Does anyone have any experience talking to their SRS surgeon about NOT stopping estrogen before surgery?

I've seen many people here and elsewhere discuss hot flashes, mood changes, etc., from stopping estrogen. All this to help prevent blood clotting, when taking estrogen other ways than orally (sublingual, injections, etc.) are supposed to prevent blood clotting themselves?

SRS is a huge life change and I want the easiest recovery possible... this won't include hot flashes or mood changes. In my opinion it's pretty strange to put the patient through this to prevent a risk that shouldn't really exist.

I have an appointment with my endocrinologist soon and I plan to ask their opinion on it.

No taking them other ways have less risks involved.

SRS is a major surgery that has lots of blood for a very long time. With blood comes clotting to try and keep from bleeding.

When on estrogen could cause extra troubles along with death.

You will be in more pain and discomfort from the surgery then you will have to deal with a little hot flashes.

So relax and do what the doctor orders, no reason to put yourself to even more life treating complications.

SRS is truly not a bed of roses that most are at aw over. Aftercare sucks and you will get sick of seeing blood and discharge real quick.

Isabell

My doc does not want me to stop HRT for SRS. Because the clotting risk rises when the Estrogen level drops fast. Pregnant women does not have a higher clotting risk. But during the two weeks after birth they clotting risk is high because their Estrogen level drops sharply.

Lara

My doc also told me a horror story about not resuming estrogen afterward until cleared to do so. 

One of his patients ignored his advice and started back on E right away and ended up with a DVT that almost killed her.

It's not worth it, folks.  We all spent most of our lives miserable without it.  Eyes on the prize!

Quote from: mind is quiet now on June 24, 2014, 12:36:30 PMYou will be in more pain and discomfort from the surgery then you will have to deal with a little hot flashes.

This is exactly my point, though.

Why would I want to deal with hot flashes and mood changes on top of everything else I'll have to deal with?

Besides taking estrogen orally the whole clotting risk seems to be way overblown.

Quote from: Lara1969 on June 24, 2014, 12:54:11 PMMy doc does not want me to stop HRT for SRS.

What was their reasoning on not wanting you to stop HRT for SRS? It'd be helpful to know when I talk to my surgeon and endo.

Quote from: Jill F on June 24, 2014, 01:02:16 PM
My doc also told me a horror story about not resuming estrogen afterward until cleared to do so. 

One of his patients ignored his advice and started back on E right away and ended up with a DVT that almost killed her.

It's not worth it, folks.  We all spent most of our lives miserable without it.  Eyes on the prize!

I'm not a doctor but I can't imagine it's healthy for the body to start/stop/start any kind of medications including hormones.

Of course taking estrogen again right away will probably lead to some kind of complications because the doctors/nurses weren't aware of this change. Also health might be a factor.

I will say best of luck.

Isabell

Whatever you decide, it is essential to keep your surgeon informed. If something happens, they need to know what medications you are currently on.

I get horrible migraines that are affected by hormone shifts. I negotiated a more limited stoppage with my surgeon as a result: I wouldn't stop spiro and I'd only stop estrogen 2 weeks, instead of 3 weeks before the surgery. I was also cleared for restarting estrogen 5 days after surgery rather than 14, assuming everything was okay post-op.

But I did all that with my surgeon's consent and assistance. You are placing your health and life into this person's hands. You have to trust them and they have to be able to trust you.

It also didn't work. I still went through hell due to the hormone shifts from the surgery. Worth it though.

Each surgeon has their own regimen and it may vary from patient to patient and each patient's risk factors.  My surgeon did not make her patients completely stop Estrogen, but has them drop to what will be their post-op recommended dosage. A slight snag on that one for me was that her post op dosage is twice what my endo was giving me pre-op, and post op, my endo still wants and prescribes HER dose for me that has not changed. (She did call my surgeon's office on the subject, she won!  The fact I am doing great on both sides of the knife is all I care about.)  I did have to stop taking Spiro and one other prescribed hypertension medication two weeks before the surgery, and even my PCP agreed with those going out until after the surgery. 

Maybe you get the picture that I had more than ONE of my doctors involved in my health medications for some time, and I know that with my health risks, it was not just desirable, it was damn well necessary to keep me in any form of good health.  My heath is better now than it has been for over half a century!!

On the blood loss issue, I have a interesting twist to it, but one which gives me an indicator of how much blood I did lose.  I have a genetic condition where I retain a toxic level of an iron compound in my blood stream unless I have 500ml's  of blood simply bled out of me every three to four months based on regular testing.  The blood just gets trashed since it would be toxic for other people to get in a transfusion, but the compound levels are controlled that way.  Eight weeks after my surgery I was scheduled to have another one of my "blood withdraws" and we went ahead with it.  Three weeks after when I had a blood test, the compound level was half of what my hematologist wants to see, and so she figures that I lost nearly the 500ml's plus what ever blood cell volume I had replaced in the 6 weeks following my surgery.  Looking at 500ml's of blood in a bottle is impressive, imagining that much was on your underwear over an extended time can make your tummy a little queasy!!

Believe me, you will be too darn miserable and much too busy after surgery to even think about fluctuating hormone levels, there were days I did not even have the energy to take the pills I needed to nor the attitude, which I could not attribute to hormone deficiency, only Advil deficiency!!  Good luck doing it your way, but another side note, the surgeons do and can talk to each other, and still make different decisions.  Your surgeon is GOD for the time you are under their care.

As I have no intention of taking any unnecessary risks, I intend to following the instructions I was given and stop HRT 2 weeks before surgery. While it is recommended not to start again until after the flight home, 3 weeks after surgery in my case, I'm a bit more sceptical about this and would like to start again a good week before going home.

I do however intend to discuss directly with the surgeon and will suggest taking an anti-coagulant shot the evening before the flight to minimize any risk of DVT. This BTW, is what my FFS surgeon did ie. no interruption to HRT but an antiacoagulant shot the evening before a very long operation.

As it happens, I just had my blood work done and after four years of HRT my free testosterone was so low, (0.4 pg/ml versus 0.6 - 6.8pg/ml normal range for females and 47.0-244.0 pg/ml normal range for males)  that I have already stopped using the very low dose of Spiro that I had been taking.

I have also reduced my Estrogen dosage and will continue to do so gradually before stopping completely as instructed. I made both of those changes a week ago and apart from immediately putting back on a couple of kgs, no doubt due to better water retention, I have seen absolutely no negative effects so far.
 
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I intend to ask Dr. O'dea what he thinks when I visit him in a few weeks. My method of intake is pellets, and thus they can not be stopped prior, during, or after the surgery. They just keep chugging along for three months. I'm going to guess that the dosage will be lowered for my insertion just before surgery. But seeing this has made me think about expanding the space from that visit to when I schedule SRS.

My doc does not want to stop me HRT because bioidentical Estradiol is not associated with a much higher clotting risk but than stopping intake of Estradiol the risk is skyrocketing. Pregnant women have extrem high Estradiol levels but not much problems with clotting. After childbirth habe have a very high risk for the next two weeks. This is well understood.

I do not take EE which may change the risk.

Lara

Quote from: Sarah7 on June 25, 2014, 12:14:07 PM
Whatever you decide, it is essential to keep your surgeon informed.

Absolutely. I've told my surgeon's practice about my concerns of stopping estrogen. My surgeon's PA wasn't there then, so they'll be contacting me Monday. I'll also be asking my endo about this Tuesday.

Quote from: Jennifer.Alexandria on June 26, 2014, 10:52:36 PM
I intend to ask Dr. O'dea what he thinks when I visit him in a few weeks. My method of intake is pellets, and thus they can not be stopped prior, during, or after the surgery. They just keep chugging along for three months. I'm going to guess that the dosage will be lowered for my insertion just before surgery. But seeing this has made me think about expanding the space from that visit to when I schedule SRS.

That'd be interesting to see what his opinion is. I thought pellets are one of the most effective and safe routes of administration of hormones? I could be wrong here.

Quote from: Lara1969 on June 29, 2014, 05:36:09 AM
My doc does not want to stop me HRT because bioidentical Estradiol is not associated with a much higher clotting risk but than stopping intake of Estradiol the risk is skyrocketing. Pregnant women have extrem high Estradiol levels but not much problems with clotting.

This is why I'm so confused about needing to stop estrogen. I'm not a doctor, but I thought one of the major reasons and advantages to bioidentical estrogen administered sublingually, shots, or pellets was that it avoids clotting? Also part of my pre-op tests included a blood test measuring the viscosity of my blood. I'm not sure if this relates to clotting... but why if they're calculating what my body is like would they want me to suddenly change that?

It seems to me this is an old general rule of thumb to say patients need to stop estrogen because some patients still do take non bioidentical estrogens in forms that could lead to clotting, so they want to be safe.

I take mine via pellets and my endocrinologist advised me to leave it in, he said all of his patients that have used them have left them in for SRS without any problems. My surgeon was Dr. Kunaporn, he was fine with it and I had no problems.

From what I understand the stopping of e and p + S refers to orally,  if you on patch,  pellet,  or injection you can continue,  at least from my instructions from Chettawut this is what I understood.

Quote from: calico on July 07, 2014, 07:15:49 PM
From what I understand the stopping of e and p + S refers to orally,  if you on patch,  pellet,  or injection you can continue,  at least from my instructions from Chettawut this is what I understood.

Quote from: cruise4burgers on July 03, 2014, 11:07:38 AM
I take mine via pellets and my endocrinologist advised me to leave it in, he said all of his patients that have used them have left them in for SRS without any problems. My surgeon was Dr. Kunaporn, he was fine with it and I had no problems.

Since I posted this thread I've met with two endocrinologists, consulted with my surgeon, and asked another physician at work. They all said the same thing - there isn't enough evidence to say either stopping or not stopping is safe. We haven't proven that there are or are not any risks. Their consensus was that we don't know if stopping estrogen provides a reduced risk of clotting, and we also don't know if not stopping estrogen has an increased risk of clotting. Their theory though is that stopping greatly outweighs the potential (although technically unproven) risks.

I'll be stopping estrogen two weeks prior to SRS.