HRT after total LAV Hysterectomy at age 44

[KDM71]

Hello!  I am new to this site & hope I'm doing this right.  I am 44 years old and had a total LAVH (both ovaries removed on 3/22/16.  At 20 years old I was given Lupron injections for experimental treatment for the mildest class of endometriosis possible (HORRIBLE advice from my doc back then).  Those injections put me into INSTANT menopause and I started experiencing for the first time in my life SEVERE anxiety and depression (along with hot flashes, night sweats, etc.) HRT was not effective back then because Lupron blocks estrogen receptors - although my doc put me on Premarin anyway, leading to severe morning sickness on top of it all!   I was only able to tolerate 3 of the prescribed 6 injections.  After stopping those shots, the hot flashes/night sweats stopped, but the severe depression and some of the anxiety never went away.  (Again, NEVER had ANY of that before the Lupron.).  For the last 24 years I have been on various antidepressants and anti-anxiety meds with varying degrees of relief.  Before my recent hysterectomy my psychiatrist had me leveled out pretty well with Wellbutrin 300 mg/day and Xanax 1mg as needed.  For unbearable constant cramping I finally agreed to the hysterectomy last month.  I was not afraid of the surgery, but I was TERRIFIED of messing with my hormones again (as I was NORMAL mentally BEFORE docs messing with them at age 20).  I had hoped to be able to keep at least one ovary, but that ended up not being possible in my case.  When I left the hospital I was fine emotionally for about a week, as they placed a large estrogen patch on my abdomen before I woke up form surgery.  When that evidently started to wear off, the EXACT SAME SYMPTOMS from when I was 20 came back with a vengeance - cold sweat panic attacks/severe can't-stop-crying depression, etc.  I live 5 hours away from my surgeon (we have recently relocated & for surgery I wanted my familiar GYN doc - NOT the same quack who gave Lupron btw) and when I called my surgeon's office bawling I was told his nurse was "very busy" & might call back in 2 or 3 days!  They had given me after surgery some samples of different strengths of Premarin, which seemed if anything to make matters WORSE.  So my local family doc called in estradiol 0.025mg/day 7-day patches.  Did not help at all, so then they called in a "bio-identical" estradiol 0.05mg/day patch to be changed every 3 days.  This almost immediately brought relief, though still had some hot flashes (I can get through those, but NOT feeling like I'm losing my mind!).  These patches helped for a couple of weeks, then I started having the cold sweat panics and severe mood swings again...though not quite as often or as severe.  Four days ago they switched me to "bio-identical" estradiol 0.075mg/day 3 day patches.  I know it has only been 4 days on the new dosage, but I've had several anxiety/depression "spells" during the last couple of days and I'm now concerned that nothing may work for me long-term?  (And I've suffered with depression for the last 24 years that was pretty well helped by the antidepressants - which I still take.  However, the cold sweat panicky anxiety attacks have NEVER happened except when I took the Lupron shots at 20 and now after hysterectomy.  Before surgery, I had only occasional mild anxiety that was easily controlled with Xanax.  Just saying all this to make it clear that I am VERY well aware of the difference between my normal depression/anxiety that might or might not have been started by the Lupron, but which I've been treated for and have been coping with for 24 years and the crazy, out-of-control, cold sweat panic attack SEVERE anxiety that I had both during the Lupron treatment and now that my ovaries are gone.). Sorry such a long post, but I didn't want to leave out something that might be relevant to my current situation.  Any suggestions or advice would be extremely welcome and appreciated.  Thanks

[old_before_my_time]

I am sorry to hear you had this surgery. I know how difficult it is. I never took Lupron so do not have that experience but ovary removal would be similar to being on Lupron permanently. I became severely depressed and mildly anxious along with a whole laundry list of other nasty symptoms after my organs were removed. And frankly, my gynecologist who did the surgery wasn't at all helpful afterwards.

You are not even on the highest dose patch; .1mg is the highest dose. But it's possible that the patch is not a good fit for you. Hormone "replacement" is not one size fits all. What works for one woman may be a miserable failure for another and it can take some trial and error to find what works best. It's possible you may just need a higher dose or a different brand. Some women find that trying a different brand can make a world of difference such as switching from Vivelle-Dot or Minivelle (3 day patch) to Climara (7 day patch). They have different adhesives that can affect uptake of the estrogen. The Vivelle-Dot did not work well for me and I didn't know any better to try Climara.  

If the patch doesn't work out, there are pills, gels, and vaginal rings you can try. Hope you find something that helps soon! I know how desperate it can feel!