Hormone Replacement Therapy After Hysterectomy


Posted: January 13, 2020 at 9:44 pm

Doctors perform an average of 500,000 hysterectomies a year in the US. These hysterectomies can be partial, total, or radical, depending on what structures are removed. Besides a hysterectomy, a woman may also undergo an oophorectomy.

In this report, we will discuss the various types of hormone replacement therapy after hysterectomy that are available based on each form of surgery.

HRT options for women include:

The surgical options for a hysterectomy include:

The type of surgery dictates whether or not you will need to receive hormone replacement therapy right away following a hysterectomy.

A hysterectomy does not always affect hormone levels. What does occur is that a woman will stop having monthly periods once her uterus is removed. Many women who have only a hysterectomy but retain their ovaries do not experience signs of menopause for many years. Others may start to get hot flashes a short time after the surgery. The reason why a woman might need hormone replacement therapy after hysterectomy is due to reduced blood flow to the ovaries following the uterine removal. If the ovaries decrease their hormonal production, the symptoms of menopause may appear. The decline in hormone secretion here is not the same as with an oophorectomy.

The ovaries are the manufacturers of progesterone, testosterone, and estrogen. When a doctor performs an oophorectomy, he is removing the primary source of hormone production for these chemical messengers. Although a small amount of these hormones will still come from the adrenal glands, the loss of the ovaries often sends women into what is called surgical menopause. This condition comes on rather quickly since hormone levels rapidly decline.

The term surgical menopause applies only to women who undergo an oophorectomy. A female who still has her ovaries will gradually experience a decline in hormone production associated with menopause. However, once the ovaries are removed, a woman is thrown rapidly into menopause due to the loss of hormone production. Once that occurs, the symptoms come on quickly, and with greater severity in most cases. That is why doctors typically start HRT while the woman is still in the hospital.

Bioidentical hormone replacement therapy after hysterectomy is vital to protect a womans bones from becoming brittle and weak. Osteoporosis risk increases for women who undergo a hysterectomy and oophorectomy.

At times, a doctor may perform only a partial oophorectomy, removing one ovary but leaving the other. Surgical menopause does not occur in that situation. However, a woman may enter regular menopause earlier than expected due to the loss of one ovary or the uterus.

Another reason for starting hormone replacement therapy after hysterectomy and oophorectomy is that losing ones ovaries before entering menopause increases the risk of heart disease. Parkinsons disease and dementia risks also increase for women who had their ovaries removed before menopause. The younger a woman is at the time of the oophorectomy, the greater her risk of long-term health concerns.

Surgical menopause occurs following an oophorectomy (ovary removal) and often causes rapid menopausal symptoms.

Symptoms of menopause are the same for women who enter it naturally as well as those who undergo a hysterectomy or oophorectomy. That does not, however, mean that every woman will experience the hormonal changes associated with menopause. There are always going to be some women who escape the traditional signs of menopause:

Even some women who undergo an oophorectomy may not have to deal with these changes.

For some females who begin hormone replacement therapy after hysterectomy, weight gain is not a concern. Their bodies used the supplemental hormones to help promote proper metabolism.

As uncomfortable and annoying as night sweats and hot flashes might seem, there are greater concerns. Bone loss is a serious issue, as is protecting the heart and the brain from decline.

After the Womens Health Initiative Study scared females and many doctors away from hormone replacement, the question was how to treat the symptoms of menopause. It is not just the hot flashes and other issues that are the problem. The more important reason to find options for safe hormone replacement therapy after hysterectomy is to protect the body. Estrogen, testosterone, and progesterone carry out critical functions that must continue through life. The sudden decline in hormone production that occurs after an oophorectomy may cause problems decades later.

Estrogen is vital to the blood vessels, the heart, brain, skin, bones, cholesterol production in the liver, and body temperature.

Progesterone is essential for the bones, blood sugar balance, blood clotting, sleep, heart health, thyroid hormones, skin, and metabolism. Additionally, progesterone has neuroprotective benefits for the brain. Most importantly, progesterone is the precursor hormone to testosterone and estrogen production.

Testosterone supports metabolism, bone density, muscle growth, libido, sexual functions, red blood cell production, heart health, and brain functions.

Options for hormone replacement therapy following a hysterectomy without an oophorectomy include:

HRT options following an oophorectomy and hysterectomy include:

Women who have only their ovaries and not their uterus removed should receive estrogen and progesterone as estrogen alone can increase uterine cancer risk. Although many doctors prescribe progestin, that is the treatment found in the WHI study to cause problems. That is why hormone specialists prefer to prescribe bioidentical progesterone that is safe to use. Progesterone lowers the risk of endometrial cancer in women who have a uterus. However, progesterone should not be used in conjunction with vaginal estrogen.

Other options for treating menopausal symptoms include:

Hormone replacement therapy options following a hysterectomy include estrogen, progesterone, testosterone, human growth hormone, and natural supplements.

It is highly recommended that every woman not only does her own research but also speak with her doctor about the pros and cons of hormone replacement therapy after hysterectomy. Ultimately, the decision is up to each woman as to how she wants to handle the changes in her hormone levels.

The pros of hormone replacement therapy after a hysterectomy/oophorectomy include:

There are some risks of hormone replacement therapy after hysterectomy that cause some women to decline this treatment. The cons of HRT include:

Your doctor will help you determine the best hormone replacement therapy after hysterectomy based on your situation. HRT should last the shortest time necessary at the lowest possible dosage for effectiveness.

Women should not begin hormone replacement therapy after the age of 60.

Many hormone specialists recommend avoiding oral HRT as that must go through the liver. Topical preparations are often better with less chance of side effects.

Some forms of hormone therapy treat specific symptoms. If you only suffer from vaginal dryness or urinary issues, your doctor may prescribe a vaginal form of HRT. Some hormone therapies only reduce osteoporosis risk and do nothing for other menopausal symptoms. It is essential to be honest with your doctor about what you are experiencing.

Estrogen therapy is not recommended for women with the following risk factors:

Hormone replacement therapy following a hysterectomy should be at the lowest dosage for the shortest necessary time.

When to Stop Hormone Replacement Therapy After a Hysterectomy

Stopping hormone replacement therapy after hysterectomy is another subjective decision to make with your doctor. Here are some general guidelines about the use of HRT:

If you are healthy and have no symptoms of menopause, you typically do not need HRT. Maintain a healthy lifestyle, exercise, get at least 7 hours of sleep, and you will likely maximize your natural hormone production.

Your gynecologist will likely be the doctor to start you on hormone replacement therapy after hysterectomy. Within 10 to 12 weeks of beginning treatment, you should ask to have your hormone levels checked. You will want to undergo blood testing of progesterone, testosterone, estradiol, and IGF-1 (for growth hormone deficiency) levels.

Some gynecologists look to estrogen and progestin as their only recommended treatments. Progesterone is a safer option than progestin. We recommend that women facing menopause speak with a hormone replacement therapy specialist who focuses on the hormonal changes that occur with age. That includes surgically induced menopause.

Please contact our hormone clinic for a free consultation with any questions you have about HRT.

A hormone specialist may have options for treatment of menopause symptoms that your doctor may not offer.

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Hormone Replacement Therapy After Hysterectomy

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