Question 6
Dear Doctor N.
I am 52 years old woman and was given a blood test a week ago to determine my hormone level. My doctor informed me that the normal FSH level was 33 and mine was 77.4. He suggested that I take estrogen tablets.
I had a partial hysterectomy when I was 32 and about a year later was put on estrogen tablets for about five years. It seemed to help my mood swings. For the last five or six years, my doctor (a new one) has been treating my symptoms of depression, mood swings, insomnia, anxiety, etc. with anti-depressants and anti-anxiety medication. Also sleeping pills. For the past two years I have been complaining of headaches. In the last two months the headaches have become much worse and I was prescribed Imitrex. The Imitrex only slightly alleviated the headache and then it came right back.
I went to a Nukka Chiropractic who took x-rays and found that my neck was quite a bit out of alignment. I have been having adjustments for that. I am so sick of trying different meds for my symptoms. I finally asked my doctor if I could possibly be in menopause again. At first he said it was impossible, but then did a blood test which turned up the results I gave above. I am not entirely comfortable with his explanation to me, because of the fact menopause was not even suggested by him prior to the blood test.
Also, my mother died from breast cancer and her sister has had both breasts removed because of cancer. I am nervous about taking a chance with Estrogen but am DESPERATE for an end to these symptoms. I am totally at the end of my rope! Can you give me any suggestions? My doctor of Chiropractic recommended that I take Evening Primrose capsules. Is that a good alternative?
Please help me if you can.
Reply:
Sorry that you're having problems. The first thing is that no one "goes through menopause." What most people mean by that is that they are no longer having symptoms that they associate with menopause. Strictly speaking menopause refers to that point in time that the the normal or physiologic menstrual bleeding stops. This happens in most cases because of age related ovarian failure causing a fall in the hormone levels that stimulate the lining of the uterus to bleed.. If the uterus has been removed and the ovaries left the ovarian failure may occur at the time an expected menopause would have occurred, or earlier if the ovaries were compromised by the surgery.
The time after this is referred to as postmenopausal. But, most of the time we use the term menopausal to refer to women who no longer have periods.
However, as far as the effects of menopause are concerned, it's the fall in hormone levels that are important. In addition to symptoms such as flushes, sweats, insomnia and headaches, diminished hormone levels are capable of affecting health, quality of life and longevity. There is an associated increase in coronary artery disease, osteoporosis and strokes. Even a natural menopause, a normal and expected event, is not benign.
So what we're leading up to here is that no one "goes through menopause." Once hormone levels fall, if they are not replaced, they remain low forever. The elevated FSH associated with being "postmenopausal" will remain elevated in most instances as long as you live. Even if the symptoms stop, the negative affects of hormone deficiency continue although there may not be an awareness of them. For instance, the first sign of coronary artery disease may be a fatal heart attack and the first sign of menopausal bone loss is usually a fracture.
If you have symptoms and problems related to hormone deficiency, the most appropriate and effective treatment is to replace the hormones that are missing. Nothing ... nothing, is as effective. However, for optimum benefit, an HRT program often needs to be individualized, and this is particularly true following a hysterectomy.
You have a concern about your family history of breast cancer. That must be frightening for you. The problem is, that your chances of getting breast cancer may be increased, and this possibility exists, whether you take HRT or not. Ultimately, you have to weigh the statistical benefits of HRT in terms of preserving your health and quality of life, against the likelihood of any increase in developing breast cancer. My own opinion is that there is no convincing evidence of any increased incidence in the rate of breast cancer among those women using HRT.
I have not found Oil of Primrose to be beneficial in alleviating symptoms in my patients.
Dr N