77: Alex Isaac on Surgically Induced Menopause and Hormone Therapy

Welcome to the Dear Menopause podcast, where we discuss the menopause transition to help make everyday life a little easier for women. Hi, this is Sonya and I am the host of Dear Menopause. Today, you are going to be listening to part two of my conversation with Alex Isaac, and we are focusing today on Alex's journey after her surgically induced menopause. Now, if you missed part one of my chat with Alex, I do recommend that you go back and listen to last week's episode Before you settle into listening to this episode. Everything will make a whole lot more sense if you do. I have loved chatting with Alex. Her openness, her transparency, her willingness to share her story so that others can learn from her and be inspired by the journey and research that she went on has been incredibly courageous and I am incredibly grateful Enjoy. So, alex, when we finished the last part of our conversation, we had just touched on the fact that you had finished up having your preventative surgeries that had put you into your surgically induced menopause.

I did a lot of research before my hysterectomy oopherectomy into HRT, because I am actually didn't even want to consider the preventative surgery unless I knew there was treatment options that would help me navigate menopause, surgical menopause. So you know, a lot of my research touched on, obviously, estrogen, testosterone, you know progestogens. So I had done a lot of the research beforehand so I knew, going into the surgery, what to expect. But there is nothing quite like feeling. It is there. I proposed the concept to my surgeon that maybe I would start HRT before the surgery. She didn't think that was worthwhile, which I understand now. But she proposed that I start my HRT a few days after my surgery, which I challenged because my understanding was that really my ovaries would stop producing the hormones within about 12 to 24 hours. So I proposed the idea that we start HRT on day one because I couldn't see why not. And she said go for it if that's what you want to do. So that's I feel, and I feel like this is a common thread with surgical menopause. Menopause, hrt is a lot of the advice out there. You know you have to be well researched yourself and you have to get your head around your own menopause journey because a lot of the advice out there is patient driven.

A lot of self-advocacy.

And so yeah, which is a bit scary for a lot of people when me included. You know this is a new area of research for me the whole menopause and hormones. I've learned a lot, but I really felt like I was driving conversation with a lot of medical professionals I was talking to. I had the surgery started, hrt on day one, I think. Really, I started on estrogen only because I've had my uterus removed, so I would not need to do the progestogens if I don't want to. I probably could if I wanted to. That's something that we'll discuss a little down the track. But yeah, so I started with the estradiol gel or Sandrina is now what I've moved over to because it's just a little bit easier in the sachets. I found within about two weeks I didn't have any hot flushes, but I started feeling some heart palpitations at night and having some sleep disturbances and I started feeling anxious, which for me was completely new. I've never had these feelings before, ever in my life. So it was very clear to me that it was hormone related. Spoke to my GP I don't know if I'm allowed to say a name. That's just like that, as you spoke to your GP, I spoke to my GP, who's phenomenal, and she said well, let's step up your dosage by about another half on what you're on, and that fits in. But that fixed it immediately. So to me I feel like it's the anxiousness, those feelings, the sleeplessness, the heart palpitations. It's so clear for me that they are related to hormones and nothing else, because I literally went into hormone and into menopause overnight. So it really can't be anything else, given. I've never felt those feelings before.

Yeah, there was such a clear line in the sand view, wasn't there, of I had these hormones and now all of a sudden I don't have these hormones. Well, when siding with that, is this symptomology? Okay, there has to be a correlation between the two. And I think also the other great takeaway from that is you know what you? You've got such a great relationship with your GP and I know your GP. She is so well educated when it comes to using hormone therapies with her patients. The big takeaway with that is walk to your GP, get a good GP. That is across using hormone therapies, because every woman's experience is going to be so unique and you have to be able to tweak your hormone therapies. So, it might be that you need to either up or pull back on one, whether it's the progesterone or the estrogen or the testosterone, if you're you know that's something that you've added in with the mix as well. It's never, it's not a cookie cutter prescription.

Absolutely. I couldn't agree more. That's another thing that my GP suggested, which is really nice to be relying on a GP that is making suggestions, because up until this point again, as I mentioned, the conversation had been driven by me. She proposed the idea that we try out some testosterone, because up until two weeks ago my body was naturally producing good, solid amounts of testosterone and now it wasn't. We started with that as well and that's helped immensely. I will say probably a lot of your listeners out there might be struggling to find a GP that will have these conversations with them. I still find it's quite difficult in Sydney, australia, to find a GP that is confident enough to talk about the various different types of HRT and to talk about HRT at all or needing HRT. I really searched hard to find a GP that would welcome that discussion. I looked on the I think it's the Australian Menopause Society website. I've got a website with some GP's that are across this. I looked there. I asked friends, family, women are the local area. It took me a good six months to find this amazing GP who is across it.

That's interesting. I'd like to just step back from that a moment, because obviously you were seeing a specialist, a surgeon. Obviously she was your first prescriber of your hormone therapy. What support did you get from her after that initial prescription?

I received the initial prescription, we knew I would have a surgical follow-up. I suppose the assumption is that I would mention any symptoms if I had any Other than the initial script that she gave me for just Easter dial. That was it. I prompted the discussion about testosterone. She said we could discuss testosterone in the future if I had a lowered libido. That was the end of the discussion with this specialist about HRT. Really, all the other information that I gathered was through my research and from the GP. That was basically where the HRT discussion ended was after Easter dial.

Would you say that you felt that that side of the conversation was lacking, considering she was the person, maybe not lacking, but was perhaps not as supportive as it could be, considering she was the person that took away your hormones?

Yeah, I mean, who is responsible for this discussion? I suppose you think it would be your gynecologist Ultimately. Maybe that specialist doesn't? I mean, they feel that they're responsible for getting you off the ground, but ultimately they're a surgeon, right? So I don't know. I guess there's a shortfall there. Who?

There is, isn't there?

Yeah, that was my experience with the medically induced menopause.

Mine was caused by my oncologist, if you like. So he was the one that administered the chemo which was the drugs that created my medically induced menopause. But then there's this gap that you all through when you leave their care to you. Know, and like you, I had to go on my own journey of discovery and find it. You know, ultimately a GP, and I'm still struggling with the whole being denied hormone therapy argument which we're not going to go into here today. There is a gap, after your care from these specialists, of making sure that you're being cared for and looked after from a menopause perspective that I think we need to do a whole lot better for our women.

Well, like you know, like you said, it's actually also not just HRT, right it's. Then, you know, bone density scans. Oh, it's yeah, right. And dietary and exercise and menopause is not just a point in time. And then you're done and you're over. This is it? I'm going to be menopause. I will be longer in menopause in my lifetime than out of menopause, absolutely Right. And so then, is it the next step? Is it an endocrinologist? Well, why do I need to be seeing an endocrinologist for the rest of my life? That's insane.

But it's also, you know, menopause puts all women, and so the earlier that you go into your menopause, the more these things become important. You know, yes, you've touched on the bone health. Cardiovascular health becomes very important because women's risk of dying from heart disease increases once you're in a menopausal state. Risks of dementia are increased, and particularly if there's family history there. I know there's still some research being done around that, but there is believed to be a link there. Someone like yourself that has gone into their menopause at such an early age. We have to be considering these factors, and that's where I find that this gap that exists between being handed over by the surgeon to finding a GP that was confident and competent enough to be able to care for you should not exist.

Right, and so the GP should be the person confident enough to manage this, because otherwise what's going to end up happening is few years down the track will, hopefully not a few years. Hopefully women are onto their symptoms. But, for example, mental health. So let's say a woman's struggling with her mental health and her anxiety and she goes to see a counsellor or a psychologist or psychiatrist. Should they then be informed and trained with HRT, or at least with hormones and hormones? Absolutely Right. So then also, yeah, as you said, the cardiologist. So let's say, a woman presents with heart issues, so do they need to be trained with menopause treatment, hrt treatment, bone specialist, you know, as you said, insulin resistance, diabetes, dietitians, you know, I mean, it's just the impact is so far reaching. So either do all these specialists need to be trained. Can the GP be up to speed so that we can avoid these people needing to see a specialist to start with?

But we definitely need to remove the onus from the woman being the one that has to go and do the research and be the advocate for herself, to join all these dots and put the pieces together herself.

Right, correct, Because we put a certain amount of trust in our medical experts you know and professionals, and we should be able to. Of course, we need to make the decision for ourselves, but it'd be lovely to have the guidance and the trained expertise to give us the right advice.

Absolutely. So how are you feeling today?

Good, I'm feeling great. I'm on my Easter Jen, easter Dal, and I'm on my tea. I've got it all. I'm feeling great. I'm feeling really good. It's definitely settling in. So, yeah, I'm feeling maybe even better than I was, who knows?

Wow that's awesome yeah.

Yep, I'm great. Back on my game. I'm 11 weeks post-surgery, so almost the 12-week mark is post-historic to me is when you can really just do anything you like. So I'm almost there. Next week I'll recommence my netball career. Woohoo, I'll be jumping around the court with the best of them.

Excellent. So you are definitely leaning into the powerful post-menopause all years.

Absolutely. I like how you've phrased that, that's for sure.

I wanted to touch on quickly, if it's okay, before we wrap up. Your experience with your surgically induced menopause has been very different to Sarah's, your sister's.

Definitely.

In what way?

Given her breast cancer history, was not offered HRT. In fact, when she questioned it and asked if she could do HRT, she was told she couldn't at that point, obviously, that was very disappointing. That was after she had her uforectomy hysterectomy. She was told she couldn't do HRT because of her breast cancer history, even though she had a double mastectomy.

In effect, she had no breast tissue left in her body.

Nothing Technically. Her risk of developing breast cancer was down to between 2% and 4% the general population risk of breast cancer. I think now we're up to 11% or 12%, am I right? She's statistically speaking.

Definitely lower than the average woman that is sitting at home drinking two glasses of wine every year.

Quite right, insane, still couldn't do HRT, even if she wanted to. I don't understand how they could have that sort of control. She challenged it for years, has finally found a GP that is on board with her Now, after experiencing significant menopause symptoms unfortunately for her for years, has now started her HRT journey, finally with me. We're doing it together. How is she feeling? She's so much. She's wonderful, so good, brilliant. We both love the estradiol, we love the testosterone. It's brilliant. She was advised, though, not to rub the testosterone on the inside of her leg for fear of transfer.

Turning into a horny 16 year old boy.

So yes, so she's been advised, not so naturally, we're both rubbing it on the inside of our legs.

Of course you are Much to your husband's delight, I would imagine.

Can't keep a good woman down.

No, I mean we laugh, but I'm so happy to hear that Sarah has found a doctor to work with that is giving her that relief and after years of really struggling with what I could imagine with probably some pretty severe symptoms, she's doing so Seeing the light.

Is she seeing the light physically present so much better? She's got this pet in her step and a bounce and she's looking fit and fabulous and I know in terms of her health she's now moved away from she had started on a tablet and I spoke to her when I started on an astrodial and we're kind of in the journey together. I recommended that she consider the gel because of there, when you take a tablet it can increase your risk of cholesterol, so obviously your body has to process it through the liver. So that's been a big benefit for her as well, going on the gel. So we'll see what impact over the next couple of months that has on her cholesterol and reducing stomach, because she does have some high cholesterol issues there, which is another marker that does elevate for many women.

Definitely big impact for both of us and you know what, and we can edit this out if you would like me to, but I know how big an impact it's had on the two of you, because your mum is also considering taking some hormone therapy for the first time.

I want to get her across the line, dad wants to get her across the line, but I don't want to know. La la, la, la, la, la, la la.

Your mum's looking at you two going. These girls are having way too much fun.

I need to be in on this We'll get her some mum HRT for Christmas.

Oh my gosh, there is a pharmaceutical company out there that is going to run with this marketing idea there's going to be an HRT advent calendar. Thanks. Oh my God, I love that, and that is a brilliant note to wrap up on. Let's leave that for the pharmaceutical companies to run with. Alex. Thank you so much for your time. I am so appreciative of you for sharing your story. You know you are glowing. It has been such a pleasure to sit down and chat with you. I really hope that there are others listening that will learn from this and that will perhaps be inspired to go and take their own action as a result.

Thanks so much for having me, sonia, it's been a pleasure.

Thank you for listening today. I am so grateful to have these conversations with incredible women and experts and I'm grateful that you chose to hit play on this episode of Dare Menopause. If you have a minute of time today, please leave a rating or a review. I would love to hear from you, because you are my biggest driver for doing this work If this chat went way too fast for you and you want more, head over to stellarwomencomau slash podcast for the show notes. And, while you're there, take my midlife quiz to see why it feels like midlife is messing with your head.