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Dr. D. Love
Dr. D. Love, Doctor
Category: OB GYN
Satisfied Customers: 18536
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am 61 yr old who just had k to back surgery. A

Customer Question

I am 61 yr old who just had k to back surgery. A hysterectomy (cervix was not remove) and prolapsed bladder surgery on 7/27/16. Three weeks before the surgery I was so scared having the procedure I started stressing so much that let to a lot anxiety and lost 8 lbs. Xanax 0.25 was prescribed to calm the nerves. After the surgery I still having anxiety , loss of appetite, emotional, a occasional hot flash, and terrible insomnia. Can all these be due because I have NO ovaries and NO ESTROGEN? They wanted to give me premarin, but I requested a blood work up 2 days ago to check my hormone levels first. Don't want to take HRT if not needed. In the meantime, they also prescribed Trazodone (a sleep aid) and Citalopram (serotonin upintake inhibitor) which I have not taken. I am seeing an acupuncturist and looking for some natural alternative. I want to get back to normal again without the drugs. ANY ADVICE PLEASE! I am sleep deprive right now.
Submitted: 11 months ago.
Category: OB GYN
Expert:  DocPhilMD replied 11 months ago.

Hi, this is Dr Phil, here to assist you. I am Board Certified with over 10 years of experience. I will respond with my answer shortly. Thank you.

Expert:  DocPhilMD replied 11 months ago.

Yes, I believe this is due to a loss of hormones.


I would recommend that you consider the hormones for this

If not, the meds you are taking are an alternative, appropriate and they should help

let me know if you have other questions.

if done for now, please leave a positive rating above the chat box so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me with "a question for Dr. Phil" in the medicine, cardiology or pharmacy categories if you have any other questions

here is my website if you need to reach me again:

Thanks for using

Customer: replied 11 months ago.
I decided to ask my question because there was 2 pics of female saying they would be answering my question. I think they would have elaborated a little more on my answer, especially on the HRT pros and cons.I I should have gone into a blog and gotten a more detail answers for free. If I want more detail right now, I have to pay another $10 - really? Not satisfied.
Customer: replied 11 months ago.
This man only has 10 years experience????? No first name or where he is from to check his credentials. Skeptical
Expert:  DocPhilMD replied 11 months ago.

You don't have to pay anymore.

you can always ask for more detail

PROS-helps with mood, energy and fat distribution as well as bone health

CONS-increased risk of heart attack, stroke, blood clot and breast cancer (slight risk)

Expert:  DocPhilMD replied 11 months ago.

Thanks for this question

Please don't forget a positive rating

I appreciate it. :)

if you have more questions, just reply

Expert:  Dr. D. Love replied 11 months ago.

Hello. This is Dr. Love, a different expert.

Were the ovaries removed at the time of the hysterectomy?

Had you already stopped having periods before the hysterectomy?

Expert:  Dr. D. Love replied 11 months ago.

I asked for some further information and have not heard back. I asked for this information because some of the history was confusing. You said that you have no ovaries and no estrogen, which would imply that they were removed. However, there was also discussion abut whether to check hormone levels, and there is usually no need to even consider checking hormone levels once the ovaries are removed, because we know that there cannot be any hormones from the ovaries.

I also ask about whether you had already stopped having periods, because women would usually have undergone menopause by 61 years of age and that would indicate that the ovaries had already decreased estrogen production. It is true that the ovaries do not suddenly stop estrogen production, and it is a gradual process over years, but if periods had stopped, then I would have then asked about when was your last period. If you had stopped having periods at least several years ago, then it is much less likely that surgical removal of the ovaries would be an issue. If the ovaries are still making estrogen, then surgically removing the ovaries will induce a sudden menopause, rather than the gradual process over years, and surgical menopause tends to be more problematic than natural menopause. But if the ovaries are not making estrogen or only making minimal amounts of estrogen, removing the ovaries will typically not induce surgical menopause.

If you were still having periods or only relatively recently stopped, then it is much more likely that surgery could result in symptoms related to the sudden complete elimination of ovarian estrogen.

We usually will try to avoid the use of estrogen replacement because of the risk for heart disease and breast cancer. In a woman with more severe symptoms, it may be appropriate to consider a limited used is estrogen, but we would want to use the lowest effective dose to relieve symptoms, and then try to stop the estrogen as soon as can be tolerated.

There are several alternatives to using estrogen for relief of menopausal symptoms. Several different antidepressants have been shown to relieve symptoms, so antidepressants may be used even in women that are not having any anxiety or depression. In a woman that is also having anxiety or depression, then antidepressants also have the advantage of having direct action to relieve anxiety or depression.

As for natural treatments, there are a number of natural substances that appear to have some estrogenic activity and may help symptoms. The most commonly discussed are flaxseed and soy products. However, the concern is that if these substances are able to provide sufficient estrogenic activity to relieve estrogen deficiency symptoms, then they also may be providing sufficient estrogenic activity to carry the risks associated with estrogen replacement. There have been some limited studies that suggest that using large amounts of soy carries some of the risk for breast cancer. In reality, there has not yet been sufficient studies on these substances to be able to state their effectiveness or their risks. However, if other interventions have failed and we are otherwise thinking to use estrogen, it may be reasonable to try a natural product.

If I can provide any additional information, please let me know.