It’s been one year and one month since my total hysterectomy (complete uterus removal, ovaries and fallopian tubes left intact). Now what?
I continue to read various things about hysterectomies often. I have yet to find a woman who has talked about having a hysterectomy for dysmenorrhea (painful periods alone). I find women have hysterectomies primarily for one of four reasons (in no particular order):
- dysfunctional or post-menopausal bleeding with or without fibroids, with or without anemia;
- fibroids with or without bleeding, with or without anemia;
- uterine and/or cervical cancer (seems to be a rare diagnosis compared to the others);
- endometriosis.
Wow! I think this is an ACTUAL picture of me.
I have considered changing the name of this blog to Hysterectomy & Beyond, but decided against it because the title alone (Hysterectomy4Dysmenorrhea) may let women who have primarily dysmenorrhea that they are not alone. Hot Flash Hell has also been a name change consideration but … I’ll hold off on that one for now.
Hormones are chemical messengers that travel through the blood to tissues and organs. They affect everything from growth and development to sexual function and mood. Produced by the endocrine glands, hormones are extremely potent. It only takes a small amount to cause drastic changes in cells, which is why an excess or lack of any given hormone can result in health problems, including migraines, depression, and weight gain.
Keeping hormones in check is a delicate balancing act.
According to Jerrilyn Prior, UBC professor of endocrinology and head of the Centre for Menstrual Cycle and Ovulation Research, it’s not a reduction of estrogen that triggers hot flushes in menopausal women. In fact, she says, it’s quite the opposite.
Prior researched the way estrogen and progesterone work in the brain within the context of addiction. Hot flushes best fit with the brain being addicted to estrogen, she says. An addict used to having heroin reacts when they don’t have it. Same with cigarettes or alcohol. Having regular exposure to high levels of estrogen, or long duration of estrogen exposure—that fits with hot flushes.
Progesterone, meanwhile, is an effective treatment for hot flushes, she says. [my emphasis]
In the recent book Prior wrote with Susan Baxter, The Estrogen Errors: Why Progesterone Is Better for Women’s Health (Praeger, 2009), the authors question why estrogen has become the ‘quintessential’ female hormone, given that the physiological balance in women requires estrogen and progesterone.
Lately on a daily basis, I am experiencing hot flashes, night sweats and insomnia. I tried halving my Lo LoEstrin tablets in half in an attempt to wean myself off hormones and try a hormone-free lifestyle. I wasn’t having any problems with the Lo LoEstrin per se — I merely wanted to see what would happen if I lowered the dose, eventually going off them.
Reducing my Lo LoEstrin has NOT been a successful idea. My hot flashes came back with a vengeance, along with the aforementioned insomnia and night sweats. I seem to be continually hot more of the time than less. Lately, in my neck of the woods the temperature this summer has been between 97-103 F (36 – 39 C).
EVERYTHING that can and is rumored to trigger a hot flash does it for me!
- Hot food & beverages
- Eating in general
- Highly caffeinated beverages
- Hot weather and warm environments
- Spicy food
- Wine and other liquor
- Emotions … merely distressing or intense thoughts
I don’t think I’ve been doing my part to help alleviate these symptoms; I continue to indulge or take part in all of the above. I can’t stop eating (who can, it’s called survival) nor can I control the intense heat of Texas. If I really want the hot flashes and other symptoms to diminish, I would need to eliminate what I can from above. But I don’t. I’m wondering if I’m in denial, lazy or hopeful … perhaps some combination of the three!
Study after study has shown that many nondrug treatments — black cohosh, red clover, botanicals, and now soy and flaxseed — simply don’t work. Prescription medicines, including antidepressants, the blood pressure drug clonidine and the seizure drug gabapentin may have some benefit, but many women cannot tolerate the side effects.
Among prescription drug treatments, the most effective may be antidepressants, including Effexor, Paxil and Pristiq, which have been shown to reduce hot flashes by as much as 60 percent, doctors say. Antidepressants are particularly useful for women with breast cancer or blood-clot disorders who do not have the option of taking a hormone drug.
Tylenol or acetaminophen (AKA paracetamol for you Europeans out there) does NOT work for hot flashes. Silly I know. I tried it because I am desperate and well, hot flashes feel akin to being febrile. Save your time and body experimentation because this foolish little medication experiment didn’t work for hot flashes.
Estrogen therapy eliminates hot flashes, and it works well in even very small doses. But many women can’t, or chose not to, take estrogen.
Selective Serotonin Reuptake Inhibitors (SSRIs) were serendipitously found to significantly reduce hot flashes in menopausal women years ago, but the drugs are only intended and FDA approved to be used as anti-depressants. Drugs such as Fluoxetine (Prozac), Paroxitene (Paxil) and Venlafaxine (Effexor), have all been found to be helpful in reducing flashes. Effexor is the most studied and seems to do the best job.
I’ve come to the conclusion that I’m addicted to estrogen. Ugh. I’ve never been addicted to anything in my life and well, here I am an estrogen junkie. Apparently, the progesterone – estrogen balance is hugely important. According to authors Susan Baxter and Jerrilyn Prior, progesterone plays an essential role in hormone balancing with an over-emphasis on estrogen as the essential female hormone.
The estrogen addiction idea fits with the reality that most estrogen-treated women who take it for hot flushes will experience an increased number and intensity of hot flushes and night sweats when they stop estrogen. Prior has found that progesterone helps women to gradually decrease and stop estrogen without a rebound increase in hot flushes (http://www.cemcor.ubc.ca “Stopping Estrogen”).
I may be ordering have just now ordered the book,The Estrogen Errors: Why Progesterone Is Better for Women’s Health. I’m excited to dig into this book and explore more about hormones (I’m such a nerd sometimes!). Sadly, I think I may be changing gynecologists because the discussions we’ve had about hormones aren’t in the depth of what I’d like. I believe he managed my surgery well, but my hot flashes are not being addressed in a way I’d appreciate. I plan to arm myself with knowledge from this book that is purported to be evidence-based, along with other reading from specialists in women’s health as well.
UPDATE: I’m NOT changing docs … this book wasn’t all I had hoped for! (CLICK HERE for latest post on The Estrogen Errors.)
By the way, I’m sweating as I write this … the house is set at 81F (27 C) with the ceiling fan going to no avail! I’m so uncomfortable and believe this is the reaction of my withdrawal from estrogen in my attempts to stop hormone therapy. My nighttime regime will return to one little blue tablet of Lo LoEstrin with Ambien 2.5 mG.
Hormone balance … my new life’s mission! I’m going to go cool off now.
da Vinci Total Hysterectomy 