Gynaecologist won’t remove my bioidentical HRT pellets

Yesterday I went to my gynaecologist, to discuss my HRT.  I wanted him to remove the bioidentical HRT pellets he implanted three months ago.

Since my hysterectomy, I haven’t felt right hormonally.  HRT is far more difficult than anyone led me to believe.  Unbalanced hormones cause depression, anxiety, irritability, no libido, sore breasts, vaginal dryness, anorgasmia, skin dryness, weight gain…the list is long.

By fat the biggest problem for me though, is the weight gain.

When I was discharged from hospital after the horror that was my hysterectomy and oophorectomy, I weighed 78kgs.  This was about 2kgs light for me, because I’d gone through major trauma, and hadn’t been eating for two weeks.

The first two months were OK. And then the weight gain began.  It was unstoppable.  Because I had so many other problems, I didn’t focus on it, but I was aware.  I wasn’t eating, due to the trauma I’d experienced, and ongoing PTSD.  When I am psychologically unwell, I stop eating. I know some people are stress eaters, or comfort eaters, I am not.  I starve myself.  Being obese is so psychologically destructive for me, that I do not self-sabotage that way.

Unfortunately, doctors work in majorities.  If you aren’t like the majority, medicine is always fraught.  Getting help is fraught.  Doctors believe that the majority of people like me, nearly 50, chronically ill with a chronic pain condition DO not exercise and DO comfort eat, and some don’t even realise how many calories they take in.  So they assume that I am like that.

But I’m not like that. I know exactly how many calories I’m taking in, and I watch everything I put in my mouth.  It kinda sux, but it’s the only way I can stay psychologically ok.  It is the result of years of being badgered about my weight and being put on diets.

I move as much as my body will allow, and I will endure considerable pain to do it.  I will be in pain whether I move or not, so I may as well exercise.

Even when I am eating, my diet is extremely restricted due to Eosinophilic Esophagitis.  So even when I’m eating ‘well’, I’m only eating chicken, beef, select vegetables, select fruits and some rice.  Sometimes a little dairy, some cheese here and there.  Rarely. It should be very hard to gain weight on a diet like that.

And yet, the weight keeps going up.

At this point, a year and two months post hysterectomy, I am 20kgs heavier than I was two weeks post hysterectomy.  I’ve logged my weight and my food intake in my Fitbit app, and it shows a steady, inexorably weight gain.  There are blips on the graph, where the weight loss briefly reverses, these correlate to my getting testosterone implants which I had to FIGHT for.

Testosterone makes me feel much better, my libido returns, fatigue decreases, fluid retention decreases, I have more stamina, and I’m stronger in the gym.  But it doesn’t last, the pellets wear off too quick, and then I have too much estrogen, and I believe all my problems are due to too much estrogen in relation to testosterone.  Because I no longer have a uterus, they don’t’ give progesterone, and I won’t take synthetic progestins regardless, because it was Depo Provera, a synthetic, long acting progestin, that precipitated ALL my health problems.

My gynaecologist doesn’t believe me.  He is a big fan of estrogen pellets, he believes they solve everything.

They don’t for me.  I need testosterone as well, and LESS estrogen.

The weight gain is unbearable for me.  I don’t fit into any of my clothes, and its hard to buy clothes, because even when I’m slim I’m a large build, and I’m 5’10”.  They just don’t make clothes to suit my build. When I’m obese, as I am now, its impossible to buy anything but shapeless sacks which look terrible.

I have a long history of eating disorders. I was anorexic for most of my teens and twenties.  I was diagnosed as Body Dysmorphic, and that’s a hard thing to overcome.  I have very low self-esteem and being obese causes depression.

And just to be clear, because I usually get a few unpleasant messages from people who think I’m anti-fat or other such ideas, I don’t judge other people on their weight.  I don’t look at people and decide they are too heavy, or too light or anything at all.  I don’t judge other people, I only judge myself, and I judge myself very harshly. It’s a psychological disease, and its not something I can just ‘snap out of’.

Many people are not at all sympathetic or empathetic to anorexia, bulimia or body dysmorphia, believing it to be based in vanity, and self-absorption.  It’s not.  People joke about wishing they had that disease.  It’s not funny.

But back to the point. I need to get this weight off me. I know what I eat, and I know that I have a sedentary lifestyle now, but I move as much as I can. I walk daily, almost up to 20 minutes now.  That walk is usually agonising, but I do it because I need to move my arthritic joints, I need to maintain muscle mass, and I need to get my heart pumping to improve my heart health.  So, I deal with the pain.

My gynaecologist told me I must be eating more than I think. I showed him my food logs and exercise logs.  I told him I was a personal trainer, life long gym junkie and fitness nut, and I’ve studied nutrition.  It took some doing, but he finally believed me.

But he’s stumped.  HRT doesn’t cause weight gain, he says.

Bull. The internet is full of people who can’t lose weight after an oophorectomy.

I asked him to remove the pellets, I’d rather dive into menopause than continue this weight gain.

He refused.  He opined that my steroid use caused the weight gain.

That old chestnut.

I explained again that I’ve been taking corticosteroids daily for eight years.  I didn’t start gaining weight until after the oophorectomy. It is NOT the prednisone!  Prednisone has never caused weight gain for me.  It allowed me to exercise harder and LOSE weight.  I wish doctors would listen. As soon as you’re on prednisone, they blame the prednisone for everything.

Given I have adrenal insufficiency, I will always be on some level of corticosteroid.  I am not prepared to taper right now.  Been there too many times.

But he refused to remove the pellets. He told me to go see an endocrinologist. I told him I already have, and she knows nothing about HRT.

So, he referred me to another one.  He will not remove the pellets without a second opinion.

So, I have to see another endocrinologist, who won’t know jack (endocrinologists don’t care about bioidential HRT pellets.  Fat, menopausal women are not their idea of an interesting patient).  I have Hashimoto’s and some form of Osteopetrosis, so I need an endocrinologist.    Hashimoto’s is simple, osteopetrosis is something else.

I do not want to start from scratch with someone else, and pay the $300 consult fee for this man to say, “I don’t know, go away and stop bothering me”.

And I’ve had my blood work done, a month ago.  My testosterone was way too high and my estrogen was at the high end of the range.    The doctors will want me to ride it out and wait for the pellets to disperse.  But that will take another six months. I can’t deal with this for that long!

I want the HRT pellets out, and then I will add back estrogen and testosterone via the bio-identical creams. That way I can control the dose myself!  Once I get the doses right, where I feel good and am back to a normal weight, I can try those doses in pellets. Or not.  This is clearly not working, so I need to try something else.

But once again, I’m held hostage by doctors who won’t listen. My gynaecologist is sympathetic, but he has never seen someone put on this much weight, so he doesn’t believe me.

And he has had many patients who have put on weight, but he says they all ate too much.

Hmmmm.  So that’s what I’m up against.

He prescribed a diuretic, despite the fact that I already take a diuretic as part of my blood pressure medication.  Its a combination of ACE II inhibitor and a diuretic.  I told him this, and he told me to just take them for a few days, ‘to see what happens’.

So I’ll lose some water weight, but it will be temporary. And while I do have a lot of fluid retention, its NOT 20kgs worth.  But fine.  I’ll take them for five days.

I have no choice but to see the endocrinologist and when he throws up his hands in disbelief, return to my gynaecologist.  He said he will then remove the pellets.

Once again, I have to jump through his hoops.  So I will. It will just take time, and many, many dollars.