Oregon writer, Rain Trueax, and Oregon painter, Diane Widler Wenzel co-author Rainy Day Thought. Diane generally posts on Wednesdays and Rain on Saturdays. There may be extra days or changes as situations warrant. Comments are always welcome and appreciated as it turns an article into a discussion.

Wednesday, May 10, 2006

The choices we make

Because this blog, among other things, is intended to discuss aging, I decided to write about something I hadn't been sure I ever would, but it is something all of us face-- male and female-- in one form or another as part of getting old-- hormonal changes. Since we are all different, my experience is not any guidepost but simply what it was for me as an aging woman.

When I was 54, I finally got a diagnosis for something that had been troubling me for several years. The pain reached a point where I went in for a series of tests which determined I needed a complete hysterectomy. It was a shock as that was not jotted down in my life plan; but the doctors (two opinions) thought it was possible it was cancer and there was no putting it off. It was not cancer, and I made a great recovery from the surgery; however, it led to something else I had also not been thinking I'd do-- hormone replacement therapy.

I could have gone into surgical menopause but opted instead to take the prescription the doctor recommended, and we worked out the dosage by how I felt. Which was incidentally better than I had for years before that time. (Perimenopause-- the time before menopause-- is an interesting time. Mostly women don't know a lot about what to expect other than books and word of mouth experiences of others. Some doctors are a help but others appear to know less than we do.)

Since then, I have read whatever comes along regarding taking hormones. To begin with, it was mostly positive; but starting a few years ago, came one article after another on negative test results for HRT. I read what I could find which didn't define much, asked my doctor about it, evaluated it all carefully. Mostly it has been--
If I do this, I increase my risk. Oh wait, if I do that, I decrease risks. Your risks are increased by this percentage over what they were before-- whatever that was. The reading alone can cause a person to age 10 years, but I did it because I wanted to be responsible in my choices.

One thing I evaluated was the age people live to be today and how many of those years did I want to live without estrogen and progesterone? Then I considered quality of life vs quantity. I didn't want to do herbal remedies as most of those are not as well tested; and to me if you take anything to a medicinal level-- in other words enough of it to impact your body-- you are taking a medicine-- whatever it's called.

A year ago I finally did enough research on bioidentical hormones and worked out from online sources what my dosage should be to match the artificial ones. I found out there was a compounding pharamacy close to where I live, which is what you really want if you are taking bioidentical as ideally you take the estrogen twice a day. The bioidentical doesn't last as long as the chemical.

When I went in for my physical last year, I requested the new prescription and changed over to them this winter. Before I began, I had a saliva test at the pharmacy to determine my current hormone levels and it was decided the dosage I had calculated was correct for now anyway. I paid for that test myself and never had any doctor offer to do one in the clinic where I go. Probably other doctors would have done it differently, but it was worth it to me to pay for that test which will be repeated about 6 months after the first to see how the bioidentical compares. I also am now paying for my own hormones and not getting them through an insurance plan anymore as it seems insurance plans are less happy with compounding pharmacies. By the time the co-pay was figured in, my cost is not much increased.

I do plan to someday go off these but not right now. I don't kid myself that bioidentical hormones could not have the same risk as the others. I am taking a medicine that impacts my body; but I also am not ready to give up estrogen just yet. I am not taking mine to prevent hot flashes, as I really never had many of those so don't know that would have been; but it has been for an overall sense of well being. They do not prevent aging, but maybe for me they are part of aging gracefully or is that gradually?

Anyway I would be happy to answer questions if anyone is still facing this choice for themselves. I certainly am no expert and can only discuss my own experiences. No women in my family before me took hormone replacements. It's not the natural way, but first my body and then I opted to interfere with natural. Whether that was wise or not is yet to be determined.

The picture above is from last week-end up the Molalla River in Oregon. It's my most recent which was one reason to use it, but it is also of a river which is fast moving, many rocks in it, some rapids, pools, who knows what lies around the bend-- kind of like life.


Parapluie said...

Great picture and metaphore. Some how you still are the same spirit even after cascading over the rocks - beautiful.
I'll keep in mind yor experience. I have quit homrmones now for several years and am surprised to still have hot flashes even at our age. Going off causes insomnia and constipation but I manage that if I don't have to drive after sleepless nights. Sometimes this life style is not what I wish and I think maybe your approach would be an improvement for "the all over sense of well being." To me I understand these words to mean mood plus being able to move about painlessly. This fall after all planned family activities I might experiment. I wonder if hormones keep the body more flexible. Or maybe I just need to exercise more.

robin andrea said...

Rain-- Interesting and thought-provoking. I once worked for a clinic in california called Hormone Balancing. We worked with perimenopausal and menopausal women. The estrogen and progesterone prescribed were always "natural" in that they were identical to what the body produces, and not synthetic. I did consider doing HRT, but opted against it when I realized that at some point I would have to stop and go through the hot flash, night sweat, insomnia or stay on HRT. I have thought long about what it means for my body to go for so long without estrogen. My bones are starting to show the effects already. We do live much longer than humans ever have, but these extra years really are a challenge.

I appreciate your sharing your personal story with us.

Mary Lou said...

Been there!! LOLOl actually, I went in for a hysterectomy when I was 36, because I was through having children, and I had ovarian cysts that grew as big as oranges. THey hurt, my periods were NEVER on time, and I had a severe case of hirsutism. I was growing a fur coat all over my body!!! BAD JUJU!! anyway, they removed one ovaray, my uterus and my cervix. I was also going through some problems with my marriage and was in therapy for depression. I then had more pain about 2 years later, and back in for more surgery...and everything was removed.

I continued with therapy, and was so depressed that I seriously considered suicide. I had mood swings so bad, that I was almost diagnosed as bi-polar.

One day, I told my therapist about my surgeries and she got a funny look on her face...and then she told me that her husband was my DR. I never knew that. She put twwo and two together and then her husband called me in for a visit, and though nothing was said about his wife, he asked if I was having mood swings, and hot flashes. DUH!!!! yeah!!! and he put me on Premarin, and then increased the dosage until I was on 1 mg of it.

I stayed on that for years, and when I was stationed on ADAK island in the middle of the aleution islands, the Naval Hospital had run out of the meds. THe corpsman got a shocked look on his face and told me "ma'am, we are out, but we dont want you stuck on this small island with no hormones, so we are going to send a med-evac plane right in to Anchorage to get it. Can you hold on until tomorrow?" I laughed and said yes, but then I thought about it, and how he looked so scared! He obviously had dealt with post menopausal hormonal women before!

I stayed on hormones until last year, when the first thing my Dr said to me during my yearly ex, lets talk about taking you off of hormones!! ACK!!!!!!

I have had a few night sweats, but not really bad, and no mood swings, and for the most part I think I have it licked!

I do have insomnia BAD though. SO I really might consider herbal therapy! anything that will help.

I am now 60, and have arthritis really bad, and cant move like I want and NEED to, but I doubt that is hormonal. The thing I hate about aging is the fact that gravity takes over, and everything is soooo much LOWER than they used to be. :(

goldenlucyd said...

Sorry Rain. I can't even say I feel your pain as I don't have the foggiest recollection of what the dreaded MP was like---nor do I aspire to!
However, I can still see and I must tell you I think you're about the most beautiful 62 year old ever! Wow.

And your analogy of life and the river is so true. There's a famous saying by psychologist Barry Stevens (I think) that is also very true. "Don't push the river; it flows by itself."

Rain said...

thanks everyone for commenting as always I enjoy reading the experiences of others.

The health stores have natural supplements that you might try, Mary Lou. I bought a progesterone cream there that my pharmacist said is not far from the level of my prescription. the thing is you do need to balance that with something with estrogen in it and they have those too. My doctors have always said-- go by how you feel for how much of something to use and having insomnia seems like a good reason to experiment some with some options that might help. I have always figured that when I go off hormones I will do it gradually. Someday...

And Lucy, thank you, if I look as good as you at your age, I'll be pleased. :) You are such a vibrant, lively looking person in all your photos.

Fran aka Redondowriter said...

What a beautiful picture of you, Rain, and a very interesting and obviously well researched story on hormones. This is a hot button issue for so many women. I had a hysterectomy at 39 and took estrogen until I turned 50 and the first breast cancer was diagnosed. At that moment, all hormone therapy is stopped because it was estrogen receptor positive. It was really hard to stop--had all the bad symptoms I had had at the time of the hysterectomy. Then in 1997, when the second breast ca presented, they added tamoxifen into the mix--which essentially leeches all hormones from the system. Ugh! But--here I am--now on Femara, one of the newest drugs. Breast ca runs in my family, but in the ensuing years, my doctors say that Premarin may have played a role in my cancer. But--who knows? You educated yourself and made choices and I admire you for that. I just did what they told me to do. My bones are thinning now and I sometimes think I'm totally asexual, but since "I know not man" at this time, who knows? The positive thing is that I am here and I am grateful to be here.

Rain said...

Fran, you don't look asexual to me, but I understand what you mean. I think that was kind of how I felt about the hormones-- when I stopped them, I'd be asexual. I do believe that is how we all (male and female) end up in the life stage of being elderly and it can probably be used spiritually and even for our families-- but I wasn't quite ready for it yet. But as you illustrated with your own story and Mary Lou's also, we don't always get what we are 'ready' for...

RavenGrrl said...

Ah, Rain I followed you to your blog from your comment on mine ... thanks for visiting. Now I have to tell you how much I TOTALLY appreciate your point of views, your writing ... this post in particular. I am 52 and in menopause (my menses stopped about a little over a year ago) and I'm sortof on the fence about hormone replacement, even the bioidentical hormones, which I have tried. Mostly, I get headaches from them, so don't tolerate them well. I will probably try again, adjusting the dose with my naturopath who specializes in women's health. I love the fact that we have a compounding pharmacy nearby and can get reasonably priced products from them. I too have dealt with endometrial and cervical cancer and have to be careful.

I agree with the commenter who said you are the most beautiful 62 year old! You are gorgeous and I can tell from your writings that the beauty is inner-beauty as well as bodily physical beauty. May you continue to be vivacious and healthy for a long, long time.

Warmly, Maureen

Rain said...

Thank you, Maureen and I'm glad I found your site. I really love the work you do, the spirituality you bring to it. The problem of hormones is a biggie for most when because so many possible ramifications to whatever we do. I started out with Premarin and Provera when they were not considered dangerous and they worked well for me and still would except for my feeling I needed to gradually get myself off things that are unhealthy and not natural. Not that once you have had a hysterectomy anything is 'natural'. It is preferrable to dying by far though and that saliva test was helpful for me