I am 55 years old, suffering from menopause symptoms (hot flashes, heart palpitations, night sweats, insomnia, low libido, mental fog…all of it) and was previously (prior to endometrioma) on bHRT via pellets (estrogen/testosterone). A rectal bulge, which was determined later after MRI to be a pelvic mass, was found during routine colonoscopy and I had surgery to remove it and pathology revealed it was an endometrioma. I am not currently on any HRT and was wondering if I could take low dose of Estradiol 0.5 mg oral along with estriol/testosterone vaginal cream to help with the vaginal discomfort during sex. I am afraid the doctor did not get all of the endometriosis lesions and taking HRT will cause a recurrence. I have had a hysterectomy (BSO) in 2018. If HRT is not the answer, please advise. Thanks for your help.
Endometriosis
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December 10, 2024
Dr. Steve Vasilev, MD, Gynecologist, Endometriosis Surgeon*:
Great question and often asked, so you are not alone. The problem with a standard answer is that everyone is different and the molecular biology of endo is not the same in each person. In general, your concern about estrogen triggering regrowth is very valid. But while some amount of estrogen replacement theoretically could cause regrowth to the point that you could experience clinical symptoms, estrogen replacement will not necessarily do that. This is because estrogen is not the only driver of endo growth and even after menopause not all estrogen is gone. There can still be local production, fat cell interconversion from other hormones, xenoestrogens from various sources etc. So, even now, it is unlikely that you are in a zero estrogen state. Thus adding a quality of life enhancing low dose replacement may be very reasonable to consider. Unfortunately, it is not possible to accurately predict what will happen and there is not enough information from what you wrote to give a complete answer. This would require a closer look at the pathology specimen with potentially some additional testing (this may or may not have been done), possibly imaging to determine if there is visible residual in the rectal area, and so on. Outside of standard replacement, plant estrogens may alleviate some of the symptoms you mentioned but will not likely help vaginal estrogenization. Additionally, there are multiple non-hormonal lubricants, which you may already have tried for the vaginal symptoms. In short, in a situation like this a deeper personal look with an endo expert would be the best course of action for the reasons noted above.
*This is not medical advice and is aimed for informational use only. Please contact the doctor’s office or consult with your doctor for any medical questions.
Thank you so much for taking the time to respond. I have been searching for an Endo expert near me. I checked the iCare site and none listed. I’m in Orlando, FL, are you nearby? I would even be willing to travel for expert advice. I am a bit miserable and definitely feel it would be worth it. Thanks again for your time.
Dr. Vasilev is in California but offers virtual consultations if needed. Please use this link to contact his practice: https://icarebetter.com/doctor/dr-steven-vasilev/