Question 18
Dr N,
I have just had a complete hysterectomy and ovaries removed 2 weeks ago... the night flushes are terrible...my doctor has put me on bellergal space tabs.. I cannot take estrogen because of the severe cases of ovarian cancer in my family.. it would be too risky.. can you tell me something about this product and is it safe. I have always been very sexual and hope this continues...I am 51 and very healthy... I work out at the gym every day and came thru the operation extremely I am also taking effexor because I have AADD.
I had a hysterectomy because I had tumors , not cancerous but I have a long history of cancer in my family in the females and all in the uterus and ovaries. My doctor at first wanted me to use estrogen and then decided against because of the history and my fear of cancer. They were cystic and glandular hyperplasia.. I am now trying bellergal space tabs for the night sweats..so far not working.. I also take effexor because I have AADD. I just want to know more about estrogen replacement and is it a safe product to use...
thanks
Reply:
Hi,
Ok. Here is what you have to consider in the decision making process.
First, your ovaries are gone so you can't get ovarian cancer in them, so I am not sure what the rationale is for withholding HRT. There is a type of cancer, which can occur on the lining of the abdomen, which looks the same when examined under the microscope, but it is not clear how often this occurs.
Familial ovarian cancer is due to a genetic mutation. The risk is very high in those family members who have inherited the genetic defect. In known or suspected familial ovarian cancer, the relatives can be tested for the genetic susceptibility genes BRCA1 and BRCA2. Family members in whom the test is negative are not thought to be at increased risk of ovarian cancer. If you discuss this with your Dr the tests can be arranged and you will know if you are at increased risk.
Regardless, results of one recent study indicated there is a slightly increased rate of ovarian cancer in estrogen users. The greatest risk was noted in those who used estrogen 10 years or longer. The increase in risk may be in the range of a relative risk ratio of 1.27. The statistics suggest that ovarian cancer will affect approximately 1% of women during their lifetime. This translates to 10 women in a thousand. The increased relative risk of 1.27 in real numbers translates to 12.7 women in a thousand. In other words, the excess risk would be less than 3 additional women developing ovarian cancer in a thousand women, still less than a 2% lifetime incidence. Actually, unless you have the genetic mutation that increases the risk of developing ovarian cancer in your lifetime chances are less that 2 in a 100 if you were talking estrogen. However, if you are the one who develops this cancer, it is a significant problem. Ovarian cancer is usually not discovered until a fairly late stage, which decreases the rate of survival.
Contrast this with the statistics of those women who use estrogen following a natural menopause, a hysterectomy and a hysterectomy with ovarian removal.
A hallmark study assessing the use of estrogen replacement and death from all causes was published in The Journal of the American Medical Association, in February of 1983. The study examined the association of estrogen replacement and hysterectomy status with death from all causes in 2,269 women age 40-69 years for an average period of 5.6 years.
The results of the study indicated that among those who had not had a hysterectomy, the nonusers of estrogen were about twice as likely to have died as the estrogen users. Among those women who had a hysterectomy without ovarian removal, the nonusers of estrogen were about 3 times more likely to have died as the estrogen users. Among those women who had a hysterectomy with removal of both ovaries, the nonusers of estrogen were about 8 times more likely to have died as the estrogen users.
The point is that withholding HRT following a hysterectomy and removal of both ovaries presents documented risks to survival. Much of the willingness physicians to make the recommendation that HRT be withheld in many cases stems from a lack of awareness on their part of the significant consequences of hormone deficiency. In addition, even some physicians who are aware of the protective benefits of HRT refuse to prescribe HRT, due to a perception that it is safer from a malpractice standpoint, not to do so. So, when a doctor tells you that he feels prescribing HRT may be "too risky" it is important to make a careful assessment as to whether they feel it's "too risky" for you or for them. This may have something to do with your Dr 1st suggesting HRT and then changing his mind when you expressed your fears about HRT. He may have felt that the prospect of you suing him for malpractice if you ever developed a problem was too threatening to him, even if he felt the HRT was in your best interests.
There is no medication over the counter that will provide any significant protection from the health consequences of hormone deficiency or provide significant relief from symptoms. I have not found Bellergal to be effective. I would suggest that if you have not already done so that you look at the Hysterectomy and Menopause pages of the web site as they may provide additional insight.
I would consider seeing another Dr for a second opinion and an oncologist.
Please let me know what and how you do.
Dr N