QuestionDear Dr. Rappaport:
I am 57 and had a total hysterectomy nine years ago for fibroids and benign ovarian cysts. Are women who have had their ovaries removed totally without a natural supply of estrogen, or do the adrenals produce some estrogen? If so, how much estrogen is produced by the adrenals in comparison to the amount that the ovaries produced? I am asking this question because after my hypsterectomy, my gynecologist prescribed .625 mg. of Premarin. Last year when studies showed that estrogen may be more harmful than was once thought, I stopped taking it (gradually) and began taking a nutritional soy supplement. Some studies say soy may be helpful, and others say soy can be very harmful. I feel just as good on soy supplements as I did with Premarin, but I would like to stop taking the soy also, since its safety is in question. I want to know if I will be totally without estrogen or if I will still have a small natural and hopefully useful supply of my own from my adrenals. I drink three glasses of skim milk a day plus a 600 mg. calcium tablet and I do weight-bearing exercise. What would you advise? Thank you so much for your reply.
Sincerely,
Janice Lackner
AnswerYou did not mention whether they removed your ovaries at the time of the total hysterectomy. Total hysterectomy is only the uterus. A bilateral oophorectomy is the removal of the ovaries. Often we remove the ovaries of women if they are over 45 years of age at the time of hysterectomy. Even when the ovaries are removed, the body will still make some estrogen (Estrone rather than Estradiol). This is much less than was produced prior to surgical menopause. The amount of estrone is usually not enough to prevent the flushes, flashes, night sweats, vaginal dryness, memory loss, etc that menopause brings. Last year, the scare was due to PremPro, a combination of Estrogen and progesterone, that was found to increase the risk of breast cancer (from 10% to 12%) heart disease, and stroke. It was found that in 10,000 women who were taking the medication, 6 developed breast cancer, 8 developed stroke, and 8 developed heart disease. That is a very small number. It was further found that the study had flaws and most of the women may have had underlying disease at the time of the study. It has now been shown that Estrogen alone (like you are taking) will not increase the risk of breast cancer. The Premarin 0.625mg is protecting you from osteoporosis as well as preventing the symptoms I mentioned above. Soy products will help alleviate the symptoms for awhile, but usually stop working afte a few months. The dangers of soy are minimal but you have to take lots of soy product for it to be effective. YOu can merely stop the soy and the Premarin and see if you have any symptoms. Just realize that you are at risk for osteoporosis, even with the minimal amount of estrone you are producing. I would get a DEXA bone density study to assess your bones, and, if you have evidence of osteopenia or osteoporosis, start some Actinel, Fosamex, or Boniva. Discuss it with your gynecologist.
