Surgical menopause - estrogen only HRT - is estrogen the 'happy hormone'?

[Spudulike3]

Hi all

I'm due to have a hysterectomy with ovary removal because of pre-cancerous cells found in uterus. This will put me into surgical (instant) menopause. I'm 44 and still having regular periods so this is a terrifying prospect.

I went to the GP to discuss the HRT options and she said I could have estrogen only HRT after the op. I won't need the progesterone element of HRT because I will no longer have a uterus.

So to get to my question (thanks for bearing with me). The GP said that estrogen was the 'happy hormone' element of HRT and therefore I should be OK with respect to low mood.

I'd be really interested to hear if people think this is true - is estrogen only HRT likely to work out better for mood than more typical estrogen / progesterone HRT?

I recently made a thread about surgical menopause in general and got lots of really helpful comments. See link below for original thread.

https://www.mumsnet.com/talk/_chat/4964373-experiences-of-surgical-menopause?reply=131495113

Yes, Oestrogen is the one that affects your mood. The progesterone is to protect your uterus. Progesterone really doesn’t agree with me so I have a mirena which is easier to tolerate as it’s local, and fairly high does oestrogen patches.

I find progesterone keeps me calm and helps with anxiety and sleep.

Thanks PiggyWig. Interesting point - I guess people who have the IUD like you would be in a sort of similar situation as the progesterone would be local only

Thanks TwoShotsInMyCup - sounds like your experience is a bit different to what the GP was describing.

The rise in progesterone in the luteal phase was responsible for my PMDD. I had a full hysterectomy and only use estrogen now, I feel so much better. Progesterone in HRT was even worse for me, I'm so glad I don't need to use it anymore. Most gynaecologists agree that we don't need progesterone unless you have a womb, it just stops the lining from thickening and becoming cancerous, whereas estrogen is essential.

Thanks Rina - I'm glad the estrogen only is working out for you

Hi. OP. I've asked GP about having a hysterectomy and getting rid of it all, I would love to avoid the suicidal thoughts I get with PMT and get rid of the mirena which just makes me so fatigued.

So I'd be on cloud nine to be told I can just have oestrogen which for me makes me feel excited about life again!

Ah Leftoversgalore I'm sorry to hear that - I do suffer from PMT but not too badly. Hormones can have profound effects on your life and I'm not sure my male (and rather high handed consultant) understands this.

I had a surgical menopause at 35, use oestrogen hrt and feel fine. It's wonderful to be free of the uterus which gave me so much grief! And I'll stick to the hrt for the foreseeable. Good luck to you !

Progesterone receptors are found in cells all over the body - the hormone is not just related to the uterus. Here are a couple of links to articles:
https://www.bodylogicmd.com/blog/the-benefits-of-progesterone-treatment-after-hysterectomy/?fbclid=IwAR22gyJVULZGBYiehs7tXUt8V8AsvJrFRvT1XWQD-D5xhmTytCIdVjCjVU

https://www.power2practice.com/article/she-needs-progesterone-bhrt/?fbclid=IwAR0h8NWOOxlNEzK6GCH1L43eMTWNfS8vhyvFiojr5mKdXzs9m4H9hEetj4

Just a note that synthetic progestins mimic progesterone only in the uterus and are NOT the same body identical progesterone which has benefits in many other parts of the body, including the brain and gut.

A friend has joined the following FB group which has a lot of women asking the same questions - she has found it very helpful
https://www.facebook.com/groups/1072908804112416

Thanks ShippingNews. I'm glad it is working out for you and I do hope I will be the same!

Thanks DomingoinLittleOakley. I knew there were estrogen receptors all over the place but not progesterone ones. I guess perhaps adding in progesterone could be good if estrogen only not going too well. I'm just apprehensive about the bumpy ride to get there (at the same time as moving house and jobs - lucky me!)

@Spudulike3 @DomingoinLittleOakley such an interesting discussion! I had my sub hysterectomy (ovaries left) a year ago and since then I’ve been toying with the idea of hrt due to some bothersome symptoms (mainly insomnia and skin thinning & sagging). I’ve done a few blood tests privately and I’m not in menopause yet. My gp and menopause nurse both say that I only need estrogen but it just doesn’t make sense to me. I’ve been reading on body identical and regulated bio identical hrt and I think that, based on my symptoms, bio identical progesterone and possibly estrogen might be helpful for me, but who can give me a solid professional advice and where can I get it from?

@Letsbepractical Thanks for your thoughts. I agree it does seem a bit suspect to just drop one hormone altogether. It's also really hard to get advice. I went to see a specialist a few days ago as I'm lucky enough to be able to pay. It was such a relief to have 30 mins to talk through things rather than a rushed 10 mins with a GP who may not know much. If you can, I would recommend this option. It's such a shame that women have to do this though. It does make me cross how much extra time and hassle and money having lady bits costs!

Hi, how did you find the specialist please - what is the correct terminology for such a consultant? And did they run bloods and other tests? Do you have to go back for future consultations? how much would you say it's cost you all in all?

Also, I see reference above to 'menopause nurse' - this is interesting to know, how does one access such a thing on the NHS, it it something GPs have?

@LittleMissSunshiner I'm going out just now but I'll get back to you later on.

Hi, @Spudulike3 To worry ahead of the surgery is natural, to try to pre-empt everything you may or may not experience isn't. I'm not sure how helpful seeing someone before any surgery could have been.

I experienced surgical menopause almost 9 years ago and am not at present on any HRT after a huge mess up last year after I came off NHS prescribed estrogen only implants. I am waiting to be seen by the NHS menopause clinic again and have had to request that my appointment be brought forward from the scheduled one I have in May.

The younger you are at time of surgery, the more acutely difficult your symptoms may be as your estogen levels would be high and then you would be falling to essentially none. These symptoms are predominantly caused by loss of estrogen - progesterone does not play any role in the symptoms of menopause and anyone who tells you it does with a view to replacing it once your uteus is no longer there is just trying to sell you something you don't need (I have personally only seen this in the private sector).

The main thing post. op. will be to replace your estrogen with a dose and type which will relieve your symptoms as much as possible and to offer bone protection especially when younger. Once this has been achieved, testosterone can be added as once you lose your ovaries - umlike women in natural menopause or after a hysterectomy- your production of testosterone will fall significantly and this can be felt as loss of libido and other issues which are curently being studied and clarified via ongoing research.

@Letsbepractical some of the above applies to you when you reach menopause re: replacing estrogen only but you are not in surgical menopause as you still have your ovaries and will continue to produce testosterone from these as they are still intact.

@LittleMissSunshiner You are very early post op. and I don't suggest you tinker too much with your HRT at present as it'll make it even harder to find balance and adjust. This means chopping and changing methods too, plus you will still have some stored estrogen of your own onboard and you won't know how you'll feel or whether your HRT needs adjusting for a while. I would stick to the 2 pumps of gel but you can certainly try the 2 pumps in one go either night or morning as it'll reach steady state after about a week or so and should hold you over symptom wise. It's designed to be dosed once daily and if you have breakthrough symptoms on this which is the standard dose, phone your GP and request going up to 3 pumps. But please give eavh dose change at least 4 to 6 weeks to bed in. HRT doesn't work instantaneously. If you really can't cope with the gel, you could request switching to an Evorel 50 patch which is an equivalent dose to 2 pumps of gel and is the most reliably available brand of patch at the moment.

I hope this helps some of you.

@LittleMissSunshiner Hello again. I think I searched for 'surgical menopause specialist Oxford' as this is where I live. It came back with a few specialist clinics. I found the experience to be positive but it did cost me £280 and I am in the lucky position of being able to pay. I would have to pay further for ongoing care but I may consider it worthwhile in order to keep functioning in my job. I didn't have any blood tests just a informative chat. She did say pre op blood tests may not be that informative. I would recommend getting a professional opinion if you can. However of course Mumsnet combined experience and wisdom so valuable. I hope you can find the answers you are looking for. Keep well. Xxxc

Another person here that's been told wait untill you've had operation then after recovery assess symptoms
Got to make you suffer first but would appear

@Unex oh that's rubbish. Do please push back if you can. I have had so much healthcare f*wittage of late. I think half the time it is about convenience and / or ignorance not clinical reasoning. Don't be afraid to ask awkward questions. I hope it all works out OK for you. Xxxx

@Spudulike3
Thanks
I really do need to start pushing back

@Unex I don't know your situation but two (paid for) professionals have told me you can start HRT day after op. If it is transdermal carries no extra risk of DVT.

@Spudulike3 I'm very sorry, but no health professional can predict exactly how anyone will react to the sudden loss of hormones following the surgical removal of ovaries in any particular individual, and that's what I'm getting at. I have been under the care historically of one of the top Consultants in the UK (she authored the present NICE guidelines) and still attend this same NHS clinic under her successor since she has retired and even she at her complex menopause specialty clinic - with over 50 years as a Professor of reproductve medicine and gynaecology - could not predict exactly how severe a woman's symptoms might be or how they might react to various HRT regimes. There is always going to be trial and error.

I think - and I am saying this as kindly and as well meaningly as I can - that what deep down you are looking for is someone to make the decision for you as to whether you should keep your ovaries or not. If indeed this is the case, I think you need to be asking very real questions of the specialist who is proposing your surgery about what exactly your risks are if you do keep them (including the numbers regarding your own presentation, not just statistics). Then and only then can you make an informed decision as to whether you want the surgery and how you will prepare for the unknowns of how your body will react to the onset of surgical menopause and whatever symptoms you may face.

Please know that I'm trying to be as well meaning as I can, but no one can give you (or anyone else) cast iron answers as to how you will experience menopause or how it may need to be treated ahead of the fact. If this were possible, we would be able to predictably treat all women and wouldn't have the huge number of threads on Mumsnet in the menopause section that we do.

I wish you the very best of luck with whatever you decide.

This will be offered as standard on the ward unless you are waiting for pathology re: estrogen postive cancer.

Not always. I was told on discharge to contact my GP for it. My GP told me they “didn’t have a clue” about HRT so referred me to menopause clinic (2 year wait). I had no follow up appointment after having my ovaries out, despite me calling and requesting one. Eventually a different GP did prescribe me oestrogen but only after I’d had a migraine for two solid months. With hindsight I wish I’d have refused to leave the hospital without a bottle of Estrogel! I’m 3 years down the line, finally had my menopause clinic appointment last week but have paid a fortune to see private menopause specialists in the meantime.