to continue hrt or not

Submitted by lilyrose on August 4, 2012 - 10:50am
Body: 

After some infections throughout the last months, my Uro-gyn changed my vaginal cream from Premarin to Estrace, then to a compounded estrogen cream. About a month after I began using the compounded formula, I began vaginal bleeding. An ultra-sound, biopsy, and D and C all showed no signs of cancer or even pre-cancer. As the bleeding (almost on a monthly cycle) continued after the D and C, I asked Uro-gyn if the bleeding could be a side effect of the Estrace and/or compounded estrogen. She said No. It was caused by hormonal imbalance. I began HRT about 10 years ago because as I began menopause I was having horrid headaches. Been using Premarin cream for about 10 years, also, for vaginal dryness. Uro-gyn says I should come off HRT and only continue to use the vaginal cream. She scheduled me for an appointment to begin this withdrawal in Sept, after the hot weather as I would probably have hot flashes.

OK - I've done extensive reading.
First, Estrace and compounded estrogen creams do have vaginal bleeding as a side effect. One study shows they can cause significant bleeding much like a monthly period. That's what I was doing. Though safer, maybe, than Premarin, they have more concentrated estrogen which can trick the body into thinking it needs to build blood in the uterus - even if you are post-menopausal. So - I switched back to the Premarin (on my own as I had still have some) about 6 weeks ago - no bleeding since. I, understand, that with prolapse women - especially post menopausal - need the estrogen cream of some sort for dryness, if using a pessary, and to encourage the vaginal wall to stay stronger.
Second - The issue of going off HRT. I'm just not convinced that's the right thing to do. A book I found, Estrogen Revisited by Walters and Crandall, plus other sources on-line, show new studies that women can continue HRT after menopause. Yes, there may be more instances of some cancers by using it, but it seems to prevent others. It doesn't seem right to me that a woman would begin HRT to stop menopausal symptoms, only to have postponed the symptoms for a few years later. If you go off HRT, then most will have the hot flashes, headaches, moodiness, brain fog, fatigue, etc. Add to that without HRT, the vagina becomes dryer and more susceptible to infection. Doesn't it seem that that would be worse for prolapse?

I'm just not ready for weight gain, hair loss, hot flashes, worse prolapse symptoms. Even things like osteosporosis and Alzheimer's can be prevented, to some degree, by HRT.

I have come to think that the bleeding was caused as a side effect of the compounded estrogen and that continuing HRT is more helpful than harmful for prolapse, general health, and mental well-being. I can't get my primary care Dr. to give an opinion, other than his mother continues HRT at 72. She tried to come off and was so miserable she went back on. I'd really like some feedback/opinions from others who may have had to make this decision.

Forum:

alemama

August 4, 2012 - 4:12pm

but have you thought about
1. slowly weaning off
2. lower dose
?

MsNightingale

August 4, 2012 - 6:29pm

Hello Dear Lilyrose, I cannot help you in your decision....but I can share with you the fact that I am 61, went through menopause at 50, and never dreamed of taking HRT. I have great respect for what nature is and do not have great respect for things that doctors have come up with (although do hope that our medicine world will someday allow for great respect). I believe in the process. I can tell you that I have never had a dryness issue, I have a very healthy sex life with my husband, and my skin will do whatever it will do. My hair is gray but long enough for a pony tail so I am fine with it. When traveling in my twenties to the Mayan area of Mexico, I saw such beauty in the Indians there and the impression of the women and their grace and beauty in their old age with lines of wisdom and long thin braids of gray. That taught me with one glance that I wanted to honor all of that. Do not worry about the hair and the skin as long as you are healthy. All of these things that you are worrying about (osteo, alzheimers, and aging issues) are much more prevented by a regular daily walk in WW posture, a positive mission in life and healthy food. You will not find what you are looking for in a bottle warding off the symptoms of menopause. If you can learn to work with your body and the whole process, you will become a wise woman and a healthy one. My very best wishes to you.

takecare

August 4, 2012 - 10:55pm

I personally use Vagifem - it is a twice weekly little pill inserted in the vagina.
I have found it to be very good with the dryness/burning and along with the WW posture alleviated a lot of the terrible discomfort of my POP.
If there was any sign of bleeding I would cease and see my doctor.
I thought about it long and hard and spoke to many specialists and natural practitioners.

louiseds

August 5, 2012 - 12:58am

HI Lilyrose, I confess that I have not had the debilitating symptoms of menopause that you have had, and I have not had HRT, though it has been suggested to me by several doctors.

I, like MsNightingale, have difficulty with the idea of loading my body with more oestrogen, and probably progesterone, just to forstall the symptoms that you experienced when your body "began menopause" and began the inevitable menopause process. The symptoms you have experienced were no doubt very debilitating, and I am not blaming you for taking HRT, which obviously solved these horrible headaches.

You say that you have done extensive reading. I do hope you understand who has written these resources, and that you are clear whether or not they are the results of research that is truly independent. Also, are you clear that there are other resources which will tell you exactly the opposite in an equally convincing way? If I was in the field of manufacturing and marketing HRT I would ensure that I was sponsoring research programs and authors and who could write convincingly in support of HRT, with appropriately chosen research results, for which the trials were sponsored by guess who. Call me conspiratorial if you like, but there are big bucks at stake in the menopause/HRT industry, and a major industry it is.

You certainly make a strong case for your staying on HRT, but the fact that you have posted indicates that you are not entirely happy about continuing it. There are words in your post that indicate that you are fearing the withdrawal process, but hoping to find other ways of dealing with your dry vagina. You are obviously also worried about the possible return of the headaches and what these will potentially do to your ability to think rationally about work out what to do next. That is all very understandable.

You seem to find yourself in a position akin to a drug addict who would prefer not to be addicted, but who fears the withdrawal process, and fears the future both with, and without, their crutch-drug. It is a little like 'being between the devil and the deep blue sea'. This is of course why many addicts stay addicts. I can understand the dilemma you face, as a woman who is currently dependent on HRT to feel OK.

I suggest that your speak to a good women's health naturopath about the possibility of helping you to establish new non-pharmaceutical ways of alleviating symptoms that you might or might not suffer during and after withdrawal. That might give you a bit more faith to give withdrawal a try, using both your doctor and the naturopath.

I guess it depends on whether or not you want to stay in an artificial hormone support state, where your body is being fed extra hormones to maintain a state it would not normally be in, or whether you would prefer to trust your body to gradually sort itself out, and ultimately balance its own hormones more gently than just adding hormones that are not native to the female body.

As far as the vaginal oestrogen is concerned I would be sorting out the HRT first, and dealing with the local vaginal symptoms when you have the oral HRT out of your system, if that is OK with the doctor.

Every woman needs to make this decision for herself, with all the information in front of her. I just get the feeling that you do not entirely trust the medical model, when you have done a trial yourself of removing the compounded oestrogen, having the bleeding stop, and then being told by the doctor that your withdrawal trial was invalid. I don't know enough about hormones to say whether or not your trial was valid proof of the cause of bleeding being the compounded oestrogen or not.

At the end of the process, if you find that you cannot establish a 'gentler' way of overcoming menopausal symptoms and enabling your vagina to agree with your pessary, then you can always go back onto the HRT, can't you? That is perhaps a question you could ask the doctor? It is always a good idea to have a safety net when going into the unknown, which might of course, turn out to be a lot better than anyone in medical world expected.

If you don't try an alternative, you will never know whether or not it could be better for you. I am sure there is an optimum path. You just need professionals who you are paying, to work with you, in your best interests, to find it.

Good luck. Keep us posted so that we can all learn from your experience, and we can hold your hand through it.

Best wishes

Louise

fab

August 5, 2012 - 2:07am

Dear Lilyrose

In making your decisions and considering the list of symptoms you mention you are not ready for if you gave up HRT: weight gain, hair loss, hot flashes, worse prolapse symptoms, possibly osteoporosis and Alzheimer’s, I would be looking at anecdotal evidence as well.

For instance, when I look at the richest, most powerful women in the world; the first ladies of the Presidents Bush, Hilary Clinton, Mrs Regan, the Queen Elizabeth of England, the deceased Queen Mother, Camellia and Mrs Thatcher, just for starters, I think I can make a shrewd guess as to who has taken HRT, who is taking HRT and who is not.

If they, generally and specifically speaking, are taking HRT then it has not prevented them from experiencing many of the symptoms on your list.

It would seem to follow then that the research findings you have unearthed have not strictly been born out.

If, on the other hand this group of women in general are not taking HRT why aren’t they?

At this point I think you would need to ask yourself why wouldn’t the richest, most powerful women on our planet not be taking HRT?

I personally do not know if they are or not. What about your doctor's 72 year old mum, is she someone you would be able to admire?

Cheers Fab

fab

August 5, 2012 - 2:18am

Dear Nightingale

What beautiful images you paint and beautiful memories you have invoked for me.

My mother did not take HRT and had fine hair to begin with. She permed and waved and cut short her hair with visits to the hairdresser every week without fail. She rinsed pink, always a bit of a rebel, not wanting to belong to the ‘blue rinse set’. The actress who plays the part of Stephanie in the Bold and the Beautiful reminds me of her (only in the hair department).

My grandmother had saved cuttings of her hair from her younger days and used them to bulk out her hair on special occasions and business days when she wanted to look her best. All very yuck I thought as a child, but I see it differently now.

My paternal grandmother wore something similar to the braids you describe.

Cheers Fab

takecare

August 5, 2012 - 3:30am

One should never assume to know what other women are experiencing in their health, emotional, business or personal lives - or which therapy or medicine they may be using based on a 'shrewd guess'.
And just to hedge bets to say just because they are rich why aren't they on HRT?
We are so much more than our hormones and our reproductive organs. Everyone has their own story interwoven with genetics, lifestyle, stress levels, family commitments, finances, illnesses and outlook.
If there was an easy fix it would be black and white.
Asking questions is the first step in making changes ... finding informed and accurate answers is half the problem.

fab

August 5, 2012 - 5:44am

Dear Takecare,

I understand that decisions are made according to the criteria that you have listed; genetics, lifestyle etc and are thoughtful, well founded, meticulous and personal.

It was in the interests of gathering information (anecdotal evidence) that I made the suggestion I did to Lilyrose. Surely, you cannot deny that some of the women I have listed are fat, have thinned hair, showed signs of osteoporosis and have been reported to suffer from Alzheimers’.

Lilyrose, if I read her post correctly, is seeking to avoid these very symptoms/illnesses amongst others.

If, as Lillyrose writes, claims have been made that HRT protects you from these very symptoms then either these women I have listed

(1) They do not take HRT , otherwise they would not have the symptoms or,

(2) They have taken HRT and it has failed to protect them from these specific issues regardless of any other benefits the treatment may be providing them.

I was only talking about the ones Lillyrose listed.

It is an easy reach for me to then wonder why (and perhaps I should not do it out loud) if HRT had been proven to be a safe preventative against these symptoms why would any woman likely to develop these particular characteristics, and most especially the richest and most powerful women in the world with all the best of advice and medical treatment readily available to them, not avail themselves of this protection?

They would have to have good other reasons surely. What they might be I cannot guess at.

To my mind the question still remains, are the claims for HRT in regards to these symptoms true?

It is a question that requires a personal, private answer and hopefully further enlightenment from our forum.

Have you met anyone of post menopausal age who takes HRT and does not have any of these symptoms would be an equally valid place to start.

Cheers Fab

Surviving60

August 5, 2012 - 6:30am

My mother, now 90, had a hyst well before menopause and was put on Premarin in her 60's because they thought it would help protect her from bone loss and other things. Even after the big study came out, no one reviewed her meds so she ended up on HRT for YEARS before it was finally stopped (and incidentally, after all those years on HRT she ended up with a broken hip and extremely thin hair.....). I have never considered HRT. During the worst part of menopause symptoms I was doing fine with some OTC phytoestrogen stuff (all this was before prolapse and WW). I know my menopause wasn't the worst, I've read many posts on here from women with horrible symptoms. But I do know they are unhealthy for women and unhealthy for the environment, and there has to be a better way.

lilyrose

August 5, 2012 - 11:12am

You all have some very interesting comments. Exactly what I wanted. I've noticed women, of all ages, in our location seem really reluctant to talk about prolapse. Some will say they've had something similar, but nothing more concrete.
I agree that natural seems the most acceptable way to go. Maybe I've had so many ups and downs the last year, I just need some time of feeling good. Discovered cysocele last Aug in the midst of a yeast infection that wouldn't leave, which turned into bacterial infection, which became another yeast - on and off for about 6-7 months. The medicines prescribed were pretty harsh. Lost 20 lbs, which I needed to anyway, just a bad way to do it. Was extremely tired and run-down. Then from the change to Estrace and compounded cream came the bleeding for another 5 months and the scare of of all the testing. Only the last month has been better.
I did start out (when I was 45 or so) thinking I'd go the natural route. Was using a mix of herbal things which were helping. I never had the hot flashes etc., only hormonal headaches. When I was about 52, that got much worse. We were going through a really stressful life change, so that may have added to the pain. When the Dr suggested HRT, it seemed like a quick fix. As I said in the other post, it never occured to me that by doing this I wouldn't prevent those symptoms. I would only postpone them.
One gynocologist said I could come off HRT slowly, that the body seems to adjust itself to the amount of estrogen it needs and does produce some post-menopause. I guess I just want to be sure that doing so won't make the prolapse worse and that I won't become a really cranky old lady (like my own mother - a story in itself - She never used HRT and seemed to be in a constant state of moodiness from about age 35 to the very day she died at 86.) So - I definitely agree lifestyle, genetics, stress, and illness effect make a huge difference in how well we go through menopause. AND - I, also, agree that if staying on HRT was proven to be beneficial then all doctors would recomend women stay on it for life.
What would be great would be that famous women would just talk about prolapse and menopause. They talk about breast cancer and the importance of pap smears and colonoscopy's; why not prolapse and menopause?

Surviving60

August 5, 2012 - 11:17am

Lilyrose, did your mom have her uterus until the end? The mood changes that some women experience after hyst. are pretty well documented.

Oh my goodness, how many times have I thought the same thing myself......when will at least one high-profile famous well-known lady "come out" with prolapse? Hope it happens in my lifetime, I just want to see it. - Surviving

lilyrose

August 5, 2012 - 3:54pm

My mother had a hysterectomy and had her bladder tied up when she was about 65. Don't remember which came first, but they weren't done at the same time. My Dad once said she'd been in menopause for 45 years. He stuck by her, though - amazing man. Now a Dr. would probably diagnose that as hormonal or depression. When she was about 80, a doctor tried to give her antidepressants, but she would have none of it.
My grandmother had a "hernia" operation when she was in her late 50's. Have often wondered if she really had prolapse. She was really a great lady. Died at 92. So, I can see that I must have genetically inherited the prolapse part.
Yes, if more attention given to this we'd probably see more results.

jaylove

August 5, 2012 - 4:38pm

Hi Lilyrose, I was just reading your posts regarding menopause and menopause symptoms. I just wanted to say that I think that the way we eat and exercise has a huge, huge impact on menopausal symptoms, our moods and our prolapse. Eating healthy and safe WW exercise will do wonders for your prolapse and your menopause symptoms including the WW Posture. Doesn't hurt to give it a try while slowly wean off of HRT. If that becomes your final decision. Best of luck to you as you continue on this most amazing journey. This WW Work does help with prolapse even sometimes reversing it or at least always improving it. Their are natural remedies to try if you do experience vaginal dryness that work also. Please let us know what you decide and how you are doing or if you have questions.

Hugs to you, Jaylove

louiseds

August 5, 2012 - 11:14pm

Hi Lilyrose

I have just been digging in my big fat book called Women Hormones and the Menstrual Cycle. Feverfew is a herb that has activity against migraines, and is used for various menstrual and reproductive purposes.

This is where the naturopath or herbalist comes in. I would not dream of giving your instructions on how to use it, but there are people who can. This would be done on a one to one basis and might also involve other herbs or substances. So, all may not be lost if indeed the migraines return.

The other things mentioned in this book for migraines are stress, food intolerances or allergies, structural problems and muscle tension in the neck and upper torso, sinusitis, motion sickness, some weather patterns and changes in sleep cycles. You may have some pre-disposing factors as well, particularly in the food area.

aussielou

August 6, 2012 - 1:07am

Hi Louise and lilyrose,
I find the following website quite helpful when researching all things herbal www.susanweed.com This is my personal view, not promoting anything.
I have made up my own tincture using info from this and other websites. Always research with care, and a touch of common sense.
Lindy

lilyrose

August 9, 2012 - 6:55am

You have all given me things to think about. My appointment is Sept 12, so I have some time to look into natural herbs and take a look at the web site and books you've suggested. Am leaving on Fri for two weeks in the mountains. We always go to the same place in August. While husband spends his days fishing, I find time smell the pines, read, do a little knitting, and refresh my mind. This time, more than most years, I need to do some reassessment of my quality of life and state of mind.
Last year I went feeling really down; couldn't put a finger on why. Two days after we got home, I felt the beginnings of a yeast infection. By the end of that week I felt, what's probably familar to most of you, that full swollen burning feeling. When I got myself to the Dr., he felt a cystocele as well as finding the yeast. I'd just been to his office the month before for my yearly check-up and pap smear. Everthing was normal. Now my world turned upside down. I'd never heard the word "cystocele". He explained and I had a sinking feeling I was in for a lot of things I knew nothing about. I came home and immediately began scouring the Internet and library for whatever I could find. The more I read, the more irritated (and somewhat angry) I became that this wasn't something that had ever been discussed at home or school or with friends - No where. My mother had her bladder "tied up". My grandmother had a "hernia" repaired. That was the most I knew, but suddenly things began to click. Hope I'm doing better for my daughter. Anyway - it was the beginning of a really intense year filled with a lot of pain and many doctor visits. I've met some amazingly knowledgeable people (mostly you ladies) and some really dumb ones (one narrow-minded old gyn and comes to mind - obviously I didn't go back there). Thankfully, I have an understanding husband. Though, he did think I was becoming obssed with reading about it for a while. Finally, over the last month or two, I've been able to cope and feel better about what my body is doing. I'm using a pessary which really helps and trying to stay in posture. My stage 2 cystocele and stage 1 rectocele aren't really very bad and I'm hoping to keep them that way. So, this year I'll be sitting by the river on that mountain doing a lot of thinking. I dealt with the prolapse; now I'll figure out how to deal with post-menopause.
Will check back in with you all when I return. Lilyrose

MsNightingale

August 8, 2012 - 7:49am

Have a wonderful trip! It sounds like heaven. I love that you give yourself time to ponder the possibilities. I so agree with you that why haven't we heard about all of this before. Yes, our daughters will be much more informed and we will give that to this next generation of women. I just wanted to mention that if you go into posts on this site, you will find a post that Christine's husband, Lanny, wrote. It is for the husbands and it is beautifully written and very informative. THat is, if you think it would be good for your husband to read. My husband too thought I was way too obsessed with the forum and reading info but now he realizes that I have been so well guided and the desire to get good information is what will help us to move forward. Best wishes to you for a beautiful holiday!

louiseds

August 9, 2012 - 2:53am

Sometimes we need time out, to assimilate new knowledge. I am sure there will be a different woman coming down the mountain than went up the mountain. Enjoy!

wholewomanUK

August 10, 2012 - 6:46am

Hi lilyrose,
Hope you have a wonderful relaxing and restorative holiday - sounds simply wonderful.
If you're doing some reading re the above, you may find some of the WW village post relevant to the above, e.g. Feb 2012.
xwholewomanuk