Ann wrote:
<Mom called today with a medication question. She had an emergency
hysterectomy 3 weeks ago, had a cancerous lesion on her cervix. Baby boy
is
6 months old. Nursing well, and eats solids too.
Mom is taking Estratest once a day. This medication is a combination of
estrogen and testosterone.
The only information I found about it is that the estrogen may change the
milk, and little is known about the androgen part of the medication,
observe
baby carefully for growth and observe for precocious changes in the
genitals. She is wondering about this medication. Her MD has said it
would
be okay. Anybody have any other information to share with this mom?>
I thought for sure someone more well informed would comment. But these
thoughts keep coming back into my mind:
cancerous lesion on the cervix-EMERGENCY hysterectomy?
That doesn't seem to add up, especially if it was a TOTAL (including both
ovaries and tubes) hysterectomy. Sounds like something of the misogynous
nightmares we might have heard of way back in the '40's, such radical,
gratuitous "complete cleaning out" of the female pelvis, without
consideration of lesser alternatives.
Surgical menopause seems to be implied. Estratest does not seem to be
the usual first choice for hormone replacement therapy (HRT). The PDR
says that Estratest is prescribed for moderate to severe vasomotor
symptoms associated with the menopause, not improved with estrogens
alone. It should never be used for depression attributed to this.
The PDR also says the methyltestosterone portion should not be used in
breastfeeding mothers because of the danger of masculinization of female
infants. I think that male infants might also be at risk for hormone
interference with this too.
Is this mother receiving this diagnostic and prescriptive information
from a general or ob-gyn surgeon, a family practitioner, or the child's
pediatrician?
If I were this mother, I would want to see a copy of my operative report
and/or pathology report. Of course, that's just me, but I think there is
less room for misunderstanding about the diagnosis, and just what organs
were removed that way.
Secondly, if in fact both ovaries were totally removed, I would want a
second, and even maybe a third opinion as to whether Estratest should be
the first choice for HRT, and whether or not it is truly "okay", given
what we have just been discussing re: medical education in regard to
breastfeeding.
I would feel I owed it to my son to get more information, to do more than
"watch and wait to see if there were any precocious changes in the
genitals", given what we know of the the effect of excess androgens on
athletes, 20 year delay in effects seen in little boys whose mothers
received DES in pregnancy, etc. Too much is at stake for his immature
endocrine system and developmental stage, and this approach sounds way
too casual to me. Actually, pretty frightening.
Just my $.02! Dr. Hale, and physicians, comments please.
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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