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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by suzie2u on May 17, 2001, at 21:43:36
Onset of menopause was due to treatment for breast cancer at age 32.
Hysterectomy was indicated due to estrogen receptors in the tumor.
Instant menopause was worse than having cancer! That is when the insomnia began.
Two years later my GYN put me on estrogen for osteoporosis which another doctor
took me off a couple of years later. I did have a recurrence of the breast cancer in
1991 but chose to do only a partial mastectomy (lumpectomy first go around). Oncologist
gave me two months to two years to live. (unclear margins) HELLO? Left the traditional medicine
for awhile and had a clear bone scan and mammogram last year :-).
This is my first post (sorry if this is too long) but I have been tortured with insomnia
except for the period of time that I was on estrogen. Doctors practically run screaming
from the building when I mention that I want to go back on HRT. I have been taking
Prosom and Ambien (alternating) for about ten years. Sometimes it works, sometimes
it doesn't. I found that increasing the dose does not increase the benefits. They either
work or they don't. Alternating cuts back on the dependency issues (sort of). The deal is
I would rather shorten my life if necessary and get some good quality sleep. After all, it
is the quality of life not the quantity that counts. I really would like some of you to give
me some feedback (please?). There are many different kinds of HRT now and it frankly confuses me.
I have an appointment next week and would really like to present the pros and cons of different
medicines. It took ten years for the cancer to show up agin and now it is almost 20 from the initial
occurance. I range in poor quality sleep from 1-5 hours a night. Oh, I have a seizure disorder
which Lamictal is treating very nicely. I also have migraines which Verapamil with B2 and baby
asprin daily treat beautifully. Now to cure the insomnia and I am golden!
Thank you.
Posted by SalArmy4me on May 18, 2001, at 0:42:52
In reply to HRT for insomnia post breast cancer, posted by suzie2u on May 17, 2001, at 21:43:36
You gotta read this...sorry its so long, but its good and I don't have the link for it:
Barlow, David H. Managing the menopause: from pumpkins to HRT. Lancet. 342(8863):66-67, July 10, 1993:
The consequences of the menopause have now exploded into an important public health issue. Today there can be few medical abbreviations better known to the lay public than HRT (hormone replacement therapy). Previously, the problems of the menopause were not thought to be very serious in terms of mortality or major morbidity statistics, and few women who were distressed by their symptoms were prepared to seek help.The effects of oestrogen withdrawal on the female skeletal and cardiovascular systems are reasonably well established. Similarly, the effects of oestrogen replacement in reducing fracture and cardiovascular disease risk are in little doubt today, although unresolved issues include how we should best balance benefit against risk and side-effects for the individual. Nevertheless, our insight into the more immediate aspect of the menopause-the menopausal syndrome-is still incomplete and this condition is not necessarily regarded as very important if studies of the care given to the women most at risk are representative [1,2]. .
Two papers from Leiden now highlight some of these issues [3,4]. Nearly 1000 hysterectomised and about 5500 non-hysterectomised women aged between 39 and 60 years in Ede, Netherlands, completed a detailed symptom questionnaire. The investigation examined not only undisputed menopausal symptoms, referred to as "typical" (hot flushes and sweats or vaginal dryness) and which affected most of those in the menopausal transition, but also twenty-one "atypical" symptoms which are either thought to be unrelated to the menopause or are disputed. Many women reported that atypical symptoms were troublesome and contributed to reduced well-being. Commonly these complaints responded to HRT, particularly tiredness and tenseness, but since the improvement correlated with the improvement in the typical symptoms the researchers concluded that any benefit of HRT was likely to be via the improvement in typical symptoms with the "atypical" improvement as a secondary effect. In addition, the hysterectomised women reported significantly more typical and atypical symptoms, especially in the youngest age groups studied (39-41 years), whether or not the ovaries had been retained.
Useful information on the prevalence of atypical symptoms was provided some years ago by Vessey's group in Oxford who showed evidence for an increase in psychological symptoms at the menopausal years-an association which could be primary or secondary to other effects, such as night sweats causing insomnia [5]. I would dispute the suggestion by the Leiden group that a correlation of some atypical symptoms with the severity of typical symptoms "proves" that the former are necessarily secondary effects. The researchers could be observing two parallel primary responses to oestrogen deficiency. In my view the nature of the psychological morbidity at the menopause remains controversial in terms of its origin but there is evidence from controlled studies that, for some women, HRT substantially improves the psychological symptoms [6,7]. I agree with the Dutch workers that the response to distressing psychological symptoms at the menopause should not be, at an early stage, an offer of tranquillisers or antidepressants when explanation, reassurance, and an offer of HRT may be more directly relevant.
The other important issue is the plight of hysterectomised women, with or without retained ovaries, who have been shown repeatedly to be more likely to experience menopausal symptoms than other women of the same age [8,9] and yet who still have a low level of HRT use [1].
Posted by suzie2u on May 18, 2001, at 20:49:40
In reply to Re: HRT for insomnia post breast cancer » suzie2u, posted by SalArmy4me on May 18, 2001, at 0:42:52
Thanks!
Posted by Chris A. on May 19, 2001, at 15:00:26
In reply to HRT for insomnia post breast cancer, posted by suzie2u on May 17, 2001, at 21:43:36
Have you tried raloxifene (Evista)? It is a selective estrogen receptor modulator (SERM). It is an estrogen antagonist in breast and uterine tissues, but results in the activation of other estrogenic pathways. There's a chance it might help with insomnia, although it supposedly dosen't bind with estrogen receptors in the brain. It did prevent my migraines, which other ERT has also done, which makes me think that it might have enough estrogenic effects to help with insomnia. The PDR indicates that there were fewer reports of insomnia with raloxifene than with placebo in clinical trials. It has been shown to have beneficial effects on bone resorption and positive effects on lipid metabolism.
It is a viable alternative to traditional HRT without the risks of increased breast cancer.My consultant suggested going back on it recently as a bridge to possibly going on Tamoxifen. Guess I am scared of Tamoxifen because of lack of knowledge and experience. I experienced no known side effects the two years I was on raloxifene. My bone density inceased, which was good. I went back onto more traditional ERT a year ago because a doc thought I needed estrogen which also targeted the receptors in the brain. My university pDoc consultant (the best in the Rocky Mtn. region) thinks the evidence for possible neuroprotective effects of estrogen is weak at best.
Hope this helps and that you get some sleep soon.
Blessings,
Chris A.
Posted by suzie2u on May 19, 2001, at 17:22:50
In reply to Re: HRT for insomnia post breast cancer » suzie2u, posted by Chris A. on May 19, 2001, at 15:00:26
Thanks Chris. I believe my onchologist suggested this once for hot flashes (which I no longer have). I will discuss on Tues however. The more I read, the more confused I become. Finally did a search in my personal journals and Premarin most definately helped with insomnia but I developed a lump in my breast which was not a cancer and subsided when I reduced the dose (interestin huh?). Dr. Susan Love was the doctor to take me off HRT and I can see that she hasn't changed her position on that score.
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