Third Opinion on HRT

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.

HRT?

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

Other options

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.

Eating Soy

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

Next step:

If I sink into the abyss, call Dr. Barwell (psychiatrist) first.  Then, call Dr. Balk and she’ll prescribe a patch over the phone.

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