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

Hysterectomy Hormone Concerns

Speaker 1
0:00

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

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answers

to

your

biggest

questions
.

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to

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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

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let's

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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

Prevention and Proactive Planning

Speaker 1
1:24

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

Risks of Delaying HRT

Speaker 2
2:55

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

Sleep Disruption and Chronic Illness

Speaker 1
4:09

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
,

Episode Conclusion and Contact Info

Speaker 2
6:10

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

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more

clarity

and

confidence
.

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?

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