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Hormone Replacement Therapy After Hysterectomy

Hormone Replacement Therapy After Hysterectomy

November 19, 2018

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:

  • Estrogen
  • Progesterone
  • Progestin
  • Testosterone
  • Human growth hormone
  • Herbs and natural supplements

The surgical options for a Trusted sourceHysterectomy WebMDGo to sourcehysterectomy include:

  1. Partial hysterectomy – removal of only the upper part of the uterus – the cervix remains
  2. Total hysterectomy – entire uterus and cervix are removed
  3. Radical hysterectomy – includes uterus, cervix, and structures around the uterus (recommended if cancer is suspected or diagnosed)
  4. Oophorectomy – removal of the ovaries (bilateral if both, unilateral if only one)
  5. Salpingectomy – removal of the fallopian tubes
  6. Salpingo-oophorectomy – removal of the fallopian tubes and ovaries

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

Hysterectomy and Oophorectomy Effects on Hormone Secretion

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 Trusted sourceSigns and Symptoms of MenopauseNational Institute of AgingGo to sourcesigns 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 Trusted sourceOophorectomy: Everything you need to knowMedical News TodayGo to sourcewith 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.

Surgical Menopause and Hormone Replacement Therapy

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 woman’s 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 one’s ovaries before entering menopause increases the risk of heart disease. Trusted sourceWhat Is Parkinson's?Parkinson's FoundationGo to sourceParkinson’s 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.

Menopausal Symptoms After Hysterectomy

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:

  • Hot flashes
  • Night sweats
  • Mood swings
  • Brain fog
  • Weight gain
  • Depression
  • Vaginal dryness
  • Low libido

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.

Options for Hormone Replacement Therapy After Hysterectomy

After the Women’s 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:

  1. Estrogen therapy – pill, cream, patch, gel, vaginal ring
  2. Progestin – synthetic hormone that increases certain health risks
  3. Progesterone – a natural, bioidentical HRT that is safe to use for most women

HRT options following an oophorectomy and hysterectomy include:

  1. Estrogen therapy
  2. Progesterone therapy – NOT progestin

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:

  1. Testosterone therapy – is a safe method of treating menopause as it is the precursor hormone to estrogen
  2. Human growth hormone therapy – HGH deficiency has many of the same symptoms as menopause and often reduces or eliminates those issues
  3. Black cohosh – manages hot flashes
  4. Vitamin D and calcium – to protect the bones

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

Pros and Cons of Hormone Replacement Therapy After Hysterectomy

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:

  1. Protecting bone density
  2. Reducing night sweats and hot flashes
  3. Balancing mood and emotional well-being
  4. Improving vaginal lubrication and sex drive
  5. Reducing the risk of colorectal cancer
  6. Supporting sleep
  7. Enhancing brain functions
  8. Decreasing the risk of gum disease and tooth loss
  9. Slowing the decline in collagen for the skin
  10. Reducing the risk of dying early from heart attacks and breast cancer

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

  1. Hormone replacement therapy after age 50 can increase the risk of cardiovascular effects
  2. Side effects may include:
    • Headaches
    • Nausea
    • Swollen or painful breasts
  3. Do not use oral estrogen if you have liver disease or other liver issues
  4. Blood clot and stroke risks increase with HRT
  5. Breast cancer incidence may be a concern – it is essential to note that estrogen alone does not cause this risk unless in use for over six years
  6. Estrogen alone may increase ovarian cancer risk
  7. Higher risk of gallstones

How to Determine What Type of Hormone Replacement Therapy is Best

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:

  1. Liver disease or other liver problems
  2. History or family risk of breast, uterine, or ovarian cancer, stroke, or blood clots
  3. Unexplained vaginal bleeding

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:

  1. Surgical menopause prior to age 45 – begin hormone replacement therapy after hysterectomy and continue until at least the median menopausal age of 52
  2. The decision to continue HRT past age 60 or 65 should be made with a doctor based on individual risk factors for bone loss, fractures, heart disease, etc.

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.

How to Begin Hormone Replacement Therapy After Hysterectomy

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.

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

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  2. Harvard Health Publishing
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  4. Verywellhealth
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  9. Hormone replacement therapy following hysterectomy for endometriosisMrF.B.P.Zakaria(MRCOG, Research Fellow)Mr, DSc, MDJ.W.W.Studd(FRCOG, Consultant
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