Monday, April 18, 2005


I went to the ob/gyn today because I'm having hot flashes so much. The cure for hot flashes is estrogen replacement, but long term studies have shown that estrogen replacement increases the risk of stroke in women. In any single woman, the risk is negligible (unless you smoke, which I don't) but across a study of a thousands of women, it was significant enough that they stopped the study. But I'm miserable. Twelve to fifteen times a day I suddenly start sweating and feel sick to my stomach and hot.

I fully expected to have to present a case for estrogen replacement. (I've tried soy, and I've exercised, which makes me feel better in general, but whenever I start exercising I have a hot flash.)

My ob/gyn knows I have cancer because Cleveland Clinic uses electronic and paper charts. (My chart is now a couple of inches thick, after years of being thin.) I walked out with a prescription. I explained to her that I wanted to get through all the adverse affects of chemo and then get off the estrogen, since menopause is something that happens to women. Sure, she said. I almost said that menopause is natural, but then, malaria is natural, but I don't want it. But I still plan to get off the estrogen eventually. But the thought of not having hot flashes made me feel as if I was walking on air.

When you're a cancer patient, people give you all sorts of drugs, just for the asking. It's weird. Or maybe doctors just pay more attention to patients now. Or maybe I'm just older and my expectations are more reasonable. I dunno. But it's nice not to be expected to tough things out.

I <3 Cleveland Clinic.


Blogger Maureen McHugh said...

Although, of course, I don't actually have cancer anymore. I'm just still in treatment. I keep expecting someone to say something like, 'Hey, you don't have cancer anymore. We don't have to be nice to you!' But so far, the bald thing seems to still work.

April 18, 2005 7:14 PM  
Blogger Madeleine Robins said...

At the risk of breaking your heart, I'm not sure being a cancer patient has anything to do with the ob/gyn giving you estrogen. I've had to talk very firmly to my new gyn here about why I don't want estrogen, and she still looks at me like I'm nuts. My guy in New York kept it as an option and would bring it up at each appointment, just in case I hadn't thought about it. Better living through chemistry, Maureen. Enjoy the cool.

April 18, 2005 8:21 PM  
Blogger Maureen McHugh said...

Well, it's true, she seemed very eager to prescribe estrogen.

Why is that? Granted, the Nurses' Study (another longitudinal study) seems to be showing that in women in their forties and fifties, estrogen is far less likely to cause stroke, but it is a risk.

April 18, 2005 9:37 PM  
Blogger Ellen Datlow said...

I tried the soy and other natural things first and they didn't work.

Then I took HRT for about two years but I was still getting cramps. So...I decided to stop: 1) because I felt it stupid to still have cramps with no period and 2) I didn't like what I was reading about HRT.

My hot flashes went away after those two years anyway. They will eventually subside.

Menapause IS natural and everyone goes through it. Malaria is NOT-it is a disease.

April 19, 2005 10:43 AM  
Blogger Madeleine Robins said...

I wonder if ob/gyns, who generally deal with things for which you can't just prescribe a pill (like, say, nine months of pregnancy?) may be disposed to prescribe HRT just because they can? Aside from the general tendency of doctors to like to fix things rather than counsel you to endure it.

When I was pregnant the first time I kept insisting that I wanted to do natural childbirth--or at least make a stab at it. The doctor and nurses nodded and were supportive, but looked at each other as if to say "she'll learn." And indeed, I did; after five hours of labor I was very happy to have them pipe drugs in to me (and as it turned out, it was a good thing, too). I think the attitude of the medical community is, "why suffer?"

My aunt and my mother in law were both on HRT for years; m-i-l is turning 81; aunt is 79. They both seem to have dodged the ill-effects (knock wood). Ellen's experience--a couple of years on, then off again--seems to be what the doctors are urging now: just take the stuff as long as you need it. So take it!

April 19, 2005 11:37 AM  
Anonymous Anonymous said...

Mary Turzillo here.

Believe me, I can identify with your wish to avoid a stroke! Apparently (because we aren't sure) my mother's dementia at 89 is the result of a series of mini-strokes. But she didn't ever ever EVER take HRT.

I'd have to look it up, but I think salt consumption and weight control are more pertinent to stroke prevention than HRT use. Also watching blood pressure carefully. I probably should look it up before I make a flat assertion like that. My mom watched her weight, but she ate a lot of salt.

I think her alcohol consumption (she drank at least a half bottle of wine a day, minimum) might have been a contributing factor, too.

And consider: if you're miserable from hot flashes (I had the kind that were accompanied by panic attacks), you are certainly not going to do the other things that make you healthier.

Having a physician who listens and doesn't insist -- or forbid --controversial treatment one way or the other is really priceless.

I kind of liked estrogen (thought it didn't help my hot flashes). I wasn't quite as pleased with progestins, even the bioidentical kind, which some people think are less likely to cause bad side effects. And they insisted I needed the progestins to balance the estrogens.

I wish I could send you to a site with even-handed discussion about bioidentical versus synthetic hormones. Every site I looked at just now had its own agenda pro or con. I believe there is no proof that bioidentical hormones are safer, though. But the physician I went to prescribed a lower dose in the bioidentical. It's a complicated issue.

Hot flashes suck. They are definitely not good for your health.

April 19, 2005 2:49 PM  
Anonymous Anonymous said...

I have something else to add to the considerations. Estrogen DID take care of my hot flashes. But, then I had a blood clot go to my lungs. Now whenever they advertise estrogen on TV they always sneak blood clots into their warnings -- they didn't used to do that.

Fortunately I'm one of the approx. 15% of lucky patients -- I didn't die as most people with pulmonary embolisms do.

April 21, 2005 3:09 PM  
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