Estrogen HRT after Hysterotomy

[catsrule40]

Hi

I had a hysterectomy in Dec 20 because of severe endometriosis. Also had a melon sized chocolate cyst stuck to my bowel and needed bowel surgery. Before my hysterotomy, I was put on Zoladex injections and Tibolone tablets whilst i waited for surgery during lockdown.

After surgery there was a brief discussion with my gynae around the need for me to be on HRT because i'm only 43 and risk of osteoporosis etc. He prescribed Tibolone and that's what i've been taking since. However recently discovered Tibolone isn't actually HRT and not giving me the hormones that i need. It is also prone to causing depression.

I spoke with an HRT nurse today who wants me to start on Estrogen HRT right away. I feel such an idiot for leaving it so long but my symptoms haven't been that bad and I've had a lot of other things going on in my life including further surgery so its been difficult to determine whether my symptoms have been down to lack of hormones or not.

I am wondering why my gynae (who specialises in Endo) would've prescribed Tibolone rather than proper HRT. I'm very worried about going onto an estrogen hormone because my endo was so bad (described by the surgeons as 'quite spectacular' and have been told it can still grow again, even though i've had a full hysterectomy so i feel like the last thing i should be doing is taking estrogen that could feed endo.

Anyone else been in a similar situation? It seems you really have to do your own research!

xx

[Lindle]

Tibolone is proper HRT as it activates the oestrogen receptors whilst also having progestogenic effects. It is one of the first line HRT treatment options along with combined oestrogen/progesterone HRT for endo patients. Oestradiol (oestrogen only) should not be given to women with a history of endo as it has been associated with endo recurrence and malignancy.

I assume your surgery was done in a specialist endo centre working to BSGE standards? They have prescribed tibolone correctly and it is worrying if nurses are giving this advise against specialist centres and the ESHRE guideline recommendations for endo.

[catsrule40 in reply to Lindle]

ah thank you so much for your reply. Its put my mind at ease. I kept asking the nurse 'so why would the consultant put me on Tibolone' and she couldn't really answer. I had my surgery done at a general hospital but with a gynae consultant with a very good reputation and specialises in endo. I had a lot going on at the time with surgery complications so trusted what he had prescribed. thank you

[Marcia71]

It’s possible that the tibolone isn’t enough for you. I found it did nothing for me after my hyster. So I switched to a combined hrt. It took a long time to find one that suited me - evorel Conti, femostan Conti and oestrogel alongside utrogestan are all ones I’ve tried. I’d suggest getting referred to a menopause clinic as they will know best about options and know that is endo ladies need combined - oestrogen and progesterone. Many hospitals have menopause clinics they are widely known about.

[catsrule40 in reply to Marcia71]

thank you Good advice, i'll do that today.