Hormones and Breast Cancer

I am 48 and had a lumpectomy and hysterectomy (still have my ovaries) last year at which time also found out I have Factor V Leiden. I was told that because of that I could not have any hormone replacement therapy. Currently I am in a constant brain fog, my perception is off, it takes me a while to actually comprehend what people are saying to me. I am a carpenter and am suddenly nervous about using my tools. I make stupid mistakes when I am doing anything - such as driving my sense of direction is off completely and I sometimes feel like I am lost, walking - tripping over things that I just don't notice. I can't concentrate on anything, have no appetite, can't read. My libido is completely off. What exactly is going on? What can I do? Is this going to be me for the rest of my life?

[Machelle Seibel, MD]

Clearly this is a very difficult dilemma you are facing. Factor V Leiden factor is an inherited problem of blood clotting. You've had it all your life even if you just figured it out. Women who have this problem do have about a 15-fold increase in having a blood clot if they take HT. That is about 15 to 40 per 1000 chance per year. If you have had a baby and didn't have a blood clot, you might be at less risk than some other women as estrogen levels in pregnancy are quite high. It is important to work with a doctor who is familiar with alternatives to estrogen and one who knows about Leiden factor  in case taking estrogen is too great a risk. Also, things like loosing weight if one is overweight, exercising, not smoking are things that can reduce risk further. Sometimes blood thinners are also given. Clearly, it is important that you find a combination of choices that improves your state of mind and helps you to feel better.
Machelle M. Seibel, MD