saw the biodentical hormone Dr....was not pleased..ugh!

[dancer67]

She told me that unless I had a mammogram(I am 44, had a baseline done in Oct of 2009) she would not prescribe any natural hormones.

 

Huh????

 

So I am confused. If I take natural progesterone, or synthetic Micronor(mini-pill which my GYN prescribed but had not taken it yet) that mammograms are a must....????????

 

Is this true? Does taking progesterone increase your risk of breast cancer?

 

In the end, she said I was better off to take the Micronor(mini pill) because the amount of Progesterone in that is much greater then she could ever prescribe in a natural form. True?

 

I wasn't planning on getting another mammo until I was 50.Or at all. I told her this and she frowned on it. She said if I am taking hormones, I should be getting mammos' every year.

 

In the end, she said she couldn't help me, and to take the mini-pill and that should help with the pre-period spotting and bad cramps.

 

Well, geez....

 

My GYN already told me that, but I wanted to try a natural approach first. But no mammogram=no biodentical hormones. She mentioned thermogram but insurance does not pay for it, and there is only one and it is two hours away. I have no family history of any reproductive cancers in the family.(I know that doesn't mean much), but I felt badgered.

 

What do you think of this?

 

(PS I waited TWO months for this appt)

[ThisIsTheDay]

I don't get it at all.

 

I'm not an expert by any means, but I have used bioidentical progesterone for several years. (Several happy years, I might add!)

 

The hormone in Micronor is synthetic, and it will not be absorbed (anywhere near) as efficiently as bioidentical, topically.

 

From what I've read, normal amounts of progesterone in your body will not increase your risk of breast cancer. I am unclear about excessive amounts. I would weigh the benefits of taking estrogen with associated increased risks of breast cancer. Those statements are my understandings only, and I certainly hope someone would jump in with clarification or correction.

 

Your whole experience is completely opposite of what I would have expected. I'd be really ticked off that I had to wait two months to get what amounts to absolutely nothing.

 

:grouphug:

[dancer67]

I tried Emerita cream with really no success. I was hoping this Dr. could help compund a formula for me. She said there is no such thing as a "tailored" formula, and serum blood tests are innaccurate.

 

I cannot take Estrogen.(to old, HBP and I smoke) Havent taken an estrogen/progesterone BC pill since I was 20 years old.

 

What I have now is Micronor. It is a synthetic, progesterone only pill.

 

I thought(maybe I am wrong) that JUST progesterone did not have an increase in breast cancers. And that it protected from uterine cancers.

 

She DID say, that if the mini-pill did not work for me, I could go back to the Emirita cream, and use the regular dosage of 1/4 tsp 2X a day fdrom day 12 for 12 days.

 

but, as far as her helping me, she would not prescribe ANY bio-dentical hormones without a mammogram. Period.

 

So confusing. I don't know now, if I should get a mammo done since I was on natural progesterone for 3 months, and going to try the mini pill, or what.

 

And, it seems you are screwed. Take hormones increase BC? Or suffer. Hmmmm......which one. Ugh.

 

Yea, and TWO months thinking this lady was going to help. Nope. Well, yea if I get my bOOks squished.

[Tigger]

Coercion by a physician is unethical - patient autonomy is to always be respected, so the decision to have or forgo a mammogram is your decision alone and if you choose not to, your doctor should not withhold treatment - if they disagree with your choice, they should ask you to find another physician, give you adequate time to do so and continue your prescriptions until you do so!

[celticmom]

Coercion by a physician is unethical - patient autonomy is to always be respected, so the decision to have or forgo a mammogram is your decision alone and if you choose not to, your doctor should not withhold treatment - if they disagree with your choice, they should ask you to find another physician, give you adequate time to do so and continue your prescriptions until you do so!

 

:iagree:However, I don't think that it is particuliarly uncommon and that is one of the major reasons that I have not been to the doctor for about 7 years now.

[Ottakee]

Coercion by a physician is unethical - patient autonomy is to always be respected, so the decision to have or forgo a mammogram is your decision alone and if you choose not to, your doctor should not withhold treatment - if they disagree with your choice, they should ask you to find another physician, give you adequate time to do so and continue your prescriptions until you do so!

 

Not so sure on this one. This was the first time she had seen this doctor so it wasn't like she wouldn't continue treatment, etc. I can see from the doctor's point of view that they want to rule out any other complicating or contra indicated usage things before giving out the hormones.

 

My girls are on lots of meds but we have to get regular blood work, EEGs, EKGs, kidney and heart ultrasounds, etc. to make sure that the meds are making anything worse.

 

While mamograms are NOT fun they can be life threatening and I guess I would rather have a doctor that said, "hey, before I prescribe something that might cause any potential breast cancer to get worse, I want you to get a mamogram" than to have the doctor just prescribe away without taking the precautions.

[dancer67]

No, I am not a regular patient of hers. I have a seperate GYN. This was my first visit with her. I guess I was shocked to hear about the mammogram requirement though.

 

And with all the changes in guidelines to have one done, it just makes things more confusing. Especially if Progesterone(Natural or synthetic) increases that risk. And I don't know if it does or doesn't?

[Tigger]

Not so sure on this one. This was the first time she had seen this doctor so it wasn't like she wouldn't continue treatment, etc. I can see from the doctor's point of view that they want to rule out any other complicating or contra indicated usage things before giving out the hormones.

 

My girls are on lots of meds but we have to get regular blood work, EEGs, EKGs, kidney and heart ultrasounds, etc. to make sure that the meds are making anything worse.

 

While mamograms are NOT fun they can be life threatening and I guess I would rather have a doctor that said, "hey, before I prescribe something that might cause any potential breast cancer to get worse, I want you to get a mamogram" than to have the doctor just prescribe away without taking the precautions.

 

Except she already had a baseline done in 2009, so it's within 5-years and unless she has a specific risk, there is no reason to order another mammogram at this point in time. Blood work, sure, absolutely, to make sure the hormones are being given in the right dose, but to coerce a patient for a test that is not indicated (she had one already two years ago), there is no good reason for withholding a course the patient wants to do and is fully informed about.

[TranquilMind]

She told me that unless I had a mammogram(I am 44, had a baseline done in Oct of 2009) she would not prescribe any natural hormones.

 

Huh????

 

So I am confused. If I take natural progesterone, or synthetic Micronor(mini-pill which my GYN prescribed but had not taken it yet) that mammograms are a must....????????

 

Is this true? Does taking progesterone increase your risk of breast cancer?

 

In the end, she said I was better off to take the Micronor(mini pill) because the amount of Progesterone in that is much greater then she could ever prescribe in a natural form. True?

 

I wasn't planning on getting another mammo until I was 50.Or at all. I told her this and she frowned on it. She said if I am taking hormones, I should be getting mammos' every year.

 

In the end, she said she couldn't help me, and to take the mini-pill and that should help with the pre-period spotting and bad cramps.

 

Well, geez....

 

My GYN already told me that, but I wanted to try a natural approach first. But no mammogram=no biodentical hormones. She mentioned thermogram but insurance does not pay for it, and there is only one and it is two hours away. I have no family history of any reproductive cancers in the family.(I know that doesn't mean much), but I felt badgered.

 

What do you think of this?

 

(PS I waited TWO months for this appt)

Mammograms are not even recommended now until you are 50, unless there is some reason or family history. And you JUST had one a couple of years ago? Really?

 

Sheesh. Go elsewhere.

[dancer67]

Mammograms are not even recommended now until you are 50, unless there is some reason or family history. And you JUST had one a couple of years ago? Really?

 

Sheesh. Go elsewhere.

 

Yes. In October of 2009. BUT, I was taking natural progesterone. And now I am going to be starting Micronor(Synthetic Progesterone mini-pill), does that change things now about getting mammo's? She made it seem like if I am taking ANY hormones, I need a mammo starting at age 40 every year.

 

I wasn't planning on getting one until I was 50.

 

No family history of reproductive cancers. Breast or otherwise. Not even any female issues expecpt my grandmother who had a hysterectomy at 45, but back then it was routine if you had heavier bleeding during perimenopause.

[Bang!Zoom!]

I just want to say I take estrogen, do mammograms yearly.

 

The exam is NOT painful at all.

 

Having swirling estrogen issues IS incredibly painful, mentally and physically, not just for the person experiencing it, but realize it affects others around you.

 

If they required me to have bi-weekly mammograms to continue treatment, I'd do it in a heartbeat and smile all the way through.

 

If you have a uterus (which I don't) and are using hormones, then it's quite reasonable to monitor breast health while having therapy.

[dancer67]

Except she already had a baseline done in 2009, so it's within 5-years and unless she has a specific risk, there is no reason to order another mammogram at this point in time. Blood work, sure, absolutely, to make sure the hormones are being given in the right dose, but to coerce a patient for a test that is not indicated (she had one already two years ago), there is no good reason for withholding a course the patient wants to do and is fully informed about.

 

And she refused to do bloodwork. She said that she has being doing biodentical hormones for "years", and that bloodwork for hormone testing, of any kind, does not give you any kind of big picture for her to prescribe a "tailored" hormone plan.

 

She said that if I got a mammo, she would give me 100mg of some kind of natural progesterone to start. But no mammo=no hormones.

 

She said to take the Micronor, it would help me better with the terrible cramps I get during the time I spot prior to my periods, and that the hormones she would give me would not help alleviate cramping, only possibly alleviate the spotting.

 

My periods are not overly heavy. I have had all kinds of tests done(minus a hysteroscopy and laparoscopy) because I was DX a half ago with iron def anemia. So I had internal

ultrasounds and uterine biopsy. I have never had a fibroid or even a cyst(and I have had LOTS on internal U/S). I also had a colonoscopy, which was clear. I do bleed heavier on day 2. My diet sucks and apparently I had been anemic since around 2006 and not one Dr ever said anything to me until July of 2010. My ferritin was an 8. my HGB was low at around 11.1(Never below that). So it has been determined it is from my heavier bleeding on day 2. But honestly, I don't care about that. I don't care that I get my periods(Well I do, but it isnt something I am desperate to get rid of).

 

What I WANTED, was to get rid of this dang 3-5 day spotting prior to my periods with horrible cramps. Once I get my period, the cramps are much better and a couple of Ibuprofen takes care of it. When I am spotting, I feel bloated, ny bOOks hurt, I have horrific cramps that even 2400mg of Ibuprofen doesn't help much.

 

Plus it seems like I am bleeding(even though it is scant spotting) for approx 11 days out of the month. I hate it.

 

Even endo ablation would not stop the cramps I was told. It would reduce or stop the bleeding, but not the cramps. And if I could just get rid of those darn cramps I would even take the spotting.

 

They asked me about endometriosis. Well, I asked my GYN about it, and he says it doesn't seem likely. Especialy since I dont have horrific cramps when I have my period. And I am not soaking pads on my second day, just changing more often(An overnight pad every 1-3 hours) and my periods last about 5-6 days. And on day 3 and 4 it is very light. 5 and 6 is light spotting then done.

 

My anemia has now been corrected. I do take 3 iron pills a day. HGB is good now and ferritin is up to 25. I also take a pill for IBS that reduces stomach acid so I am sure that has something to do with

it as well. My Hematologist does bloodwork now only every 4 months instead of every 2. Now I am just considered "Iron Deficient".

 

I don't know, a vag hysterectomy is sounding better and better to me. A friend of mine(acutally a few friends of mine) had it done and they said they wish they had done it sooner. No cramps, no bleeding, no nothing.

 

Recovery time was quicker(faster then a c section). I don't know, sick of all of this.

 

So, guess I am going to get on the Micronor. See if that helps. Gonna pray it helps with the cramping and spotting.

 

And, I cannot even see another bio Dr. as she is the only one in this area. Bummer.

Edited December 24, 2011 by dancer67

[dancer67]

The exam is NOT painful at all.

 

 

 

No, I know it isn't. I had a baseline done in 2009. But with the new guideline changes I was going to wait until I was 50.

 

She just said that taking the Micronor would be better for me anyways because the biodentical hormones would NOT help with my painful cramps during the time I spot.

 

She just seemed to kind of brush me off.

 

Then she said "Sounds like to me though, you would be a good candidate for HRT when you go through menopause"

 

HUH???!!!???? no thanks.

[TranquilMind]

Yes. In October of 2009. BUT, I was taking natural progesterone. And now I am going to be starting Micronor(Synthetic Progesterone mini-pill), does that change things now about getting mammo's? She made it seem like if I am taking ANY hormones, I need a mammo starting at age 40 every year.

 

I wasn't planning on getting one until I was 50.

 

No family history of reproductive cancers. Breast or otherwise. Not even any female issues expecpt my grandmother who had a hysterectomy at 45, but back then it was routine if you had heavier bleeding during perimenopause.

It's not even safe to get a mammo every year from 40 on. The radiation causes changes that can lead to the very cancer they SAY they are trying to avoid (though my inner skeptic notes that breast cancer is an extremely lucrative business in the billions per year).

 

I had one at 40. I won't be having another unless there is a significant reason to do so.

[dancer67]

It's not even safe to get a mammo every year from 40 on. The radiation causes changes that can lead to the very cancer they SAY they are trying to avoid (though my inner skeptic notes that breast cancer is an extremely lucrative business in the billions per year).

 

I had one at 40. I won't be having another unless there is a significant reason to do so.

 

:iagree:

[TranquilMind]

dancer67: And she refused to do bloodwork. She said that she has being doing biodentical hormones for "years", and that bloodwork for hormone testing, of any kind, does not give you any kind of big picture for her to prescribe a "tailored" hormone plan.

 

She said that if I got a mammo, she would give me 100mg of some kind of natural progesterone to start. But no mammo=no hormones.

 

I'm starting to get annoyed with this doctor on your behalf!

 

My periods are not overly heavy. I have had all kinds of tests done(minus a hysteroscopy and laparoscopy) because I was DX a half ago with iron def anemia. So I had internal

ultrasounds and uterine biopsy. I have never had a fibroid or even a cyst(and I have had LOTS on internal U/S). I also had a colonoscopy, which was clear. I do bleed heavier on day 2.

 

Everybody bleeds heavily on Day 2! I am over 50 and the pattern was quite clear. I'm not done but have periods more infrequently now, after 40 years on absolutely on time regular periods. After you have kids and are in your 40's, the periods will get heavier and heavier toward 50, and then will begin to lighten up in late 40's. Then finally you will have periods closer together, like every three weeks, and then skip a month (yahoo!).

 

 

My diet sucks and apparently I had been anemic since around 2006 and not one Dr ever said anything to me until July of 2010. My ferritin was an 8. my HGB was low at around 11.1(Never below that). So it has been determined it is from my heavier bleeding on day 2. But honestly, I don't care about that. I don't care that I get my periods(Well I do, but it isnt something I am desperate to get rid of).

 

Fix your diet and some of these issues will become better, I promise!

 

What I WANTED, was to get rid of this dang 3-5 day spotting prior to my periods with horrible cramps. Once I get my period, the cramps are much better and a couple of Ibuprofen takes care of it. When I am spotting, I feel bloated, ny bOOks hurt, I have horrific cramps that even 2400mg of Ibuprofen doesn't help much.

 

Why? Has the gyn examined why you are having this problem? My apologies if you answered this and I missed it. Rather than give you medication for it, your doctor or gyn needs to find the root. If they can't, go to an alternative doc who can.

 

Plus it seems like I am bleeding(even though it is scant spotting) for approx 11 days out of the month. I hate it.

 

Some women do do this, I'm sorry to say.

 

Even endo ablation would not stop the cramps I was told. It would reduce or stop the bleeding, but not the cramps. And if I could just get rid of those darn cramps I would even take the spotting.

 

 

Sounds bad. I'm sorry.

I don't know, a vag hysterectomy is sounding better and better to me. A friend of mine(acutally a few friends of mine) had it done and they said they wish they had done it sooner. No cramps, no bleeding, no nothing.

 

Well, my Mom had to have this done and they took 10 years to figure it out. She felt like a new person afterward, as they had been telling her to take Darvon and deal with it.

 

 

And, I cannot even see another bio Dr. as she is the only one in this area. Bummer

 

I'd drive out of area if she told me I had to get more radiation exposure when I'd just had a mammo a short time ago.

[Tigger]

 

My periods are not overly heavy. I have had all kinds of tests done(minus a hysteroscopy and laparoscopy) because I was DX a half ago with iron def anemia. So I had internal

ultrasounds and uterine biopsy. I have never had a fibroid or even a cyst(and I have had LOTS on internal U/S). I also had a colonoscopy, which was clear. I do bleed heavier on day 2. My diet sucks and apparently I had been anemic since around 2006 and not one Dr ever said anything to me until July of 2010. My ferritin was an 8. my HGB was low at around 11.1(Never below that). So it has been determined it is from my heavier bleeding on day 2. But honestly, I don't care about that. I don't care that I get my periods(Well I do, but it isnt something I am desperate to get rid of).

 

What I WANTED, was to get rid of this dang 3-5 day spotting prior to my periods with horrible cramps. Once I get my period, the cramps are much better and a couple of Ibuprofen takes care of it. When I am spotting, I feel bloated, ny bOOks hurt, I have horrific cramps that even 2400mg of Ibuprofen doesn't help much.

 

Plus it seems like I am bleeding(even though it is scant spotting) for approx 11 days out of the month. I hate it.

 

Even endo ablation would not stop the cramps I was told. It would reduce or stop the bleeding, but not the cramps. And if I could just get rid of those darn cramps I would even take the spotting.

 

They asked me about endometriosis. Well, I asked my GYN about it, and he says it doesn't seem likely. Especialy since I dont have horrific cramps when I have my period. And I am not soaking pads on my second day, just changing more often(An overnight pad every 1-3 hours) and my periods last about 5-6 days. And on day 3 and 4 it is very light. 5 and 6 is light spotting then done.

 

 

You NEED a diagnosis as to what is wrong. Your doc is not taking the time to evaluate your symptoms and doing the necessary tests to actually diagnosis what is causing your symptoms, instead you're getting things thrown at you, hoping something sticks to work.

 

Personally, I'd find someone else for one.

 

While endometriosis is probably not your problem, it isn't impossible, it's just an unlikely suspect.....more likely is a fibroid that isn't being seen on ultrasound (depends on the quality of the image, the competence of the imager and who reads it), it could also be polyps in your uterus which are notoriously difficult to see on ultrasound, and may even be adenomyosis (like endometriosis, but inside the uterus and won't be seen on ultrasound). To figure this out, you need to have a laparoscopy and a hysteroscopy done, by someone competent and prepared to take care of whatever they find while they're doing them.

[cin]

I have the same problems, horrific cramps 2-3 days, heavy bleeding and horrific PMS. I am on the pill with NO break. Therefore, I have no periods. My Dr. told me that I need to have a mammogram every year now. I'm almost 47. I'll have the mammogram every year if it means that I can have my life back.

[TracyR]

That is strange. From my understanding natural hormones do not place you in any danger of developing cancers. Its the synthetic that you need to worry about it.

Thermograms are MUCH better to have than Mammograms. Mammograms set you in a high risk for developing cancers too (radiation).

 

If you already know what you need you could always order it online and bypass the doctors altogether. http://www.iherb.com/Life-Flo-Health-Progesta-Care-Natural-Progesterone-Body-Cream-Tropical-4-fl-oz-118-ml/29794?at=0

 

That just does not sound right at all. I've yet to hear of other doctors requesting something like that before giving Bioidentical Hormones. You need a different doc. But your story doesn't surprise me as I've dealt with doctors like that too.

 

Also, have you had your thyroid checked out? Heavy periods, anemia,,, hmmm, sounds a bit thyroidish to me.

Edited December 25, 2011 by TracyR

[dancer67]

I was pretty annoyed with that Bio Dr. as well.

 

 

Yes, I have had all my thyroid levels done.(Free T3 or whatever they are called, everything has always been normal)

 

I have had this for 2 1/2 years. It hasn't gotten worse, or better. It is the same every month. My GYN did mention laparoscopy, but didn't feel it was necessary. And I am scared of any invasive tests, Hysteroscopy I heard is the most painful thing on earth, so no thanks. They would have to put me out and I hate that as well. If they are gonna knock me out then just rip out my uterus. :confused:

 

So, if I take synthetic progesterone,(Micronor) do I need to get a mammo done every year then?

 

You guys have given me some great advice and I appreciate all the feedback.

Edited December 25, 2011 by dancer67

[Michelle in AL]

Breast cancers can feed off estrogen and other hormones. She might be playing it safe and checking to make sure there is no cancer before she prescribes hormones, which would be responsible in my opinion.

 

I'm an oncology nurse and most of the people I know who have breast cancer are under 50 (this includes patients, family and friends). Granted, in the hospital I only see the worst cases, but the worst cases are almost always under 50, so a mammogram is worth the risk for some.

[dancer67]

Breast cancers can feed off estrogen and other hormones. She might be playing it safe and checking to make sure there is no cancer before she prescribes hormones, which would be responsible in my opinion.

 

I'm an oncology nurse and most of the people I know who have breast cancer are under 50 (this includes patients, family and friends). Granted, in the hospital I only see the worst cases, but the worst cases are almost always under 50, so a mammogram is worth the risk for some.

 

If this is the case, then why didn't my GYN tell me to have a mammo before he gave me the micronor? He asked me about having one, I declined, I said I wanted to wait until I was 50, and he said "Ok, no mammo until 50" and gave me a script for it.

 

He was respectful of my decision.

 

 

I cannot find any evidence that supports an increase of BC for POP users. Only combined pills. Maybe someone can chime in and answer this question for me.

[zookeeper]

I didn't read all the replies, but I would say find a different dr. It doesn't sound like this dr is really that knowledgeable about bioidentical hormones.

[Catherine]

No physician is going to prescribe a medication that increases the risk of a major, major problem, without insisting that the patient have an appropriate screening procedure, if it exists, first. Patient autonomy simply means that patients have the right to make their own choices about their lives and their treatment. They do not have the "right" to any prescription medication on terms other than the prescriber's, including their own.

[Catherine]

Endometrial cancers are in many cases causes by estrogen overstimulation. Obese women store estrogen in their fat cells and because it hangs around longer in the body, it overstimulates the endometrial lining, leading in some cases to cancer.

[HiddenJewel]

Can you get a thermogram instead?

[StephanieZ]

Coercion by a physician is unethical - patient autonomy is to always be respected, so the decision to have or forgo a mammogram is your decision alone and if you choose not to, your doctor should not withhold treatment - if they disagree with your choice, they should ask you to find another physician, give you adequate time to do so and continue your prescriptions until you do so!

 

Well, it is not coercion. The DR is a professional, not a superstore. You don't get to choose how they practice medicine. I don't know the relevant medicine, but there are MANY circumstance where a DR can and should refuse requested treatment if the DR does not deem it safe or necessary. In this case, presumably the DR does not feel it is safe to prescribe the medication w/o a recent mammogram.

 

If you went to a DR and demanded narcotics, it is obvious that it is reasonable for the DR to refuse them if they didn't feel they were medically needed, or if you refused whatever baseline tests the DR felt was standard-of-care needed to ensure you were a good candidate for the drug and that the drug was going to help you and not harm you.

 

It IS the DR's obligation to use their judgment in these areas.

 

There is NO DOCUMENT a patient can sign that can prevent the DR from carrying ethical, legal, and financial responsibility for the care they provide. If the DR does something contrary to reasonable medical prudence, they can and often are held responsible -- losing licenses, losing huge $$, possibly losing their entire livelihood.

 

In this particular case, I have no idea why the DR requires a mammogram, and if she can't explain it to your satisfaction, then you just need a different doctor.

[BamaTanya]

Hysteroscopy I heard is the most painful thing on earth, so no thanks.

 

I don't have much knowledge on your particular issues, but I did have a hysteroscopy to try to determine heavy blood loss. It was not painful at all. I had read about it beforehand and considered taking pain medication beforehand. I opted, instead, to wait and ask for something if I needed it. I was completely unmedicated and alert while the dr showed me everything he was doing on the screen. It was interesting! Seems like they gave me a few minutes to lie still afterward before helping me to sit up and asked me if I felt okay . . . No cramping or dizziness. I was surprised since I'd expected it to be worse.

 

I know that doesn't mean it's the same for all women, but I want you to know that it isn't necessarily painful at all.

[dancer67]

Can you get a thermogram instead?

 

No. My insurance doesn't pay for it.:confused:

[dancer67]

Endometrial cancers are in many cases causes by estrogen overstimulation. Obese women store estrogen in their fat cells and because it hangs around longer in the body, it overstimulates the endometrial lining, leading in some cases to cancer.

 

Well, I am not sure about this. I haven't done a lot of reading on Estrogen(and didn't know they made natural estrogen??) I do know that Progesterone protects the uterus from uterine cancers.

 

But, I am still wondering about Progesterone, and if there is an increased risk of breast cancer?

[Michelle in AL]

I use google scholar for almost all my medical research. It produces articles that are usually scientifically significant. Here's 2 that refer to progesterone use and breast cancer:

 

http://www.sciencedirect.com/science/article/pii/S0046817789800036

 

http://cebp.aacrjournals.org/content/11/11/1375.short

 

Oral contraceptives do have some cancer protective properties, that make their use worthwhile. They also are very effective for treating a multitude of cycle related difficulties that truly effect the quality of life.

 

If you search bioidentical hormones on googlescholar, you'll get a wealth of information too that may help you decide how to best treat your issues.

[Tigger]

Well, it is not coercion. The DR is a professional, not a superstore. You don't get to choose how they practice medicine. I don't know the relevant medicine, but there are MANY circumstance where a DR can and should refuse requested treatment if the DR does not deem it safe or necessary. In this case, presumably the DR does not feel it is safe to prescribe the medication w/o a recent mammogram.

 

If you went to a DR and demanded narcotics, it is obvious that it is reasonable for the DR to refuse them if they didn't feel they were medically needed, or if you refused whatever baseline tests the DR felt was standard-of-care needed to ensure you were a good candidate for the drug and that the drug was going to help you and not harm you.

 

It IS the DR's obligation to use their judgment in these areas.

 

There is NO DOCUMENT a patient can sign that can prevent the DR from carrying ethical, legal, and financial responsibility for the care they provide. If the DR does something contrary to reasonable medical prudence, they can and often are held responsible -- losing licenses, losing huge $$, possibly losing their entire livelihood.

 

In this particular case, I have no idea why the DR requires a mammogram, and if she can't explain it to your satisfaction, then you just need a different doctor.

 

My comment about patient autonomy was specifically because the OP had a mammogram in 2009 - two years ago. There is no reason to require another one at this time, so patient autonomy here is relevant. The OP still has no diagnosis as to what is wrong either - simply throwing various meds and hormones at an unidentified problem is not IMO acceptable - she really needs to know what is causing the problem so that the various things they're doing don't exacerbate something that could be serious!

[dancer67]

My comment about patient autonomy was specifically because the OP had a mammogram in 2009 - two years ago. There is no reason to require another one at this time, so patient autonomy here is relevant. The OP still has no diagnosis as to what is wrong either - simply throwing various meds and hormones at an unidentified problem is not IMO acceptable - she really needs to know what is causing the problem so that the various things they're doing don't exacerbate something that could be serious!

 

Is spotting prior to periods in perimenopausal years common? You are saying something could be "serious". Not sure what that means. My GYN says it is a drop in Progesterone. Common in women my age. I have had this for 2 1/2 years. The cramping has *maybe* gotten a little worse, but the spotting pattern has not changed at all. And neither have my periods. They come about every 25-27 days, lasting 5-6 days. And I know I am going to spot when my bOOks start hurting about 2 days prior.

 

I would assume, being I have had this for such a long time, with really no change, it would get worse over time.

 

I don't know. I just know I loathe tests, since I have been poked and prodded so many times.

 

If the Micronor does not work, I will be back at the GYN and I will speak to him about further testing.

 

I guess I was under the impression that spotting prior to getting your periods at my age(44) is quite common. Maybe not then?

[Tigger]

Is spotting prior to periods in perimenopausal years common? You are saying something could be "serious". Not sure what that means. My GYN says it is a drop in Progesterone. Common in women my age. I have had this for 2 1/2 years. The cramping has *maybe* gotten a little worse, but the spotting pattern has not changed at all. And neither have my periods. They come about every 25-27 days, lasting 5-6 days. And I know I am going to spot when my bOOks start hurting about 2 days prior.

 

I would assume, being I have had this for such a long time, with really no change, it would get worse over time.

 

I don't know. I just know I loathe tests, since I have been poked and prodded so many times.

 

If the Micronor does not work, I will be back at the GYN and I will speak to him about further testing.

 

I guess I was under the impression that spotting prior to getting your periods at my age(44) is quite common. Maybe not then?

 

No, it isn't quite common - you're only 44 and this started when you were 42 -- something changed that is causing spotting, cramps and tender B00ks a few days before your period starts.....your cycle however remains the same at 25-27 days, so your luteal phase (from ovulation to period) remains, but something is interfering with it being firmly set, your spotting before you should be shedding any of your lining. IF it was progesterone that was the issue, supplemental progesterone would resolve the problem....it hasn't - that indicates that something else is potentially going on - this is where your doctor is supposed to be a detective and find out what that something is!

 

Is it that your progesterone supplement isn't enough, or that your estrogen is also off and not being resolved to balance? (this can be answered with some serial blood work for hormone levels)

Is it that you have adenomyosis (like endometriosis, but inside your uterus)?

Is it that you have some polyps that are not seen on ultrasound?

Is it that you have a small growth (fibroid) that has been missed on ultrasound?

Is there something structural that's not been a problem in the past that is now?

Is there a hormone releasing tumor somewhere?

 

Is your doctor doing the ultrasound himself, or relying on a tech to do it and read it for him? Or is he at least present to read the scan while it's being done if he's not actually doing it himself?

 

There are a number of things that could be causing your symptoms and that they remain unresolved, to me, is concerning - if it were me, I'd want to know what is going on with a definitive diagnosis and not have the doc put band-aids on it and hope for the best....there are too many things it could be and that it remains a problem - that's a problem!

 

A laparoscopy and hysteroscopy isn't the worse thing in the world - they allow for a clear view inside to rule out or diagnosis the potential for what's going on - with a definitive diagnosis, you can then actually get treated for the cause, without it, you're flying blind, hoping it'll get better, and continue along with no resolution, ykwim?

 

As I said in another post, find a doctor who knows what they're doing with regard to the hysteroscopy and laparoscopy and be sure they're prepared (you've consented) to take care of anything found while you're under so you don't have to have a second anesthesia (unless you want to wake up and think about what needs to be done, that's okay too).

[dancer67]

Do they do both tests, or do they only need to do one?

 

The only thing I have tried is thre months of natural pogesterone cream and that didnt help, but I found out I wasn't using it properly anyways.

 

But, I do get what your saying.

 

I have not taken the Micronor yet. If it fails, I will be speaking with my GYN about getting those tests done and getting to the bottom of this.

 

Oh, and if i do get those tests done, they can take whatever they want, as long as it stops me from spotting and cramping.

 

Thank you for the advice!

[HiddenJewel]

No. My insurance doesn't pay for it.:confused:

 

Neither does mine so I pay for my thermograms out of pocket. You can detect unhealthy tissue much earlier than a mammogram when treatment does not have to be as severe, and it does not carry the risks that the mammograms carry. If you see an issue on a thermogram you can then follow up with further testing if desired.

[Tigger]

Do they do both tests, or do they only need to do one?

 

The only thing I have tried is thre months of natural pogesterone cream and that didnt help, but I found out I wasn't using it properly anyways.

 

But, I do get what your saying.

 

I have not taken the Micronor yet. If it fails, I will be speaking with my GYN about getting those tests done and getting to the bottom of this.

 

Oh, and if i do get those tests done, they can take whatever they want, as long as it stops me from spotting and cramping.

 

Thank you for the advice!

 

Both should be done at the same time - some surgeons want to schedule them separate, but it isn't for safety, it's to bill you fully for both as separate surgeries which is wholly unnecessary - when they're done together there is only one billing for anesthesia, OR time and the first is full surgeon fees, the second is half billed because the whole set up to get started is already done. When I suggest the doctor need be prepared to take care of anything found, I'm talking about things like polyps or fibroids - you're under, no need to wake you up and take you into another surgery for something you already know you'll consent to -- but, I'd caution not to consent to conversion to a full-open surgery to do something like a full hysterectomy -- for something like that you'll either want to be consulted (unless what's found is immediately life threatening), thus woken up, or have your designated health person (like a husband or parent) consulted before anything radical is done....on some big things you will want a second opinion!

[Staceyshoe]

It sounds like this dr is not knowledgable at all about the differences between bio-identical hormones and synthetic ones. I would get a second opinion from another dr. Usually compounding pharmacists can recommend a dr if you're having trouble finding one.

 

So sorry you had a bad experience!:grouphug:

[dancer67]

Both should be done at the same time - some surgeons want to schedule them separate, but it isn't for safety, it's to bill you fully for both as separate surgeries which is wholly unnecessary - when they're done together there is only one billing for anesthesia, OR time and the first is full surgeon fees, the second is half billed because the whole set up to get started is already done. When I suggest the doctor need be prepared to take care of anything found, I'm talking about things like polyps or fibroids - you're under, no need to wake you up and take you into another surgery for something you already know you'll consent to -- but, I'd caution not to consent to conversion to a full-open surgery to do something like a full hysterectomy -- for something like that you'll either want to be consulted (unless what's found is immediately life threatening), thus woken up, or have your designated health person (like a husband or parent) consulted before anything radical is done....on some big things you will want a second opinion!

 

Thanks Tigger. Honestly, I am scared to death of general anesthesia. I had sedation with my colonoscopy, and although I did fine, it is not something I would like to do again.(I have a severe phobia of anesthesia, and think I am not going to wake up).

 

With that said though, if the Micronor does not help, it is at the point where I am going to have to suck it up and see the Dr. and demand answers. Because I am tired of the cramps with the spotting every month.

And when that happens, lets hope it isn't a time I have the cramps/spotting when I have those tests done because that is when I get to the point of just telling them to take out my uterus and be done with all this!

 

no uterus,=no cramps, no periods, no feminine products,no iron def, and never have to worry where the bathroom is on my second day. I don't know, sounds pretty good to me.:tongue_smilie:

[Sara R]

Is this true? Does taking progesterone increase your risk of breast cancer?

 

Breast cancers can be estrogen and/or progesterone positive or negative. If a cancer is progesterone positive, that means that progesterone causes it to grow. Each case of cancer is tested to see if it is hormone positive or negative.

 

My cancer (diagnosed at age 32) was estrogen positive. That's natural, bio-available estrogen, nothing synthetic. I wasn't on any artificial hormones. Mine was progesterone negative, but other cancers are progesterone positive.

 

If you had an undiagnosed progesterone positive cancer at the time you started taking progesterone, that would be a bad thing.

 

I don't know if there is any proof either way of progesterone increasing the risk of breast cancer. I know a lot of young women on the internet message boards who had their suspicions.

 

Is breast cancer in your 40s uncommon? Not exactly. The absolute risk is 1 in 69. It's great that you don't have a family history, but neither do 4 out of 5 of new breast cancer cases.

[Negin]

It's not even safe to get a mammo every year from 40 on. The radiation causes changes that can lead to the very cancer they SAY they are trying to avoid (though my inner skeptic notes that breast cancer is an extremely lucrative business in the billions per year).

I had one at 40. I won't be having another unless there is a significant reason to do so.

:iagree:

Thermograms for me and no mammograms until 50 or over, and only if there's a good reason for one. I would rather do daily self-checks and be fully aware of what's going on. I have lots and lots of info on all this, but don't wish to overwhelm. If anyone is interested, I can post.

[mom2hunangirls]

I would say, at this point, get a laparoscopy and hystersopy. That will show things that other tests won't. I was having similar issues and had 3 sonograms and saw nothing...went in to look for endo and lookey! A lemon-sized fibroid hiding right on top of my uterus. And tons of endo.

So much junk in our food system mimics estrogen and cutting out that stuff has made a huge difference in cramps for me.

I wouldn't be appalled at the dr. I'm frustrated with my internist for just rxing one med after another and never suggesting I just make some healthy changes in my life. You are free to go to someone else. But if it's really that you are now just confused why....I would do the other tests (lapro etc).

The lapro/hystersopy have zero recovery time. I had a longer one due to getting the surprise lemon out. My friend just did this for your exact symptoms and they found "severe endo" and she took a week of taking it easy to recover (mostly from co2)...but she was able to do what needed doing.

[dancer67]

Even if they found polyps in my uterus by doing these tests, I have read that the best way to reduce them or get rid of them is with progestins anyways. Statistics showed that women who have had them removed surgically, a big percentage were not happy with the results and did not fix the problem, they were given progestins anyways. Because they almost always grew back within the year without some kind of hormonal treatment.

 

True?(I read this on the NEJM site)

 

As far as fibroids, if they have done an internal and external ultrasound(on several occassions) wouldn't that show a lemon sized fibroid? A tech does my U/S, but she is not allowed to read them. My GYN interprets the results.

 

I have also had a uterine biopsy that was negative for anything, and even during my U/S my endo lining was perfect for the timing of my periods.

 

They measured my uterus on several occassions and was all normal as well.

 

I am not an overly-heavy bleeder. I do not flood, and I can leave my home, even on the second day. I do not pass clots very often at all. My bleeding time is normal, never longer then 7 days and that is only scant spotting, and it is rare. It is usually 6 days.

 

Before I do any(even minimally) invasive surgery, I am going to try the non-invasive route first. By trying the micronor. If that fails, then I will insist on those tests. Then I will know once and for all. If it shows nothing, then they will have to tell me it is hormone related, I would assume.

 

I just keep praying for menopause.:)

Edited December 27, 2011 by dancer67

[zookeeper]

I am so sorry you had such a bad experience with this dr! She really sounds like she doesn't know that much about bio-identical hormones. They have really changed my life! It took some looking around and trying different drs before I finally found one who knew what she was talking about. Keep looking if you can! It's so worth it!