Hysterectomy, HRT, mental health (TRIGGER WARNING: suicide)

[HelenMirrensWeightedBlanket]

Hi everyone,

apologies in advance for the long post. I’m very tired and very anxious and I don’t know who else to talk to.

im 48 and I’m having a full hysterectomy next week. I’m terrified- not of the operation, but of going through a surgical menopause so suddenly (no menopause symptoms right now).

The reason I’m so worried is that I’ve had depression for 35 years and I’m scared of what the menopause / op will do to my mental health. When I went through puberty, I was suicidal for 3 years. I can’t go through that again. In terms of hormonal change, is it like puberty??

im having the hysterectomy because I have severe endometriosis plus fibroids (been bleeding for two years non stop). Presumably the endo means I’m producing excess oestrogen right now (?) The consultant has said they’ll put me on HRT straight after the operation - but no-one seems able to tell me how they know how much to give me.

It’ll be oestrogen only - but if I’m naturally producing loads of oestrogen today, won’t they have to give me a really high dose? I’m so scared of being v v depressed but not being well enough to push for the dose I need.

can anyone give me some advice / reassurance? Is there a standard/ high dose I should be asking for? It’s all on the NHS so although I’ve seen loads of doctors, none of them have had the time to explain how HRT works or how they’ll calculate the dosage.

I’m so frightened of ending up suicidal again. Please be kind x

Sorry, just realised how rambling my message is… basically I’m asking:

1. how will they know what dose of HRT / oestrogen to give me?
2. can I push for a higher dose if I’m not ok?
3. how long does it usually take to get the dosage ‘right’?

Thank you for reading

Sorry OP, no idea about answers to your questions so giving you a bump. I’d ask the consultant doing the operation /G.P I think.
My aunt had a hysterectomy and was fine afterwards, she did take HRT but had to stop as her breasts became lumpy- I’m going back about thirty years!

💐Hope all goes well.

I am halfway through a fabulous book that just came out 2 weeks ago, called The Upgrade by Louann Brizendine. She is a psychiatrist at UCSF who specializes in Female Hormones. The book covers hormones and what you might need to try in all sorts of situations like a hysterectomy. (I think she even specifically talks about what she requested when she had her own hysterectomy.). She talks about the lack of education and research in the field of female hormones and in particular Menopause (which she renames The Upgrade). Full disclosure, she is a family friend, but is an absolute expert and this book is amazing and empowering and every woman in her 40's and beyond should be reading this book immediately.

1. They will definitely have a very good idea what your starting dose needs to be as they have done many 1000s of hysterectomies and have the data from these. Also, maybe they use one of your pre op blood tests to inform your starting dose?
2. If you still have difficult symptoms caused by low oestrogen you will definitely be able to have an increase. Remember post menopausal women produce no oestrogen either and are fully or almost fully supported by the hrt oestrogen
3. I don’t know about dosage levelling after hysterectomy, I would imagine it would be quicker than when starting hrt at perimenopause as you are starting from a “primed” position with your body’s own oestrogen supply. Fwiw as a beginner I’ve been told to try it for 12 weeks before review, but I know I can contact the drs sooner if I want to. Actually I think there’s a good chance you could barely notice the oestrogen transition.

I think you should write these questions out and ask your doctor before the op to relieve your worries. Also I totally get your fear at the idea of slipping back into the black hole. This won’t happen though as you have your own oestrogen, and before it runs down your hrt oestrogen will kick in, so you will never be without.

You do need an action plan though to keep your mental health strong. A hysterectomy is a major op and it is physically and psychologically natural to experience mood fluctuations afterwards. You can take control of this situation. So try to jot down some self help ideas about how you will keep your outlook healthy over the next 6 weeks.

As PPs have said, talk this over with the drs.

Endo doesn't mean you produce 'loads of estrogen'. It means you have womb lining tissue in other parts of your body. Have you they never suggested a Mirena coil to control your bleeding? And is this constant bleeding part of peri menopause?

Estrogen comes in different doses and some are very easy to change. Like estrogen gel. You can use the right amount to get the best results.

Most women in peri or post menopause would start on a dose of around 1mgs a day. Some women need up to 3mgs a day. It is trial and error, but with estrogen gel you can try a dose for a few weeks then increase if necessary.

Try not to worry as it may all go fine.

Good luck!

Thank you for all the helpful replies, particularly to @HairyKitty . And thank you to the PP who recommended that book, which I’ll definitely be buying.

To answer some questions:

1. I was told by a gynaecologist a few years ago that they don’t know what causes endometriosis but it’s due to excess oestrogen (??) Obviously I know the symptoms of endo (tissue in other areas) - I’ve already had parts of my bowel and bladder removed due to this.
2. I’ve tried the coil twice - both times it made the bleeding much worse. Also made the depression worse.
3. I thought the bleeding must be peri menopause but apparently my hormone levels aren’t pointing to PM, so who knows…

Recent research suggests that endo is caused to too much testosterone in the environment while in the womb. It's a new take and quite different to what had been thought previously.

We have a lot on common Helen. Similar ages but I've already had the surgery. It went well but surgical menopause was quite a shock. My consultant suggested trying to get by without hrt because he felt that with severe endo the less oestrogen the better. I was back in his office within a week asking for the hrt. There was a little playing around with the dosage but it wasn't a drama. Just enough to stop the hot flashes, too much and I was feeling weepy with sore boobs and bladder problems. I was on anti depressants before the surgery and stayed on them afterwards. I didn't notice a difference in terms of depression but my confidence took a hit with menopause. I'm reading about how testosterone can really help with surgical menopause. I want to try that next. Some parts of the world seem to offer it routinely after hysterectomy. Have a read on hystersisters.com. There are a lot of people there in the same position. Personally, while its been far from easy, it's still the best thing I've ever done. It's so freeing to be able to live without worrying about constant bleeding and severe pain. I'd go so far as to call it life changing. Good luck with the surgery. I hope your experience is equally positive in the end💐.

Hi OP.

I am just thinking about things from the depression side of things and your worry about it sneaking up on you (which it can do). I wondered if having a plan to follow to monitor this might help? This is one way you could do this - if it fits for you…

You could make a note (from memory) of what the first warning signs were when you started to feel really low. Was it sleep? Appetite? Activity? Certain feelings? Withdrawing? Physical sensations? Thoughts?
Ask yourself what were the signs it was getting worse? It might be worth doing this with with a mental health professional if you think it could be really difficult and bring up high levels of emotion - or a trusted friend if you have one.

Then get a diary so that you can monitor these daily afterwards. Rate things out of 10 (0 being none and 10 being worst) so you can track things.

Make a list of what helped you out of the hole before. What did you do differently? What do you that helps your mental health? What have others done? What professional support helped? What meds etc.

Then make a plan for if you notice the signs creeping in - what you can do (what helped before - food/diet/meds/talking etc). What will you need to ask of others? You could let them know (I am worried my mood might dip post OP, can I put you down as a ‘go to’ person to talk to if I notice this happening?

Make a plan for if you notice thoughts of killing yourself coming into your mind. Who is your ‘go to’ person, have your GP number handy.

May be you could write a note to yourself now that you put on an envelope giving yourself the perspective that you have today and giving yourself some encouraging words - (make sure you only write compassionate and kind things - something a really good, empathic friend would write - and ignore your inner critic). Put it in an envelope and write on it the circumstances under which you should open it (e.g Dear HelenM.. Open this if you start to notice that…).

You could even do a series of notes for yourself for if you notice mild, moderate or severe signs you are heading downwards. You could have an emergency one that tells you to go to A&E if you are feeling at immediate risk.

If there is anyone in your life you could involve in this then you could ask them to check in on you.

Chances are you won’t need any of this and the HRT will get sorted asap but it might make you feel more in control and less worried about it if you do the above? Just ideas though and might not fit for you.

Best of luck with it OP! I really hope it all goes as well as it possibly can for you. 💐

I went straight into menopause at 41 due to cancer treatment.

Up til that point my periods were still bang on regular. Like clockwork.

I went onto HRT after treatment finished and I feel almost like my old self. Some things aren't the same but I'm looking into ways to fix them.

I can't help with the mental side of things sorry, as I've not suffered in that way - but just wanted to respond from the health perspective.

Are you keeping your ovaries, @HelenMirrensWeightedBlanket? I did look at all your posts, and sorry if I missed that.

I had a BSO TH (ovaries & everything out hysterectomy) and can advise on that if it would help.

I was menopausal and on HRT. I subsequently needed a full hysterectomy and the after affect of a surgical menopause was worse as regards hot flushes/temperature of my body. I was put on HRT by the team when I asked for it later. Nobody seemed to have thought about it before then 🙄. I also had fibroids and had to have a full incision as they needed to get the fibroids out whole. In the days afterwards set yourself a little routine each day ( I was living alone when I had mine) - rest up in the morning , get up at your leisure, have your wash/shower, lunch in one part of the house, back to bed early evening to watch TV etc. This may sound silly but I had a long recovery and it really helped to have a routine. This may also help you manage your anxious feelings.You will soon get a feel for the gel yourself and know when it is helping. Best of luck!

Also wondering if there is a reason you can't keep your ovaries?
I had a hysterectomy last year after horrendous bleeding caused by fibroids and endo.
I opted to keep my ovaries and because of this have not had to deal with instant menopause.

Prior to surgery I was put into menopause by an implant called zoladex (to try to shrink fibroids and to stop the bleeding).
I was given eostrogen immediately which was a mistake as I hadn't had time for the level to fall (and it was subsequently found I had an imbalance and already had too much of the stuff in me).
The symptoms of this was anxiety. I spoke to consultant and stopped the eostrogen and normal life returned. I am telling you this so you can be mindful if you do get anxiety symptoms.
With all of the hrt, you are able to play with the levels and find your happy space.

My advice to you would be to face the situation with confidence in your own ability. You will know if you do not feel ok and you can advocate for yourself.
In practical terms, having the op was honestly the best thing I ever did. One year on and life is unrecognisable in the best way.
Wishing you good luck and speedy recovery.