doctors that prescribe HRT for women who have had DCIS

[Anonymous]

I would like to go on HRT (mainly for sleep/memory and lowering risk of osteoporosis vs hot flashes) but had DCIS 4 years ago. I have done some reading of the studies and it seems like there is a reasonable case to be made that this is a risk/benefit decision where there is no "right" answer (I have a background in biostats so I am comfortable with my ability to interpret the studies). Can someone recommend a doctor who will prescribe HRT to patients who have had DCIS? I know my oncologist at Georgetown will not prescribe it.

[Anonymous]

A sketchy for profit online telehealth company may prescribe it. Wouldn’t do it personally

[Anonymous]

I doubt anyone around here would Rx it if it was ER+ cancer.

[Anonymous]

I don’t have anyone to recommend, but I think it’s great that you are exploring it.

Estrogen dies not cause breast cancer, although it does feed it if you already have it. There are so many lifestyle choices we can make to lower our risk of breast cancer (not talking about HRT, more diet, exercise, alcohol etc.). People are unwilling to do these things, but shout cancer when anyone brings up HRT, which actually does have a lot of health benefits. Sure, you have to be diligent regarding lowering risk of and screening for breast cancer, but you should be doing that anyway.

To those saying no, read the book estrogen matters by Avron Bluming.

[Anonymous]

Anonymous wrote:A sketchy for profit online telehealth company may prescribe it. Wouldn’t do it personally

Eh, something will probably get you before it does OP.

OP, do a search by zip code here -

https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx

[Anonymous]

Anonymous wrote:A sketchy for profit online telehealth company may prescribe it. Wouldn’t do it personally

+1. Someone who doesn’t have to look you in the face and feel responsible if your cancer recurs.

OP there are non-hormonal medications and therapies that can help. Look into that. because I hear the hot flashes from tamoxifen are brutal.

[Anonymous]

Anonymous wrote:I don’t have anyone to recommend, but I think it’s great that you are exploring it.

Estrogen dies not cause breast cancer, although it does feed it if you already have it. There are so many lifestyle choices we can make to lower our risk of breast cancer (not talking about HRT, more diet, exercise, alcohol etc.). People are unwilling to do these things, but shout cancer when anyone brings up HRT, which actually does have a lot of health benefits. Sure, you have to be diligent regarding lowering risk of and screening for breast cancer, but you should be doing that anyway.

To those saying no, read the book estrogen matters by Avron Bluming.

wtf no.

[Anonymous]

OP here. If I were most worried about hot flashes I would take one of the new drugs that treats them. I am most worried about brain fog and osteoporosis. The way I look at it, there are better breast cancer treatments than there are osteoporosis treatments. My mom broke her hip at 65 and was never the same. And if I lose my job due to brain fog, that will have its own negative health consequences.

[Anonymous]

Anonymous wrote:OP here. If I were most worried about hot flashes I would take one of the new drugs that treats them. I am most worried about brain fog and osteoporosis. The way I look at it, there are better breast cancer treatments than there are osteoporosis treatments. My mom broke her hip at 65 and was never the same. And if I lose my job due to brain fog, that will have its own negative health consequences.

You need to reason through this with an actual doctor including a specialist in osteoporosis. WRT brain fog - risking a cancer recurrence for the very minor (if at all) reduction in “brain fog” does not add up, at all. Chemo would give you much worse brain fog.

[Anonymous]

Anonymous wrote:

Anonymous wrote:A sketchy for profit online telehealth company may prescribe it. Wouldn’t do it personally

+1. Someone who doesn’t have to look you in the face and feel responsible if your cancer recurs.

OP there are non-hormonal medications and therapies that can help. Look into that. because I hear the hot flashes from tamoxifen are brutal.

I’d love to hear about these. Can you please share more?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A sketchy for profit online telehealth company may prescribe it. Wouldn’t do it personally

+1. Someone who doesn’t have to look you in the face and feel responsible if your cancer recurs.

OP there are non-hormonal medications and therapies that can help. Look into that. because I hear the hot flashes from tamoxifen are brutal.

I’d love to hear about these. Can you please share more?

Here you go: https://menopause.org/wp-content/uploads/professional/2023-nonhormone-therapy-position-statement.pdf

The one that really intrigues me is hypnosis. Huge effect size although the studies are small and not enough to be the basis for a strong recommendation. But seems worthwhile to try!

Also this paper was written before the latest drug for hot flashes was approved recently: https://news.med.virginia.edu/clinical/fda-approves-new-menopause-drug-for-hot-flashes-night-sweats/

[Anonymous]

Anonymous wrote:OP here. If I were most worried about hot flashes I would take one of the new drugs that treats them. I am most worried about brain fog and osteoporosis. The way I look at it, there are better breast cancer treatments than there are osteoporosis treatments. My mom broke her hip at 65 and was never the same. And if I lose my job due to brain fog, that will have its own negative health consequences.

I’m four years post- ER/PR+ stage one invasive breast cancer (undetected DCIS that escaped the milk ducts.) Tamoxifen made me crazy, so I do quarterly Lupron shots with a daily AI to minimize estrogen.

You’re 100% right about the side-effects of this cancer-prevention regime. My brain fog is significant, especially when it comes to executive function (task planning and execution, time management, and working memory.)

Also, in the past four years, my bone density dropped - first to osteopenia and now osteoporosis in one spot (the others are still osteopenia.) The endocrinologist has recommended an annual Reclast infusion to prevent further bone loss (and for some, it reverses some of the recent loss, so that’s a possibility.)

I share this for two reasons: first, to agree with you about the large and real downsides of blocking estrogen post-cancer; and second, to give you a heads up about Reclast, if osteoporosis remains a concern. It’s a proven treatment that has been around a long time. (My friend’s doctor actually had her start annual infusions as soon as she hit osteopenia, rather than wait to see whether there would be further bone loss. I wish I had known that was an option - my doctor never mentioned it, and I only learned about it after the fact.)

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here. If I were most worried about hot flashes I would take one of the new drugs that treats them. I am most worried about brain fog and osteoporosis. The way I look at it, there are better breast cancer treatments than there are osteoporosis treatments. My mom broke her hip at 65 and was never the same. And if I lose my job due to brain fog, that will have its own negative health consequences.

I’m four years post- ER/PR+ stage one invasive breast cancer (undetected DCIS that escaped the milk ducts.) Tamoxifen made me crazy, so I do quarterly Lupron shots with a daily AI to minimize estrogen.

You’re 100% right about the side-effects of this cancer-prevention regime. My brain fog is significant, especially when it comes to executive function (task planning and execution, time management, and working memory.)

Also, in the past four years, my bone density dropped - first to osteopenia and now osteoporosis in one spot (the others are still osteopenia.) The endocrinologist has recommended an annual Reclast infusion to prevent further bone loss (and for some, it reverses some of the recent loss, so that’s a possibility.)

I share this for two reasons: first, to agree with you about the large and real downsides of blocking estrogen post-cancer; and second, to give you a heads up about Reclast, if osteoporosis remains a concern. It’s a proven treatment that has been around a long time. (My friend’s doctor actually had her start annual infusions as soon as she hit osteopenia, rather than wait to see whether there would be further bone loss. I wish I had known that was an option - my doctor never mentioned it, and I only learned about it after the fact.)

OP here, thanks - who do you see for your osteoporosis treatment?

[Anonymous]

OP you say you "had" DCIS 4 years ago. Was it removed?
I probably had that but in the 18 months between mammograms, whatever I "had" evolved from undetected to a 4-mm IDC.

[Anonymous]

Anonymous wrote:I don’t have anyone to recommend, but I think it’s great that you are exploring it.

Estrogen dies not cause breast cancer, although it does feed it if you already have it. There are so many lifestyle choices we can make to lower our risk of breast cancer (not talking about HRT, more diet, exercise, alcohol etc.). People are unwilling to do these things, but shout cancer when anyone brings up HRT, which actually does have a lot of health benefits. Sure, you have to be diligent regarding lowering risk of and screening for breast cancer, but you should be doing that anyway.

To those saying no, read the book estrogen matters by Avron Bluming.

DCIS is breast cancer so I am not exactly following.