A hysterectomy is the surgical removal of the uterus. It's a very common procedure, with about 600,000 hysterectomies performed each year in the United States. There are various reasons a hysterectomy may be recommended, such as fibroids, endometriosis, uterine prolapse, or cancer.
After a hysterectomy, the ovaries may or may not be removed as well. If the ovaries are kept, they will continue producing estrogen and progesterone normally until menopause. However, if the ovaries are removed along with the uterus, this induces surgical menopause and hormone replacement therapy (HRT) is typically recommended.
HRT after hysterectomy serves several important functions:
- Alleviates menopausal symptoms like hot flashes, night sweats, vaginal dryness, mood changes, and sleep disturbances. Estrogen in particular helps significantly reduce hot flashes and vaginal atrophy.
- Protects bone health and reduces risk of osteoporosis. Estrogen plays a key role in maintaining bone density. Without adequate estrogen levels, accelerated bone loss occurs. HRT helps preserve bone mass.
- May reduce risk of heart disease. Estrogen has a positive effect on cholesterol levels and may help protect cardiovascular health. HRT can help maintain these benefits in women who have surgical menopause.
- Improves urogenital and sexual health. Vaginal dryness and pain with intercourse are common after hysterectomy. Estrogen replacement improves lubrication and elasticity of vaginal tissues. It also helps maintain the health of surrounding structures like the urethra and bladder. This promotes better urinary function and sexual comfort.
- Alleviates mood and cognitive issues. Estrogen influences serotonin and other neurotransmitters in the brain that affect mood regulation. Declining estrogen levels are linked to depression and memory problems. HRT can help stabilize mood and cognitive function.
The most common types of HRT after hysterectomy are:
- Estrogen-only therapy - Used if the ovaries were removed. Estrogen is typically taken as a daily oral tablet, transdermal patch, vaginal cream, or ring. It may also be administered as injections.
- Combined estrogen plus progestin therapy - Used if the ovaries were not removed. A progestin is needed to provide protection against uterine cancer in the remaining ovarian tissue. The estrogen component alleviates menopausal symptoms while the progestin provides endometrial protection.
There are some risks associated with HRT that should be discussed with your doctor:
- Slightly increased risk of breast cancer - The risk is small but needs to be considered, especially if taking combined HRT with estrogen and progestin. Estrogen-only HRT does not appear to increase breast cancer risk.
- Blood clots - Estrogen raises clotting factor levels in the blood. This may increase chance of deep vein thrombosis or stroke.
- Gallbladder disease - Estrogen can cause gallstones in some susceptible women. Inform your doctor if you have a history of gallbladder problems.
- Uterine cancer - For those who retain their ovaries, unopposed estrogen without progesterone raises endometrial cancer risk. A progestin is protective.
Overall however, the benefits of HRT often outweigh the risks for most women. Treatment is customized based on each woman's needs and risk factors. Many experts now feel that HRT is safe for the majority of women who have surgical menopause, at least in the first few years after hysterectomy.
When beginning HRT after hysterectomy, regular follow-up with your healthcare provider is important. You should have routine pelvic exams, mammograms, and bone density tests. Your doctor will monitor for any potential side effects and make dosage adjustments as needed. Most women can take low-dose HRT safely for many years after hysterectomy.
If you've had a hysterectomy with ovary removal and are struggling with menopausal symptoms, consider making an appointment with Hormone Harmony. Our caring providers specialize in hormone replacement therapy for women transitioning into menopause. We offer cutting-edge hormone testing and work closely with each patient to develop a customized treatment plan to meet their needs. Convenient telehealth visits are available. Contact us today to learn more about HRT options after hysterectomy. You don't have to suffer through menopausal symptoms - help is available!
