Dr. Sukumvanich said “no hrt.” Dr. Brufsky said “yes hrt.” So, I sought a third opinion to try to see if I could get a majority vote on one side or the other. These are my notes from meeting with Dr. Balk.
There’s no right answer – risks v. benefits; because of history of BRCA and DCIS, there is a risk of recurrence of breast cancer. Does estrogen alone increase risk of breast cancer? – probably not. Hormones could react differently for a BRCA carrier, but that hasn’t been studied. Would put me on estrogen immediately if I hadn’t had the DCIS. I’d rather have cancer than go through the PPD symptoms again. Mood – will estrogen keep my mood stable? – yes. Four-fold chance of having depressive episode after surgery after having PPD. Surgical menopause – will lose hormones immediately (within three days) – loss of testosterone can affect well being/mood/libido. Mood change can happen very quickly. Pros of hormones — mood, cardiac benefit, bone health. She leans more toward to giving me the estrogen – benefits outweigh the risks. Short course for a few years of low dose. Transdermal estrogen is better (patch, not pill) — don’t increase triglycerides, don’t raise clotting proteins, more natural, steady sustained level — medium dose patch
Possible that the Viibryd I’m already on could work for hot flashes. Effexor is an option. Lifestyle modification for cardiac health. Acupuncture – well studied for hot flashes, helps with sleep. Was the PPD more psychological than hormonal – because I was on an ineffective anti-depressant. Balk does the acupuncture – she will do it for me. Yoga, hypnosis, mindfulness stress reduction.
Minimal effects. Don’t actively get a lot of it, but don’t avoid it entirely. Tofu maybe once a week.
Fruits + Veggies, then whole grains, then proteins
If I sink into the abyss, call Dr. Barwell (psychiatrist) first. Then, call Dr. Balk and she’ll prescribe a patch over the phone.