I am a BRCA carrier and I recently entered surgical menopause at 35 1/2 after having a total hysterectomy and oophorectomy, as well as a double mastectomy. I was really scared of menopause. I am on estrogen-only HRT in the form of a 0.1-milligram semi-weekly estradiol patch. How do I know if it’s working correctly? How long will it take me to know if I’m on the right dose? I haven’t had any hot flashes or night sweats, and the only sign of hormone changes prior to today has been some acne. However, today is the day when I would have gotten my period, and I feel like I have an almost-headache. My gynecological oncologist said it could “take a few months” to know if we have the right dose and that “it’s more art than science” to know what’s right, but I feel both a little lost and thankful that I’m feeling better so far than I feared.
—Surgical menopause help!
I am so glad you are feeling better than expected. Many women undergoing oophorectomy are fearful of the symptoms they may experience. The drop in estrogen levels that occurs when the ovaries are removed may be dramatic and can trigger significant symptoms for many women. It sounds like your forward-thinking gynecologist oncologist started your estradiol right away.
When we treat a woman under age 40 in menopause — whether it is surgical or due to primary ovarian insufficiency — with estrogen, we have several goals. We are hoping to stave off bone loss and prevent women from developing cardiovascular disease early. But we are also trying to effectively manage the symptoms of menopause.
It is ultimately your symptoms — or lack thereof — that drive the decision-making about how to dose your estradiol. If you are not having symptoms of hot flushes, night sweats, or sleep disruption, that suggests you have enough estrogen.
However, too much estradiol can cause side effects, the most common of which are breast tenderness (though not in your case, since you no longer have breast tissue), nausea, acid reflux, and headache. If you are experiencing any of those symptoms, your doctor may recommend decreasing your dose of estradiol.
The goal is to balance the benefits of estradiol for your menopause symptoms with possible side effects like headache. This balance will be different for every woman, and therein lies the art. The good news is that once you settle on a dose of estradiol that strikes that balance for you, it is likely to continue to do so for a long time.
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