Estrogen saved my life.
I’m not talking about the estrogen my body used to produce. That disappeared the day I had my hysterectomy. If you haven’t heard that part of my story, check it out here.
I’m talking about my hormone replacement therapy or HRT. It took months, but when I finally found the right combination of estradiol and testosterone it literally saved my life. I could not have kept living the way I felt without my hormones.
So when I hear about doctors who warn patients away from HRT without giving them all the information, it makes me mad. And when I learn first-hand that doctors are giving out wrong information based on studies that have been shown to be inaccurate, it makes me furious!
Here’s what happened to me.
I consider my primary care doctor as the quarterback of my health team. She’s the key to keeping my entire body healthy. But because of my hysterectomy and all the problems hormone imbalance caused me, I also have a hormone specialist who takes care of that part of my life.
But no matter how great they are, my doctors can only work with the information that I give them. Here’s where things almost got messed up in a big way.
A few months back, I realized I was having symptoms that had me worried. Periodically it felt like my heart was being squeezed and released. It took my breath away when it happened. Thinking back on it, I also realize that I’d been having occasional chest pain and shortness of breath. But it didn’t happen often enough for me to really put it all together.
When I finally thought to talk to my doctor about my symptoms, she started with a typically opening line – was I under stress? Picture me shaking my head in disgust. Of course I was under stress! I’ve been traveling so much I was losing weight and when I was home, I was always playing catch-up between my family and work.
And really, what woman doesn’t have stress! Don’t get me started on the whole subject of work/life balance for women. There is no such thing in my book. We have too much on our plates to ever think it’s going to balance out.
My doctor went on to run all the right tests, and told me my heart was so good I should never expect to have heart problems. That was great news! But I still had symptoms that weren’t going away.
My next stop was the cardiologist – a local woman recommended by my doctor. Here’s where I was absolutely shocked.
The cardiologist told me I had to go off my HRT. She said my estradiol was hurting my heart. I was shocked and horrified. And to make it worse, she quoted a nursing study that I won’t name because I know it isn’t accurate.
She was giving me bad advice based on bad data. Hearing it was almost enough to give me a heart attack right then and there!
Of course, I told her what I do – that I am the founder of EmpowHER and a health advocate and that I have read every study on HRT that I can get my hands on. I offered to connect her with my board of directors here at EmpowHER and to send her the accurate studies.
And I refused to go off my estrogen.
That’s the first thing I hope you remember from this. Doctors aren’t perfect. They don’t always have the right information. And not all research is accurate. So if a doctor tells you something and it just doesn’t sound right, get a second opinion!
That’s what I did. I called my hormone doctor to tell her the story and she agreed. What the cardiologist wanted to do was wrong for me. In fact, it was completely backward to what I needed. I learned something else new about my HRT that day.
Estrogen is a sex hormone. But it affects systems throughout your body. One of the symptoms of having too little estrogen can be a feeling like your heart is being squeezed, or a butterfly flutter in your chest.
Bingo! That was exactly what I was feeling.
My hormone doctor ran another blood panel and realized that my estrogen patch dose was too low, probably because of all the weight I’d lost. I was burning through my estrogen because my body didn’t have enough fat to hold on to it.
When she increased my estrogen dose, all my heart symptoms disappeared.
I know I’m not alone in this experience. Dr. Philip Sarrel is a member of my Medical Advisory Board here at EmpowHER as well as the founder of the Yale Menopause Program. He told me about an important study at Columbia-Presbyterian Hospital in New York City that showed one out of three women who have hot flashes also experience chest pain.
Other studies done at Yale and the National Heart and Lung Institute in London showed that women with severe chest pain and normal arteries who didn’t respond to cardiac medicines did respond to estrogen. So clearly there can be a connection between heart problems and estrogen levels.
I’m telling you this story because it still makes me angry when I think about a cardiologist with a great reputation who didn’t know that too little estrogen could cause my symptoms.
I absolutely believe every woman has the right to complete, accurate information about her health. And part of that story is the important role hormones play, not only in our sexual lives, but in all areas of our health.
Here’s my advice to you. If you have symptoms you can’t explain, get them checked out and ask to have your hormones checked. Make sure you do the research yourself so you can understand what your numbers should be.
You owe it to yourself and your family to educate yourself so you can be your own best advocate. That’s the only way you can make the right decision. And whatever you do, don’t be afraid to stand up for what you know in your heart is right for you.Read more in Advancing Health After Hysterectomy
Add a Comment12 Comments
How long did it take for the symptoms to go away with estrogen increase?June 16, 2017 - 12:55pm
I'm 57 yrs old, had a hysterectomy before I was 50, began having terrible anxiety, lost my desire for sex, was tearful and bitchy, not sleeping but 2-3 hrs a night, edema...I also started having this heart squeeze thing and since I have a heart issue (hypertrophic cardiomyopathy) I assumed it was bothering me. I thought I was losing my mind, eventually, a woman asked me if it could be menopause. Duh I said, YES! So started the adventure. First my doctor said I was too young, I pushed and insisted he do blood work, eventually he did, and said all was fine. But from all the books and online reference, I was NOT fine. I pushed some more and eventually he gave me Premarin, well that helped with some of the anxiety, but not much else. I got patches different pills...nothing really helped.
And a few years later I found a hormone doctor, she prescribed estrogen, testosterone and progesterone cream (have been off testosterone for several years now). I did see some relief, no more night sweats, no more hot flashes, less bitchiness, less mental confusion, less depression, and almost no heart squeezes. But eventually stopped sleeping again, got hot flashes...so would decrease or stop one of the hormones trying to figure out which one was causing the problems. My regular doctor said you don't need progesterone since you had a hysterectomy, the hormone doctor said I do. And I did regain my sex drive with progesterone and had not with just estrogen.
So...now we're in 2016 and I began to have shortness of breath, racing heart...every doctor shrugged at me. One day I lost consciousness on a neighbors lawn and woke up 3 days later in a hospital. Turns out I had afib and received a pacemaker for it. I also had ablation surgery December 2016. I did began to feel better again and continued with my hormones when I got home.
Now, it's May 2017 and I stopped sleeping again, super bitchy, cranky, depressed...so again I think it's got to be the hormones. And occasionally having that heart squeeze no doctor could diagnose, and couldn't find anyone online who would say "heart squeeze" but that's exactly what it feels like, and then it passes as fast as it comes....so I stopped all of the hormones for 3 weeks. I was ok, it didn't fix bitchy or the sleep issue, but I felt fine. Well then I began to get mentally confused, dizzy, depressed, hot flashes, weight I can't lose despite the healthiest diet ever (no caffeine, no chocolate, rarely sugar--oh yeah, I developed silent acid reflux too with menopause)...so 5/19/17 I went back on the hormones and get blood work next week.
Still would love to know why the heart squeezes, is it not enough estrogen? Is the progesterone causing me problems? If I don't take it and only estrogen will I become even bitchier and sleep even less. Some says estrogen relaxes you and others say no it's the progesterone. I just don't know anymore and can't seem to get the right balance. I'd love to sleep again, not have situational or stress induced anxiety, not be hot at night as I try to sleep...and I'd love not to feel dizzy again.
So for me, I agree, doctors are only human, and they call it "practicing" medicine for a reason. But I'd love to find any that could agree on what is wrong with me, and which hormone or lack there of is causing the problem. If it's even that. But this heart squeeze really scares me, you feel like you're fading out or going to pass out, and then it's gone.
Any insight or experience anyone has with any of this I'd love to hear it.
SherryMay 26, 2017 - 1:37pm
Hi Michelle,October 7, 2014 - 9:22am
Congratulations on your wonderful work and advocacy! I am 58 years old, and experiencing some weight gain, constant hot flashes, that exact heart squeeze and flutter you described, bouts of depression and sleeplessness and feeling just out of whack. I am very healthy, except for having had a serious medical crisis about 8 years ago: After flying to various destinations in a shot period of time (and not getting up from my seat while I was on planes), I returned home experiencing severe lung pain. Turns out I had a pulmonary embolism--a blood clod that landed in my lungs. Extensive testing showed that this was not caused by heredity, nor did I have any blood disorders. it was --as the doctors said -- a fluke. My gynecologist will not prescribe any form of hormone, because hormone therapy increases the risk of blood clots. Any suggestions? Thanks,
Thanks, Michelle. Great article and great comments. I , too, had a hysterectomy, now about 2 1/2 years ago. My Gyn surgeon prescribed Estradiol and Progesterone. I'd been on progesterone only birth control pills decades before and my body did not respond well; spotting and extreme sudden weight gain, so I was concerned about this. I started experiencing the weight gain again, so I stopped the progesterone, but I was also experiencing incredible fatigue and lower back and leg weakness. If I was standing for even 5 minutes my legs would practically give out. I went through an MRI and the doctors found no explanation. I found EmpowHER then, and I went in search of a hormone specialist, which I found in the doctors at my local Medspa, who ordered a complete hormone panel, and we found that my Testosterone levels, for a woman, were extremely low. I started on a subcutaneous treatment of my Estrodial which was a lower dosage and thought to be lower risk than the oral I'd been proscribed, alone with testosterone, and almost immediately the back pain and weakness disappeared. I am now in the best shape of my life, at 47, and I'm even running marathons (which I thought I'd never even want to do). Michelle, EmpowHER, and Dr. Bentz have saved, and significantly improved my quality of life! Thank you so much, and keep up the fight!September 5, 2014 - 10:14am
I have to respectfully disagree. It happened to me. I lived it and still am living it. Every day I was a science project because no one knew how to treat me after my hysterectomy. I was overdosed on progesterone and given 100 x's the required dosage for someone who has a uterus! I didn't have one. Why in the world would I need progesterone without a uterus?
You need to look at the studies I talked about in the article. Show me the studies that say progesterone will benefit a woman after she's had a complete hysterectomy. It made me deathly ill taking progesterone and caused me to have severe depression, weight gain (just what I didn't need), bloating and edema, just to mention a few of my symptoms. I was told to rub it all over my body. I never felt so sick!!!
Also, after my hysterectomy my cholesterol numbers went up. My cholesterol was always normal until then. It continued to go up until I got on the right HRT regime. Which for me was estradiol and a bit of testosterone. All of a sudden my bad cholesterol decreased by over 50 pts and my ratios were so much better. So, you can't tell me there is no benefit to the heart when it comes to Estrogen! I have lived this nightmare and have been over medicated, under medicated, given medications I should have never have had and now have to take them for the rest of my life because someone thought maybe I had a thyroid problem. I have to have at least one more surgery as well.
Here's the truth- I was having heart issues and then my Hormone Doctor who specializes in women and hormones gave me a bit more estrogen and the heart issues were gone. Totally gone. Have not had another episode since. How does one explain that?? I want you to be informed and it sounds to me like you are very informed in many areas but are missing a big piece of this whole hormonal puzzle. I'm happy to give you more studies about estrogen and the benefits. I also have some on why I shouldn't take progesterone if you'd like too. I want you to be informed as I wouldn't want you to go through the same thing I did if you're a woman, and/or have someone you know have it happen to them. I feel the BEST I've ever felt at 54 years old and no progesterone is needed.
I almost died because some health care professionals are misinformed. It's not their fault, it's the fault of the broken system in which we continue to live with in today's world. But please don't tell women that estrogen can protect their hearts. You sound like the cardiologist who wanted to take me off of it. She could have killed me! I've been through enough and seen enough and read enough to know about hormones. No, I'm not a doctor but I certainly am an educated patient by default because of misinformation around women and hormones. Why can't we all have consensus around this topic? Just goes to show you how little we've done to get good solid information out to the consumers as well as the healthcare professionals.
Please show me the studies about estrogen coupled with progestins and how it reduces all of these female cancers etc... I would love to see what you're talking about as I've not seen these studies before. I am more than willing to read and learn anything and everything I can so women can get the best information around their hormonal health and overall well being. That's the most important thing for me as the founder of this company.
Thank you for commenting on my article. It starts a great debate which I believe is healthy for everyone concerned. We need to have great data and studies for women around their hormonal health. Today, we are boxed into the WHI which didn't help women and or doctors. We now know it killed at least 50,000 women because women went off of their estrogen. That study is on our site. I want science based information and studies proving points. That's why I always ask a thought leader in a particular area of women's health before I post an article like this. Hence, the reason Dr. Phillip Sarrel is referenced in the article and knows the studies. He is a thought leader in this field. Let's see if we can get him to comment on this as well. The more information and studies we can find....the better it is for all women and their doctors. Be well! MKRSeptember 4, 2014 - 4:02pm
I was very careful to say progesterone and not progestIN. Very different substances.
Like I said, unopposed estrogen has unique risks - afib, abdominal aortic aneurysm, decreased verbal fluency, and certainly uterine cancer (if you have one). The French E3N study also suggested that unopposed estradiol (without progesterone) increased breast and ovarian cancer, whereas estradiol and progesterone (not progestins) did not.
While no randomized trial has ever been conducted on estrogen with progesterone in women without a uterus, there also have never been any long term clinical trials of estradiol alone in women with hysterectomy. Unopposed estradiol increases recurrent stroke and stroke death and secondary cardiovascular prevention studies show early increases in MI and blood clots.
The points I am making AREN'T "don't take estrogen ever", they are 1. don't take estrogen WITHOUT natural progesterone 2. don't expect hormone "replacement" to protect you from age related disease. That has been disproved. True, WHI was imperfect for many reasons. But the age-based analyses were a statistical manipulation of the data to try to eke out some benefit from estrogen that obviously was not there. Statisticians will tell you that if you do enough analyses (32 or more), you will come up with a statistically significant "finding" that may or may not be true.September 25, 2014 - 12:41pm
Below are links to clinical trials (some were part of the WHI). Also a few observational studies. My point is to highlight the risks of taking estrogen WITHOUT progesterone. (For progesterone to effectively counterbalance estrogen it must be given in an oral micronized form; creams are insufficiently absorbed to protect the uterus and breasts or improve sleep).
1. E-alone increases atrial fibrillation.
2. E-alone lengthens the QT interval (an arrhythmia that predisposes to both sudden cardiac death and torsade de pointes); progesterone and/or testosterone SHORTEN it
3. E-alone increases peripheral arterial disease, particularly abdominal aortic aneurysm.
4. E-alone decreases verbal fluency in "younger" postmenopausal women
5. Combined testosterone and estradiol have no positive impact on cognition, verbal or spatial abilities
6. Estradiol triples the risk of fatal stroke
7. Estradiol alone without progesterone increases both breast and ovarian cancer (French E3N study)
These studies indicate that progesterone is not just some annoying tagalong to estrogen to protect the uterus. It is both a partner to estrogen and a counterbalancing hormone. All the negative symptoms that get dinged as "PMS" or "menopause" (mood swings, negative affect, bloating, breast tenderness, heavy bleeding, migraines) are not due to progesterone; they are due to high estrogen. The best evidence for this is puberty: a time when adolescent girls are dealing with an overwhelming surge of estrogen, necessary to mature their bodies. But it takes years for ovulation (and sufficient progesterone) to become consistent and to "calm" this chaos. Perimenopause is the same phenomenon: high estrogen, low progesterone, and MUCH misery.
Anecdotes aside, the body of evidence supports the concept that unopposed estrogen, whether as HRT or even in a woman's own body, is neither safe nor beneficial to quality of life. If you absolutely must take estrogen after menopause, added progesterone is also necessary, uterus or no uterus.September 26, 2014 - 3:40pm
Estradiol (or any other estrogen) does not prevent heart disease. That your physician did not include progesterone as part of your hormone "replacement" is physiologically unsound. Doctors think that progesterone's only job is to protect the uterus and that with no uterus, all you need is estrogen. That is wrong.
Unopposed estrogen increases the risk of certain diseases and conditions not seen with combination estrogen/progestin (I know that progestin is not progesterone but it is the most studied compound, so I will reference that here, KNOWING that it is a subpar substitute for natural progesterone): increased risk of atrial fibrillaton and a prolonged QT interval (both potentially fatal arrhythmic disturbances); abdominal aortic aneurysm; obviously uterine cancer; possibly ovarian cancer; decreased verbal fluency. Estrogen/progestin also lowers the risk of colorectal cancer and diabetes and improves quality of life (sleep, bodily pain, and emotional wellbeing). (E-alone does not.) Estrogen/progestin is also better for bone than estrogen alone and leads to a greater increase in bone density and sustained fracture prevention even after cessation of therapy. Again, estrogen alone does not.
When a woman complains of heart palpitations and fast heartbeat, that usually occurs during perimenopause, not postmenopause. Perimenopause is not a time of dropping estrogen - rather it is a phase of life characterized by HIGH and swinging estrogen levels and low or absent progesterone. That is why there is a mix of "menopausal" symptoms, like hot flahses and night sweats, but also premenstrual/pubertal symptoms, like sore breasts, heavy flow and mood disturbances.
As far as heart DISEASE is concerned, neither estrogen nor estrogen/progesterone prevents it. Estrogen increases clotting, and it is that pitfall that probably explains why the hormone increases the risk of stroke, blood clots and heart attack. (Remember a woman's own estrogen during pregnancy puts her into a hypercoagulable state, which explains the small increased risk of vascular complications seen in a small percentage of pregnant women.)August 31, 2014 - 10:19pm
I want to respond to your first sentence as that addresses the subject of the original article by Ms. Robson. Her chest pain responded to estrogen therapy which is what I would have expected. As to estrogen reducing the risk of heart disease and preventing myocardial infarction: The most recent reports of the Women's Health Initiative(WHI) study of women who have had a hysterectomy and who start estrogen within 10 years of losing their ovarian hormones clearly indicate a reduction in coronary heart disease of 40% and reduced mortality of 11/10,000/year. (Manson et al. JAMA 2013;1353-1368). The WHI findings confirm numerous cohort studies since the 1980's (starting with the coronary drug project) showing that treatment with estrogen alone reduces the risk of heart attacks by over 40% and reduces mortality . Estrogen acts in many ways in the wall of arteries to prevent constriction, stabilize blood flow and inhibit the development of atherosclerosis, the underlying cause of most heart attacks. The WHI findings also indicate that the women who received estrogen-only treatment, whatever their age group, showed more than a 20% decrease, compared to women receiving placebo, in the risk of developing breast cancer.September 5, 2014 - 7:54am
Understanding the actions of hormones used for treating menopause symptoms and preventing disease due to hormone deficiency is complicated. Ms. Robson sticks with the story for use of estrogen to stop her chest pain and describes a "syndrome" seen almost entirely in women which is severe chest pain but absolutely normal findings of tests of coronary arteries and heart function The symptom is scary but, as our cardiology research showed many years ago (Sarrel et al. Angina and normal coronary arteries. Am J Ob Gyn 1992;167:467-472), the treatment of choice is estradiol taken in a way that maintains stable levels of the estrogen.