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Women Who Can't Take HRT

There are many women who are ushered into the Surgical Menopause Jungle, who either can’t or opt out of using Hormone Replacement Therapy. Of the women in this category, most do so due to cancer diagnoses or high-risk factors that don't interact safely with HRT such as a predisposition to blood clots.  Some women also choose to not use medications out of concern for personal health and well-being or wanting to take a more "natural" approach.


One of the reasons for women choosing to forego HRT comes from the idea that a natural or alternative treatment is a safer choice than HRT.  Other women do not consult their doctors regarding their menopausal symptoms because of shame or not wanting to bother their physician with personal and sometimes, sensitive issues. The majority of women still do not recognize that the benefits of HRT usually outweigh the risks for women, and that many HRT options (in fact the majority of them nowadays)  are derived from plants.


It is essential to think about the reasoning for wanting to take an alternative treatment approach to Surgical Menopause. Although alternative treatments may help with some individual symptoms of menopause they are not as effective as HRT. Additionally, natural methods of treating surgical menopause do not protect your long-term health nor reduce your risk of osteoporosis or heart disease, whereas HRT does and can.


Navigating surgical menopause without HRT poses some challenges; however, there are things that can be done to help offset some of the menopausal symptoms that women are left with after having their ovaries removed and hormone (chiefly estrogen, progesterone, and testosterone) production is haulted. 


Hot Flashes:

Women NOT avoiding HRT due to cancer diagnosis, can try some of the phytoestrogens.  Phytoestrogens are plant-type estrogens that fill in empty hormonal receptor sites.  Because these plant-type estrogens can act like estrogen in the body, they are usually NOT considered safe for women with estrogen-related risks.  Black Cohosh and Soy are two types of phytoestrogens that have been proven to help relieve hot flashes, but they carry some risks of their own.  There is some concern that Black Cohosh can be associated with liver damage over time, and it has been shown in animal studies to possibly stimulate metastasis of existing cancers, however, it does not create new ones.  Soy is another phytoestrogen that has been proven to have an estrogen type effect. Furthermore, Soy can be a thyroid disruptor and can bring about new problems on its own.  We recommend speaking with your doctor if you choose to go the phytoestrogen route and make sure anything you use is compatible with your body, and that your liver and thyroid are periodically monitored. 


Essential Oils can often be a welcome alternative for hot flashes.  While they may not stop the hot flashes, some essential oils like Peppermint, placed on the back of the neck, has the ability to give a cooling effect to the body.  Essential oils do not contain hormones, so they are considered safe for all women.  Oils are also wonderful for moods and sleep.  Be sure to buy all your oils from a reputable brand to avoid any added contaminants or fillers.   


Another viable option for women wanting to cool hot flashes down is the use of SSRI antidepressants (Selective Serotonin Reuptake Inhibitors).  Low estrogen can cause the decline of serotonin in the brain which can be a big contributor to hot flashes.  SSRIs boost serotonin and help decrease the intensity and frequency of hot flashes.  Some common brands are Effexor, Paxil, and Prozac.  Antidepressants are unique to each woman’s body, and the administration should be overseen by a qualified doctor.


Heart Health:

Taking an aspirin a day can help reduce your risk of heart-related events by as much as 33%. Aspirin isn’t a good choice for everyone as it can be harsh on the stomach and thins the blood.  However, monitoring and reducing your risk factors can help keep your heart healthy on a long-term basis.  Working on keeping your blood pressure and weight in a good range, as well as getting regular exercise can help reduce those risks as well.  Alcohol can increase your circulating estrogen levels, so keeping alcohol to a minimum and not smoking, which can thicken your blood, are also very important.  Having regular checkups with your doctor to make sure your blood pressure, cholesterol, and lipids are in a healthy range is one of the best things you can do to keep tabs on your overall heart health. 


Bone Strength:

Bone health in menopause is usually a top concern.  Making sure that your bones are healthy is like making sure you have a good sturdy foundation on your house.  Every woman, when first entering Surgical Menopause, should ask their doctor for a DEXA scan.  The scan will give a current overall view of your bone health, and provide a baseline to compare to as you age.  To keep bones healthy, women should focus on getting the correct nutrients to promote bone growth and strength, as well as participate in weight-bearing exercises.  The recommended doses per day are: Calcium (1,000-1,200mg), Magnesium (320mg), and vitamin D3 (600-800IU - some doctors will prescribe up to 2,000 IU for women who are deficient).  As always, we recommend you discuss your specific needs with your physician.


Vaginal Atrophy and Urinary Problems:

 Vaginal Atrophy and Urinary/Bladder issues can go hand in hand.  When the tissues in the vagina dry out, they can get frail and tear easily.  This can also cause the bladder to weaken.  Keeping those tissues hydrated and healthy can alleviate a lot  of pain and frustration.  For women who can't use vaginal estrogens, the Mona Lisa Touch procedure, or using products such as Vitamin E suppositories, coconut oil, or commercial lubricants like Replens, or Ky liquid can help plump those tissues and keep them from drying out.  Avoid using drying medications and soaps, and be sure to drink plenty of water to keep those tissues healthy and happy. 



Low estrogen is notorious for causing sleep issues such as hot flashes, or the inability to fall asleep or stay asleep.  Using relaxing essential oils like vetiver, lavender, or lavender blends can be incredibly beneficial for sleep and calming to the body and mind.  Bedtime teas like Sleepytime Tea, Chamomile, Passionflower, or Valerian can soothe the body into sleep.  Dressing for bed in layers or having layers of bed blankets can help with middle of the night hot flashes that are usually followed by cold flashes.  Dressing in pajamas that wick moisture away and having iced water on the bedside table can help cool you during hot flashes.  For women that have extreme trouble sleeping or staying asleep, sometimes medication will be needed.  Medications can range from low doses of Melatonin, to more pharmaceutical options like antidepressants or sleep aides.  Making sure you get the best quality sleep possible will help your mood and ability to function daily.


Dry Skin, Hair and Eyes:

One of the most common complaints is the dry hair, skin and eyes that come along with surgical menopause.  Dry skin can cause itching, cracking or flaking, and keeping it hydrated is the best option to relieve those symptoms.  Drink plenty of water each day.  To monitor your fluid intake, your urine should be pale yellow.  Darker urine means your body is dehydrated and needs more water.  Using soothing and hydrating creams can help the dry itchy skin.  Look for moisturizers that have hyaluronic acid or natural oils as a base.  Hyaluronic acid can attract and hold more than 1,000 times its weight in water, and creates a very hydrating effect.  Some women prefer to go the more natural route, and oils such as Coconut, Olive or Sunflower oil have been around for years, and have a proven track record of being very soothing and hydrating.


Dry eyes can also be very irritating.  Keeping those eyes healthy and lubricated helps protect your vision and keeps out infection.  Eye doctors will recommend lubricating eye drops such as, Systane,  which can be found over the counter in most pharmacies.  However, if your dry eyes are severe, taking a trip to visit your eye doctor can help.  They can prescribed medicated eye drops or artificial tears. 


To keep your hair healthy you want to be confident that you're getting enough intake of Omegas and Essential Fatty Acids.  Make sure that you are eating enough oils from things like Salmon, Sardines, or Mackerel, or supplementing them with a good brand of Omega fish oil daily.  Also supplementing with B vitamins can help strengthen and promote hair growth. 


Adding moisture to your body in as many ways as possible can help relieve a lot of the dehydrated feeling that comes so quickly with Surgical Menopause.


Depression, Moods, Anxiety:

Many women in Surgical Menopause claim the moods swings can be one of the worst symptoms.  Options range from supplements to pharmaceuticals, and often they can give relief.  Exercise is a wonderful option as it releases “feel good chemicals” that can elevate mood and relieve stress.  Essential oils also have the benefit of uplifting or calming moods.  St John's Wort is well known for its antidepressant type effect.  If things get to a point where a woman feels they are not coping well,  we recommend seeing your doctor and discussing medications that can help relieve anxiety or depression. 


It has been proven that low hormones can affect the neurotransmitters in the brain, contributing to the feeling of depression or anxiety. There is no shame in needing pharmaceuticals to help balance those neurotransmitters, and frequently medications can offer much-needed relief in many areas.  Many women have also found the use of a therapist during the transition period can be extremely beneficial.  Therapists can help monitor a patient’s mental health, and suggest treatments and coping strategies that can offer relief.  Also, joining support groups can help many women with anxiety, depression, and isolation that comes from hormonal upheaval. 


While support groups can offer advice and a supportive place to talk and share, be aware that support groups can seem to have a lopsided focus on the negative at times.  Women who are having an easier time with the surgical menopause transition typically don’t join support groups, so the group can seem like everyone is struggling or having a difficult time; however this is not the case, and you need to keep that in mind when engaging in social support groups. 


Surgical Menopause can be a difficult road to travel, and women who can’t do HRT might need to search and try different methods before finding relief that works well for their body.  Be patient.  There is no right or wrong way to handle surgical menopause and don’t compare your recovery to other women.  Being upfront with your doctor about your symptoms can help you put together a plan that can offer some relief. 

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