HT
and breast cancer, with the preponderance of evidence supporting benefits over risks with amelioration of downstream
morbidity and mortality^

I fully get that this may not override the advice and treatment of your current dr, but the one thing I've learned over the years (and I've been on HRT long term) is that there are almost as many opinions on risks as there are consultants!

Ultimately, the choice is yours. There may be a tiny tiny risk, but it's your choice in the end if you need quality of life over that. A good dr will allow you to choose. There are women like Kirsty Walk- her story is on the Newson link- who had BC and have now gone back on HRT.

It's a hard choice and I'm not pushing hrt- just saying you will probably find other consultants telling you something different!

BTW if you DO go onto estrogen for 2 years and you feel ok and then feel not ok if you stop, there are other drs who will allow you to choose. You don't have to stay with the same dr forever, if they are not allowing you choice.

Thanks so much for all your effort and all the info. @JinglingHellsBells.