QC: The Silent Cost of Delaying Hormone Replacement: With Dr. Christine Vaccaro

Are you faced with the decision of having a hysterectomy and potentially removing your ovaries and you have a lot of concern when it comes to your hormones and how you're going to feel after surgery. What is the risk-first benefit of having hormone replacement therapy and planning for it prior to your surgery, and what are the risks of not doing hormone replacement therapy? That and so much more in this episode of Quick Connect with Dr Christine Peccaro Stick around. Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights. Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need.

Speaker 1:
0:43

No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect If someone is planning to go into the operating room, have their ovaries removed or even just have a hysterectomy. Is there a benefit to pre-surgical planning for hormone replacement therapy and what are some ways that we can approach this with our providers.

Speaker 2:
1:31

Yeah. So, alana, I think you ask a really important question. I love prevention and I love proactive women. I love when I see a patient coming in for a variety of reasons why they're having their uterus out and their ovaries out and they want to have the conversation. You know, here's what happens if you don't supplement your hormones, that we're going to be abruptly ripping from your body. You know, and make it obviously a conversation, shared decision making, right? Because, again, for a variety of reasons, some women may not want hormone therapy. At least they know and they understand the risk. I don't think we also clearly talk about what this happens to your bones, right? Just osteoporosis alone kills so many women every year and, again, we don't talk about that enough either. So it's just all sorts of prevention. So, again, imagine a world which I do see this often actually, and I love it that a woman comes in, okay to meet with her surgeon and or, potentially, a hormone specialist, and they go through all the options, they go through the expectations and there's a plan for either hormonal or non hormonal therapy and that can actually start the day of slash before after, whatever they agree upon, you don't have to wait until symptoms are severe and you're feeling awful and anxiety and depression and brain fog sets in.

Speaker 2:
2:50

The point about prevention is to prevent feeling terrible, so catching it before it starts. I think there's a misperception still in the medical community that transdermal hormones cause or can contribute to blood clots. Transdermal estrogen products do not cause blood clots. But I think again, sometimes surgeons still have this sort of perception and they don't want to start anything in and around the perioperative timeframe either. That you know before, right, immediately after, etc. So a lot of times women are in this you know, six week zone of suffering until they go into their post-op visit and then it's like, oh, how are you feeling? And it's like I feel awful. But we have avoided that six weeks of awful and just helped them through that with replacing again what their body was already making. It's not like we're giving supra-therapeutic doses here. We're just giving a little gas in the tank so it doesn't run on empty.

Speaker 1:
3:48

Yeah, I think what's hard too is a lot of people coming out post-operatively kind of associate what they're going through as post-op pain as opposed to the significant changes in their bodies occurring instantly, and I definitely experienced that. Are there risks associated with holding off on hormone replacement therapy, even if it's a year or two?

Speaker 2:
4:13

Yeah, the best data we have is in bone health. So for bones the loss is pretty significant right away. The best data we have is the perimenopause window, which is like four to seven years before menopause. During that just that transitional time where again sometimes estrogen is normal and sometimes it's really low, we lose like 10% of our bone loss just in that up and down time. So if you can imagine one year without hormones completely, which is a huge change, the bones take a huge hit there. I don't have a number to quote, but again it could be up to 10%. You know, we don't know. But again, women that have normal testosterone then go down to zero. That's a huge change and the bones definitely feel that I mean other things are going to be harder to zero. That's a huge change and the bones definitely feel that I mean other things are going to be harder to quantify.

Speaker 2:
5:01

Right, we know how much sleep is disrupted during hot flashes, night sweats, and again, it doesn't even have to be a hot flash of night sweat. You can just wake up for no reason at all, meaning like you're a great sleeper, and then all of a sudden you're like why am I awake at 2am? For no reason, and then the mind starts going and then things start happening and then you can't fall back asleep. Okay, so then you have, you know, months slash years of poor sleep, which poor sleep is directly related to chronic illnesses, skeletal pain, depression, et cetera, et cetera. Right, so it's.

Speaker 2:
5:35

All these things layer on each other and only the patient themselves know how devastating that you know year of waiting can be. You know, again, I just hate to see women suffer at all. So my approach is that that time frame is zero days, like I want them to start right away. I even have some patients that are already low on testosterone start testosterone before their surgery, because it does take several months to ramp up on testosterone. So every patient's a little bit, a little bit different, based on their age, symptoms that they're already experiencing. But again, you know, think about one year, think about a diabetic with one year without insulin.

Speaker 1:
6:12

You know, that's a really important human hormone.

Speaker 2:
6:14

Think about a hypothyroid patient with one year without their thyroid. They're going to feel miserable, and I don't know why we treat sex steroids as something that we withhold for some reason, just to allow women to suffer Like it doesn't make any sense to me at all. So to prevent pain and suffering and also to prevent chronic disease like osteoporosis, I don't recommend waiting unless there is a concern about hormonal dependent cancers, or there's a concern, and then again then that's a more of a detailed discussion with the patient about risk benefit.

Speaker 1:
6:48

That's a wrap for this quick connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.