QC: The Silent Cost of Delaying Hormone Replacement: With Dr. Christine Vaccaro

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Surgical removal of reproductive organs creates an abrupt hormonal shift that requires thoughtful planning and preventive care. Dr. Christine Vaccaro discusses the importance of pre-surgical hormone replacement therapy planning and the significant risks of delaying treatment after ovary removal.

• Prevention is key—proactive planning can help avoid the "six weeks of awful" many women experience after surgery
• Transdermal estrogen products do not cause blood clots, contrary to some medical misconceptions
• Bone health suffers dramatically with hormonal depletion—even perimenopause can cause 10% bone density loss
• Sleep disruption without hormones can lead to cascading health problems including depression and chronic illness
• Starting hormone therapy immediately after surgery prevents suffering and protects long-term health
• Some patients with already low testosterone may benefit from starting replacement before surgery
• Withholding hormone replacement makes as little sense as withholding insulin from a diabetic

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Episode Transcript

Speaker 1 (00:00):
Are you faced with the decision of having a
hysterectomy and potentiallyremoving your ovaries and you
have a lot of concern when itcomes to your hormones and how
you're going to feel aftersurgery.
What is the risk-first benefitof having hormone replacement
therapy and planning for itprior to your surgery, and what
are the risks of not doinghormone replacement therapy?
That and so much more in thisepisode of Quick Connect with Dr

(00:24):
Christine Peccaro Stick around.
Life moves fast and so shouldthe answers to your biggest
questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights.
Short, powerful and right tothe point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember expert

(00:47):
opinions shared here are forgeneral information and not for
personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect If someone is

(01:21):
planning to go into theoperating room, have their
ovaries removed or even justhave a hysterectomy.
Is there a benefit topre-surgical planning for
hormone replacement therapy andwhat are some ways that we can
approach this with our providers.

Speaker 2 (01:31):
Yeah.
So, alana, I think you ask areally important question.
I love prevention and I loveproactive women.
I love when I see a patientcoming in for a variety of
reasons why they're having theiruterus out and their ovaries
out and they want to have theconversation.
You know, here's what happensif you don't supplement your
hormones, that we're going to beabruptly ripping from your body

(01:53):
.
You know, and make it obviouslya conversation, shared decision
making, right?
Because, again, for a varietyof reasons, some women may not
want hormone therapy.
At least they know and theyunderstand the risk.
I don't think we also clearlytalk about what this happens to

(02:13):
your bones, right?
Just osteoporosis alone killsso many women every year and,
again, we don't talk about thatenough either.
So it's just all sorts ofprevention.
So, again, imagine a worldwhich I do see this often
actually, and I love it that awoman comes in, okay to meet
with her surgeon and or,potentially, a hormone
specialist, and they go throughall the options, they go through
the expectations and there's aplan for either hormonal or non

(02:35):
hormonal therapy and that canactually start the day of slash
before after, whatever theyagree upon, you don't have to
wait until symptoms are severeand you're feeling awful and
anxiety and depression and brainfog sets in.
The point about prevention is toprevent feeling terrible, so
catching it before it starts.

(02:55):
I think there's a misperceptionstill in the medical community
that transdermal hormones causeor can contribute to blood clots
.
Transdermal estrogen productsdo not cause blood clots.
But I think again, sometimessurgeons still have this sort of
perception and they don't wantto start anything in and around
the perioperative timeframeeither.

(03:17):
That you know before, right,immediately after, etc.
So a lot of times women are inthis you know, six week zone of
suffering until they go intotheir post-op visit and then
it's like, oh, how are youfeeling?
And it's like I feel awful.
But we have avoided that sixweeks of awful and just helped
them through that with replacingagain what their body was

(03:39):
already making.
It's not like we're givingsupra-therapeutic doses here.
We're just giving a little gasin the tank so it doesn't run on
empty.

Speaker 1 (03:48):
Yeah, I think what's hard too is a lot of people
coming out post-operatively kindof associate what they're going
through as post-op pain asopposed to the significant
changes in their bodiesoccurring instantly, and I
definitely experienced that.
Are there risks associated withholding off on hormone

(04:10):
replacement therapy, even ifit's a year or two?

Speaker 2 (04:13):
Yeah, the best data we have is in bone health.
So for bones the loss is prettysignificant right away.
The best data we have is theperimenopause window, which is
like four to seven years beforemenopause.
During that just thattransitional time where again
sometimes estrogen is normal andsometimes it's really low, we
lose like 10% of our bone lossjust in that up and down time.

(04:38):
So if you can imagine one yearwithout hormones completely,
which is a huge change, thebones take a huge hit there.
I don't have a number to quote,but again it could be up to 10%
.
You know, we don't know.
But again, women that havenormal testosterone then go down
to zero.
That's a huge change and thebones definitely feel that I
mean other things are going tobe harder to zero.
That's a huge change and thebones definitely feel that I

(04:59):
mean other things are going tobe harder to quantify.
Right, we know how much sleep isdisrupted during hot flashes,
night sweats, and again, itdoesn't even have to be a hot
flash of night sweat.
You can just wake up for noreason at all, meaning like
you're a great sleeper, and thenall of a sudden you're like why
am I awake at 2am?
For no reason, and then themind starts going and then

(05:20):
things start happening and thenyou can't fall back asleep.
Okay, so then you have, youknow, months slash years of poor
sleep, which poor sleep isdirectly related to chronic
illnesses, skeletal pain,depression, et cetera, et cetera
.
Right, so it's.
All these things layer on eachother and only the patient
themselves know how devastatingthat you know year of waiting

(05:44):
can be.
You know, again, I just hate tosee women suffer at all.
So my approach is that thattime frame is zero days, like I
want them to start right away.
I even have some patients thatare already low on testosterone
start testosterone before theirsurgery, because it does take
several months to ramp up ontestosterone.
So every patient's a little bit, a little bit different, based

(06:04):
on their age, symptoms thatthey're already experiencing.
But again, you know, thinkabout one year, think about a
diabetic with one year withoutinsulin.

Speaker 1 (06:12):
You know, that's a really important human hormone.

Speaker 2 (06:14):
Think about a hypothyroid patient with one
year without their thyroid.
They're going to feel miserable, and I don't know why we treat
sex steroids as something thatwe withhold for some reason,
just to allow women to sufferLike it doesn't make any sense
to me at all.
So to prevent pain andsuffering and also to prevent
chronic disease likeosteoporosis, I don't recommend

(06:36):
waiting unless there is aconcern about hormonal dependent
cancers, or there's a concern,and then again then that's a
more of a detailed discussionwith the patient about risk
benefit.

Speaker 1 (06:48):
That's a wrap for this quick connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(07:12):
Until next time, keep feelingempowered through knowledge.