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

That's abysmal! This should not have been the case at all and at the very least, it should have been requested in the discharge letter to your GP to collect as soon as you returned home. I'm so sorry and angry for you that you were treated this way.

I was told by NHS senior gynae consultant that I could have oestrogen only HRT from the day of my op. Saw her for a very brief and rushed 5 min chat a few weeks before my surgery but she's very senior and experienced and that's what she said. I wasn't under her so I was lucky to have a few mins with her.

Once my surgery was underway, I literally had no-one to discuss anything with as my surgeon 'doesn't communicate' (uh let's just say she's extremely eccentric and self-employed so I'm not sure she's accountable or answers to anyone except herself and can only cope with anaesthetised people not walking talking ones).

In hospital the ward round doctors included a gyanecologist (I was not on a gynae ward I was on general surgery which was a nightmare in and of itself but anyways) and on my second day in recovery I asked if I shouldn't be on HRT and the next day, day three they sent up an oestrogel pump via a nurse. However, she mistakenly believed it was to rub into my vaginal tear stitches and when I politedly argued this she had a tantrum, took it away and refused to give it back. So, I didn't start on oestrogel until day 6 after surgery as it was handed back to me. I didn't notice any menopause symptoms during this period.

The NHS has already collapsed in my opinion and if one wants to live and thrive it is an obligation to research, inform self, and know ones rights from them and your GP. It is a tragedy for anyone who is too unwell or too vulnerable to advocate for themselves and I'm blistering angry about that fact as people are being injured / harmed / falling through the gaps / dying. HRT is a drop in the ocean in all of this, we are lucky we can share info.

@LittleMissSunshiner God that's awful but good for you for sticking up for yourself. I can't believe it took 6 days to get it sorted.

You have really eloquently expressed how I feel about it as well. I am a scientist so able to deal with medical jargon, adept at dealing with bureaucracy and able to pay for some things. I'm also only working part time at the moment. I struggle with navigating through things so I dread to think what is happening to people without my advantages or who are not able to advocate for themselves.

I totally get why you are blisteringly angry.

@LittleMissSunshiner for any HRt related issues my surgery doesn’t offer GP appointments; instead, they have a nurse who specialises in HRT. But it was just the usual 10 min conversation. Ive asked my friends who are with the same surgery and seen her and we all seem to have had the same experience: if you don’t feel well - just up the estrogen levels. Madness.

I’m on estrogen only hrt with a medical menopause and I’ve never felt better in my life!

Yes that is madness and unfortunately it's also reflected all around the internet. Don't feel great - increase your dose of oestrogen.

Whereas I've been finding some experts saying 'don't feel great' in certain ways can mean too much oestrogen. Personally I think maybe I've gone in the 'too much' category even though I'm only just 4 weeks post surgery.

Symptoms I'm struggling with = chronic lethargy, sleepiness, lack of volition, tension headache that sets in within only minutes of taking my oestrogel dose. I've never had a hot flush. I've lost my appetite and feel slightly nauseous all the time (no bad thing as wish to lose weight).

Some sites say the lethargy, headaches, and nausea, are signs of too much oestrogen. My breasts are starting to feel ever so slightly tender too, another sign. Also some of my symptoms pre surgery are those of 'oestrogen dominance'.

I guess my body's own oestrogen would have been fairly low by the age of 53.5 (age at which I've had surgery)? Also, I'm strictly vegan, have been for over 30 years and much of what I naturally eat is plant based products described as natural 'phyto-oestrogens'.

Whenever I put the oestrogel on, it repulses me, in a sort of intuitive way as if my body is say NO don't do this.

I'm cutting down to one pump in the morning. I'm frightened of not being on HRT as I don't want to rapidly age so vanity is my only issue tbh.

@Spudulike3 I've not read all the replies here so apologies if I'm repeating anything.

The reason you need estrogen is that at 44, you will be classes ass having a early menopause (periods stopping before 45.)

This is a medical condition because losing estrogen early (average age of meno is 51-52) you are at risk of bone loss (osteoporosis) and heart disease.

So it's not really about being a 'happy' hormone- it's what women need for long term health to avoid serious bone loss and fractures in 10 or 15 years.

Progesterone is only given to offset the effects of estrogen on the womb lining (to stop it growing too much and possibly becoming cancerous.)

SOME women find one sort a sedative (Utrogestan), others hate it , and most women find all progestogens give some unwanted side effects (headache, acne, weigh gain, mood swings.)

@LittleMissSunshiner Unfortunately, the advice to increase the dose is probably right.

You should have been advised to give your HRT 3 months before making any decisions. That's the standard advice because it takes that time for it to reach all the estrogen receptors in your body.

I mean this kindly, but you're over-thinking it all and reading stuff online that's probably meant for women not in surgical menopause, (who are struggling with their HRT.)

There is no thing 'estrogen dominance' - that's a mythical condition that's been imported from the US by some 'alternative' practitioners who are usually selling products (ie progesterone cream.) Sadly, the term estrogen dominance is now all over the web. It started about 20 years ago.

You've had a major op.
Your body is healing and adjusting to that. It's not surprising you have headaches and feel out of sorts.

You can stop your HRT if you feel that's the right thing to do, of course, but bear in mind symptoms may come back or get worse and you've always the choice to restart.

I have weird hormones and find I'm irritable when I'm on on high doses of oestrogen but calm with continuous Utrogestan. It helps me sleep. I don't think you can know until you experiment, unfortunately.

These sites are not UK based, and are selling products.

It's worth mentioning that it's the addition of progesterone (or progestogens ) along with estrogen that are the risk (with HRT) for breast cancer.

Women using only estrogen HRT have a lower risk of BC than women NOT using any HRT.

For that reason, it makes sense to avoid progesterone and synthetic progestogen if you can.

The risk with natural progesterone appears to be lower, but there is not enough evidence yet to say it has no risk.

Well said! These websites and disinformation have been around for years and proliferated under one Dr. Lee in the US, as I recall.

It was indeed! He was trying to sell (and did) progesterone cream as a meno support cream but it was based on fraudulent claims because the type of cream could never be absorbed into the skin (to be of any use.)

Sadly, many US websites are not all they seem and their 'About Us' often shows the 'drs' as naturopaths and similar whose qualifications are meaningless.

I'm all for complementary and alternative support for meno and there is some limited evidence of some things helping but the idea of 'estrogen-dominance' isn't true.

So against my instincts I’ve decided to follow my menopause nurse advice and I started taking oestrogen (topical, 1 pump). It’s day 4 and I’m feeling horrendous: sore boobs, bloating, nausea. If oestrogen is the miraculous solution why am I feeling this way?

@Letsbepractical it wears off. Mine took about 3 months. Those are PMT symptoms for me so I was well used to them.

Honestly it's worth persevering with. I was quite pleased as it showed just how low my oestrogen was if that's the way I reacted.

I had total hysterectomy age 38 and had Estrogen only.. it was absolutely amazing and so wish l could have stayed on it forever . My hair / skin/ nails improved.. my libido was through the roof... my mood was permanently happy.
Good luck with everything. 🌺

I felt like this initially. Your body is adapting to the hormone. I retained water and was incredibly bloated.
It wears off though (around a month, I think)
I now LOVE oestrogel. Feeling great.

Thank you ladies for the advice and encouragement to persevere. 🤞🏻 all these symptoms will wear off soon.

@Moier That's great - I hope this happens to me!

The advice is to allow 12 weeks and it may settle down.

If 1 pump is giving you these side effects, drop down to half a pump.
This is what I was told years ago by my menopause consultant. I was advised to start with a pea-size amount and work upwards.

@JinglingSpringbells thank you - I may have to do that as right now I feel like I’m poisoning my body.

It's worth trying.

It won't be poisoning you as it is exactly the same (molecular structure ) as our own estrogen. It's nothing like the Pill which is a synthetic type of estrogen.

@Moier

When did you come off the eostrogen only? And why weren't you able to keep on taking it? Did you have symptoms when you ceased it, like withdrawal / meno symptoms? Sorry for all questions, I'm just curious.

@JinglingSpringbells

Thanks for this info.

My GP explained to me yesterday that I'll be feeling terrible for a while due to the effects of anaesthesia and other issues relating to surgery as well as the sudden removal of ovaries.

My surgery was really brutal and complex for various reasons. So it's probably for the best that I accept I'm not well for a few months yet and that could be for many reasons including simply recovering from serious bodily injury. Plus I have pre-existing M/H issues.

Staying level on the oestrogen HRT is probably the sanest and most rational thing I can do for now, even if in the long term I decide against it or want to make changes.