I’m one of these women who have taken hormone replacement therapy to supplement what my ovaries decided they were no longer going to produce.  I had a hysterectomy at the age of 32, and I was adamant about my ovaries remaining intact at the time of that surgery for multiple and extensive fibroids and endometriosis so that I wouldn’t have to deal with such an issue at a fairly young age.  However, five years later, when I was 37, I started having symptoms of menopause: hot flashes, night sweats, vaginal dryness and painful sex, no libido, depression.  Since I no longer had periods per se, I charted my basal body temperature at home and did some ovulation predictor kits to prove that my ovaries weren’t doing what they were suppose to do anymore, although with the symptoms I had, it was pretty much a no-brainer.  I finally went to my OB-GYN who did my surgery in 1987 and explained to him what was going on.  He prescribed my first hormone replacement therapy, a combination therapy of conjugated estrogens and testosterone.  It did wonders for me and I’ve chosen to stay on it since that time. 

Okay, a few years ago, studies started to hit the media that demonstrated HRT wasn’t good for a woman.   The Prempro (a combination estrogen/progesterone drug) study showed that women taking that particular drug had a higher incidence of heart disease and stroke than women not taking HRT, refuting the previous claim that estrogen had protective benefits in menopausal women against heart disease.   Women stopped taking their HRT, even women who were not on Prempro.  I did not.  The scientist in me said that the study was not conducted using my  particular medication, only Prempro, and there was no evidence yet to warrant painting all HRT medication with broad brushstrokes.  (By the way, this has borne out…. so far!)

My family practice doc has been nagging me ever since about stopping my HRT.  My particular kind of HRT — estrogen and testosterone (the testosterone to help my libido and sense of wellbeing) — has been shown to increase a woman’s risk of breast cancer.  He wanted me off, off, off!

I tried going off it about a year ago.  I had tapered off to taking half a tablet of Estratest HS every other day and finally stopped it in February a year ago.  The hot flashes and night sweats resumed about six weeks later, and I stood that for about a month before deciding to go back to what I was doing — half a tablet every other day.  It controlled the symptoms, and at the time I went in for my checkup in June, I was feeling great.  Not only that, but my antidepressant therapy was stabilized at a minimal 5.0 mg dose of Lexapro, and I actually was feeling emotionally and physically better than I had in a long time.

So what does my family practice doctor do?  Take me off the Estratest HS and put me on a low dose of a different kind of estrogen (estradiol) alone.

By the end of August, I was feeling like crap.  Lower than a snake’s belly in a wagon rut.  I had no energy, no libido, I felt generally unwell.  The fatigue and malaise were overwhelming.   I was due to see my psychiatrist for my annual visit and went in to see him in early October.  “What’s up here?”  I wanted to know.  “This is the only thing that’s changed in my life.”  I handed him the before June and the after June list of prescriptions.

He looked at it for a minute and then said, “You were on HRT that had some testosterone in it in June, right?  Now you’re not.”

“Right,” I confirmed.

“Well, that’s it, then.  Testosterone can improve a woman’s energy and sense of wellbeing.  Taking it away has caused you to ‘tank.’  It’s very similar to how a woman feels when she becomes hypothyroid.  The energy is gone, the drive is gone, and it’s not coming back,”  he explained.

“But my family practice doc doesn’t want me on it anymore!” I told him.

The only thing he could think of to do was bump up my Lexapro to 10 mg with the hope of counteracting the withdrawal effects from no testosterone in my life.  Increasing an antidepressant can have its own list of side-effects, though, and a recent study has suggested that women on selective serotonin reuptake inhibitor (SSRI) antidepressants are at an increased risk of osteopenia, something I’m already demonstrating.

I had some Estratest HS in a bottle here at home that I hadn’t finished from the old prescription since I was cutting the tablets in half and taking half every other day.  I started taking it again.  I also made an appointment to seek a consultation with an OB-GYN doc I’ve seen in the past at my HMO.  I saw her on Thursday this past week.

“First of all,” she explained to me, “you are in a sub-set of women who are taking HRT because either they don’t have ovaries any longer or they’re no longer functioning.  You are at no greater risk with HRT than you would be if your ovaries had continued to produce hormone until the normal time of menopause, which is usually early 50s.  And the increased risks associated with HRT don’t start to appear until five to ten years beyond that point.  At half a tablet of Estratest HS every other day, you were truly taking a minimal amount, and I don’t think you’re increasing your risk of breast cancer and heart disease at that level.  I’m okay with you being on it at that dose right now.”

She wrote me out the prescription and said that our goal should be to get me back to where I was last June — on half a tablet of Estratest HS every other day and back down to 5.0 mg of Lexapro.  Hopefully, I can feel as good once I get stabilized again as I did then.

I’ve been feeling like crap, folks.  I don’t have much energy.  I feel no creative spark.  My brain feels listless and disinterested.  I have no interest in creating my jewelry, no motivation to write.  I have no interest in sex.  My reflexes and thoughts feel sluggish.  I’m praying that this plan to get me back to where I was eight months ago in terms of my sense of wellbeing works.  I would LOVE that!

In response to the question, “How are you?”, that’s how I’ve been! 

And also feeling a bit like a guinea pig at times!  Maybe that’s the worst feeling of all.