Putting The Risks And Benefits Of Hrt In Perspective
If you’re just glancing at list above, some of the risks of HRT might seem to overwhelm the benefits. Could a reduction in vaginal dryness possibly be worth an increased risk of cancer?
But look at the details. The risks of HRT — while real — are quite small for an individual person. For example, the 2002 Women’s Health Initiative study found that ERT increased the risk of strokes by 39%. That sounds frighteningly high. But the actual number of people affected is very small. Out of 10,000 women who are not taking ERT, 32 have strokes each year. Out of 10,000 who are taking ERT, 44 have strokes each year. That’s an increase of just 12 people out of 10,000.
On the other hand, when it comes to controlling the symptoms of surgical menopause, a huge number of women feel the benefits. One out of four menopausal women has severe hot flashes. Treatment with hormone therapy cuts down the number of hot flashes per week by 75%. So if a woman had 24 hot flashes per week, HRT would drop that number to six. That could make a big difference in the quality of their day-to-day life.
What Other Symptoms Can You Experience After A Hysterectomy
The most obvious symptom of a hysterectomy is actually lack thereof: no more menstrual cycle! For many people, a hysterectomy symbolizes an improved quality of life however, others might experience grief over the loss of fertility or a disinterest in sex.
Dr. van Dis shares that for women whose menstruation or fibroids were interfering signifcantly with their quality of life, they may experience great joy after recovering from a hysterectomy. She elaborates, They may feel free to have more sex, if sex was painful. They may decide to perform exercise that before caused bladder leakage or pain. In short, she says, The majority of women who have hysterectomy experience marked improvement in their quality of life.
Welcome To Medical Menopause
If a womans ovaries are removed during a hysterectomy she will immediately go into menopause, a state known as medical menopause. Even if the ovaries are not removed, many women begin to have symptoms of menopause immediately after a hysterectomy and more will follow within the first year.
When the uterus is removed, the ovaries lose an important blood supply from the uterine artery, and their production of hormones can drop off significantly.
For women with medical menopause the symptoms can be quite alarming. Speaking on the topic of medical menopause, Dr. Randy Randolph MD said
because there is no opportunity for gradual adjustment to the hormonal drop-off, the symptoms of artificial menopause can be sudden, severe, and debilitating, requiring an immediate intervention of supplemental hormone therapy.
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Alzheimers Caused By Lack Of Brain
One study found that women who removed their ovaries before 40 and did not receive hormone replacement therapy have double the risk of Alzheimers disease.
This is because the sex hormone, estrogen, binds together with a receptor in your brain reducing the production of the protein amyloid-beta. This causes plaque to form on the brain of those with Alzheimers.
A Change In Recommendations
These studies were the first large-scale trials that looked for cause and effect with heart disease and HRT. HRT does offer some benefits, such as preventing osteoporosis and reducing the risk of colon cancer. But the data on heart-related risks from these studies were very compelling. As a result, the American Heart Association and the U.S. Food and Drug Administration developed new guidelines for the use of HRT:
The bottom line, say physicians at the Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic: weigh the benefits of HRT against the risks and discuss the whole subject of HRT with your physician to be able to make an informed decision.
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After A Hysterectomy Explore Connecticut Estrogen Therapy As An Option
If you have undergone a procedure and would like more information about Connecticut estrogen therapy after hysterectomy, call the office of Dr. Edward Jacobson today and arrange a consultation. You may also want to discuss bioidentical hormone replacement therapy prior to your hysterectomy, to get started as soon as possible post-surgery and avoid menopausal side effects.
Treatments For Vaginal Dryness
Vaginal dryness and discomfort can be bothersome menopausal symptoms for some women.
Devices that use lasers or other forms of energy to rejuvenate vaginal tissue are now being studied as well, although its not yet clear how helpful they might be. Its important to discuss the possible risks and benefits of these treatments with your doctor before deciding if one is right for you.
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Does An Oophorectomy Change The Type Of Hormone Therapy You Need
Determining the proper type of hormone replacement therapy after hysterectomy is crucial for safety and efficacy. The most important aspect that we mentioned in the last section is for women who undergo only an oophorectomy. If a woman still has her uterus, she must receive supplemental progesterone to protect against endometrial cancer.
When considering the facts about hormone replacement therapy and hysterectomy, you also want to keep in mind the following:
- Take the lowest effective dosage possible
- Use hormone replacement therapy for the shortest time
- Turn to bioidentical rather than synthetic hormones whenever possible
- Speak with a hormone specialist to discuss options, not just a gynecologist or primary care physician
Seek the guidance of a hormone specialist when discussing options for hormone replacement therapy.
What Is Surgical Menopause
A complete hysterectomy, including oophorectomy, has significant hormonal implications. Regardless of a womans age, if her ovaries are removed during a hysterectomy, it creates a condition known as “surgical menopause.” Since the ovaries are the primary producers of estrogen in a womans body, removal of the ovaries in premenopausal women will result in what doctors refer to as “surgical menopause.
Surgical menopause can put women through the same kind of debilitating symptoms as the loss of estrogen that occurs during natural menopause.
When a woman reaches her last menstrual period, usually around the age of 50, she can start feeling the well-known symptoms of menopause mood swings, night sweats, hot flashes, etc. These uncomfortable symptoms are a reaction to a gradual loss of estrogen before, during, and after menopause.
After removal of the ovaries during a hysterectomy, estrogen levels plummet all at once. That sudden drop in estrogen can make the symptoms of surgical menopause much more severe than during natural menopause.
When it comes to treating the symptoms of natural menopause, hormone replacement therapy can be subject to individual choice. Some women with mild symptoms of natural menopause may choose to forgo hormone replacement and “grin and bear it.” Others choose hormone replacement therapy.
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Why Take Hormone Replacement Therapy After Hysterectomy
1. Hormone replacement therapy after hysterectomy reduces some risks for younger women. Risks associated with HRT in the WHI study primarily involved older menopausal women . Women who undergo hysterectomy, including the removal of their ovaries will experience menopausal symptoms due to caused by the removal of the ovaries which are the primary manufacturers of estrogen. Health experts are convinced that instead of being harmful, hormone replacement therapy after hysterectomy is beneficial in helping younger women to go on with their normal lives even after the surgical procedure. Proof that HRT helps decrease the risks for heart disease and Parkinsons disease among young women is gradually taking shape and has long been shown to prevent/treat osteoporosis.
2. HRT after hysterectomy is shown to reduce the occurrence of hot flashes by as much as 75 percent. HRT is proven to be effective in relieving many menopausal symptoms, such as hot flashes, sleep problems, and vaginal dryness. Other alternative treatment options are not as effective.
3. HRT after hysterectomy offers other health benefits. It has been demonstrated to have a role in decelerating osteoporosis and in intensifying bone density. Estrogen and progesterone therapy is also believed to somehow lower the risk of developing colorectal cancer.
What Are The Risks Of Hrt
The health risks of HRT include:
- Increased risk of endometrial cancer For women who have had a hysterectomy , this is not a problem
- Increased risk of breast cancer with long-term use
- Increased risk of cardiovascular disease
- Increase in inflammatory markers
- Increased risk of blood clots and stroke, especially during the first year of use in susceptible women
All women taking hormone replacement therapy should have regular gynecological exams . The American Cancer Society also recommends that women over age 50 should:
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What Are 2020 Safer Analogs To Hormone Replacement Therapy And Weight Loss
The well-composed plan of HRT helps to prevent osteoporosis, controls body temperature, returns active sexual life, and works as a dietician. Hormone replacement therapy and weight loss reduce a patients food cravings and convert fat into energy. What are 2020 safer alternatives to hormone replacement therapy and weight loss for menopausal women?
What Happens If You Dont Have Hrt After A Hysterectomy
Estrogen plays a key role throughout the body. It affects the brain, the bones, the skin, the heart, blood vessels, and more. While estrogen levels gradually drop during natural menopause, they plummet drastically after hysterectomy that results in surgical menopause. That sudden drop in estrogen can lead to menopausal symptoms that can be quite severe.
Women who are in their 20s, 30s, or 40s will experience all of the symptoms of menopause earlier than they should if they do not have HRT after a hysterectomy. Early menopause can cause hot flashes, night sweats, mental fog, sexual health issues, and other symptoms typical of natural menopause. Hormone replacement therapy will eliminate these kinds of symptoms or makes them less severe if they do occur. HRT also helps with other early menopause symptoms, such as mood swings and sleep problems.
Among other potential negative consequences, if you do not have hormone replacement therapy after hysterectomy, you are at risk for weak bones later in life, which can lead to osteoporosis.
Now that you know a little bit more about how hormone therapy can be helpful after hysterectomy, why not contact us today and learn more about the safety and efficacy of hormone replacement therapy.
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Contraception Pregnancy And Hrt
Oestrogen used in HRT is different from oestrogen used in the contraceptive pill, and is not as powerful.
This means its possible to become pregnant if you are taking HRT to control menopausal symptoms. In some cases, a woman can be fertile for up to 2 years after her last period if she is under 50, or for a year if she is over 50.
If you dont want to get pregnant, you can use a non-hormonal method of contraception, such as a condom or diaphragm.
An alternative is the IUS , which is also licensed for heavy periods and as the progestogen part of HRT. You will need to add oestrogen as either a tablet, gel or patch.
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Youre A Woman In Perimenopause Or Menopause
Menopause is the time when your periods end, and so does your fertility. The years leading up to menopause can cause a number of uncomfortable symptoms that can significantly affect your quality of life.
If you have hot flashes and night sweats, vaginal dryness, sore breasts, thinning hair, dry skin, and depression, BioTE bioidentical hormone therapy can help put your estrogen levels back into balance so these symptoms lessen, or perhaps resolve entirely.
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Hrt And Surgical Menopause
So what is surgical menopause? It’s menopause that develops suddenly after the ovaries — the main producers of the hormone estrogen — are surgically removed.
The removal of the ovaries is called an oophorectomy. The procedure is often combined with a hysterectomy — removal of the uterus — but not always. And in fact, women who only have their uterus removed will not go into surgical menopause. Their ovaries are still making estrogen. They’ll go into menopause naturally when they get older, although sometimes a bit earlier than usual.
Estrogen plays a key role throughout the body. It affects the brain, the bones, the skin, the heart, the blood vessels, and more. While estrogen levels lower gradually during natural menopause, they plummet with surgical menopause. That sudden drop in estrogen can lead to menopausal symptoms that can be quite severe.
Hormone therapy after surgery — either with estrogen and progestin or with estrogen alone — is a way to counteract the supply of estrogen you’ve lost. Women who have both the uterus and ovaries removed usually just get estrogen replacement therapy alone. But women who have only the ovaries removed need both estrogen and progestin. That’s because estrogen alone can increase the risk of cancer in the uterus. Adding progestin removes this risk.
Rarely, if ever, will both ovaries be removed without the uterus. Often, only one ovary may be removed, which will negate the need for HRT at the time of surgery,
Does Having Or Not Having A Uterus Make A Difference In Deciding What Type Of Hormone Therapy I Should Take
Yes, it does.
If you still have your uterus:
Progesterone is used along with estrogen. Taking estrogen without progesterone increases your risk for cancer of the endometrium . During your reproductive years, cells from your endometrium are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in your uterus, a condition that can lead to cancer.
Progesterone reduces the risk of endometrial cancer by making the endometrium thin. If you take progesterone, you may have monthly bleeding, or no bleeding at all, depending on how the hormone therapy is taken. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously.
If you no longer have your uterus :
You typically wont need to take progesterone. This is an important point because estrogen taken alone has fewer long-term risks than HT that uses a combination of estrogen and progesterone.
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Bioidentical Or Natural Hormones
Bioidentical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones.
Practitioners claim these hormones are a natural and safer alternative to standard HRT medicines.
However, bioidentical preparations are not recommended because:
- they are not regulated and its not clear how safe they are theres no good evidence to suggest theyre safer than standard HRT
- its not known how effective they are in reducing menopausal symptoms
- the balance of hormones used in bioidentical preparations is usually based on the hormone levels in your saliva, but theres no evidence that these levels are related to your symptoms
Bioidentical hormones are not the same as body identical hormones. A body identical hormone, or micronised progesterone, can be prescribed to treat menopausal symptoms.
Many standard HRT hormones are made from natural sources, but unlike bioidentical hormones, theyre closely regulated and have been well researched to ensure theyre as effective and safe as possible.
Bioidentical Hormones After Hysterectomy
These two studies provide convincing evidence of the health benefits of hormone replacement after hysterectomy. Although the patients in these two studies were given Premarin which is a natural hormone , we find that a cocktail of bioidentical hormones including estradiol, estriol, progesterone, DHEA and testosterone works as well or better than the horse hormones. Since all women are humans, we I consider it preferable to prescribe human hormones rather than hormones from pregnant horse urine .
Left Image: pregnant horse, courtesy of wikimedia commons. Why use horse hormones when human hormones are available?
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What Type Of Hormone Therapy Do You Need After A Hysterectomy
Although it may not always be needed, HRT is often recommended at least for a short time following an oophorectomy. The immediate drop in hormone production may not cause hot flashes and mood swings, but it may impact ones bones, heart, or brain functions.
In the following hormone replacement therapy guidelines, hysterectomy and oophorectomy needs are explained:
- Hormone therapy options following an oophorectomy and hysterectomy:
- Estrogen therapy
- Progesterone therapy women without their ovaries should not use synthetic progestin as that can increase certain side effect risks only natural or bioidentical progesterone therapy is advised
While those are the standard guidelines for hormone replacement, there are other options that every woman should know:
Understanding hormone replacement therapy and hysterectomy needs are crucial so that you ensure you are getting the right treatment.
Women who have their uterus intact and only undergo ovarian removal need progesterone to reduce the risk of endometrial cancer.