Wednesday, April 17, 2024

Hormone Therapy After Hysterectomy For Endometriosis

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Ruling Out Conditions With Similar Symptoms

Personalized Hormonal Treatment for Endometriosis

Many conditions cause pelvic pain. In many cases, the cause is unknown, and the condition often resolves on its own. However, some causes of pelvic pain can be serious and should be ruled out during a work-up for endometriosis.

Primary Dysmenorrhea

Primary dysmenorrhea is defined as pelvic pain associated with menstruation in the absence of an identifiable cause. Commonly, its onset occurs in women younger than the usual age of dysmenorrhea associated with endometriosis. Primary dysmenorrhea is common.


A condition called adenomyosis occurs when nodules of endometrial tissue develop within the deep muscle layers of the uterus. This disorder is often classified as endometriosis, but adenomyosis is a different disease.

Adenomyosis is a significant cause of severe pelvic pain and menstrual irregularities. It typically occurs in women who have uterine fibroids, women age 40 to 50, and women who have had children. Women, who have had surgery for endometriosis, yet continue to suffer from menstrual and pelvic pain may actually have adenomyosis.

Other Causes of Pelvic Pain

Many conditions cause pelvic pain that may or may not be related to menstruation. Some causes of pelvic pain that can be serious and should be ruled out include:

  • Pelvic inflammatory disease
  • Uterine fibroids
  • Ectopic pregnancy
  • The use of an intrauterine device for contraception
  • History of sexual abuse or trauma
  • Severe kidney or urinary tract infections
  • Irritable bowel syndrome

Symptoms Of Hysterectomy And Menopause

Symptoms of the climax after removal of the uterus can be noticed already after three weeks from the day of surgery. These can be:

  • increased night sweating
  • brown discharge after menopause and hysterectomy
  • depressive states.

When the uterus is removed, hormone replacement therapy is necessary, especially for women under 50 years of age. For this purpose, estrogens and gestagens are used. Hormone therapy is important to prescribe as soon as possible, no later than a couple of months after the procedure. It helps reduce the risk of heart disease and hysterectomy and weight gain menopause problems. But, it is important to remember that HRT may not always be prescribed. There are contraindications. Here, they are:

  • surgery was related to uterine cancer
  • diseases of the liver and kidneys

The duration of treatment is from two to five years. No need to wait for the complete disappearance of menopause after the therapy. Depending on the duration of hormone therapy, clinical manifestations are only reduced.

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Why Bother With Supplements After Hysterectomy

When you have a hysterectomy it will put you in the surgical meno. There are some side effects that go alongside this, some which youll probably be familiar with, such as hot flashes, difficulty sleeping and feeling more anxious.

Other problems include higher risk of osteoporosis and heart disease, mood changes, anxiety, lack of sex drive, vaginal dryness and poor sleep.

Hormone changes, namely the drop in estrogen, is responsible for these uncomfortable, annoying and sometimes embarrassing symptoms.

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Case Reports And Case Series

There were 32 case reports/series including 42 patients identified by our search. An additional article describing endometriosis-related malignancies in six women who had taken oestrogen replacement was retrieved . This article is discussed separately, as insufficient data are reported for the individual women to enable inclusion in our summary statistics.

A Note From Cleveland Clinic

Endometrial Ablation

The decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Discuss the risks and benefits of hormone therapy with your healthcare provider at an office visit specifically dedicated for this conversation. Youll need the time to address all the issues and answer questions in order to arrive at a decision that is best for you. Factors considered should be your age, family history, personal medical history and the severity of your menopausal symptoms.

Be sure to talk about the pros and cons of the different types and forms of HT as well as non-hormonal options such as dietary changes, exercise and weight management, meditation and alternative options.

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How Long Should You Take Estrogen After A Hysterectomy

This is a question that should be discussed with your doctor. Typically, patients will take estrogen therapy for the rest of their lives. However, some women may only need to take it for a few years.

If you are considering a hysterectomy or oophorectomy, it is important to talk to your medical provider about hormone replacement before the procedure. Here at Hormones by Design, we specialize in BHRT.

We can help you with determining your estrogen levels and help you make a plan for the best method to replace all your needed hormones.

If you have any questions, please dont hesitate to call our new New Braunfels location at 627-7979. We would be happy to help!

Menopausal Hormone Therapy And Cancer Risk

For decades, women have used hormone therapy to ease symptoms of menopause, such as hot flashes and sweating. This is called menopausal hormone therapy, and you may see it abbreviated as HT or MHT. You may also hear it described as hormone replacement therapy , postmenopausal hormone therapy , orpostmenopausal hormones .

In the past, many doctors and their patients believed that MHT didnt just help with hot flashes and other symptoms it had important health benefits. But well-conducted studies have led many doctors to conclude that the risks of MHT often outweigh the benefits.

This information covers only how MHT can affect a womans risk of getting certain cancers. It does not cover other possible risks of MHT such as heart disease or stroke.

You can use this information when you talk to your doctor about whether MHT is right for you.

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Types Of Hysterectomy Procedures

Hysterectomies may be performed abdominally or vaginally . A variation of the vaginal approach is called laparoscopic-assisted vaginal hysterectomy . There are other laparoscopic approaches as well, including total laparoscopic hysterectomy and robotic assisted laparoscopy. Recovery times for vaginal hysterectomy and laparoscopic procedures are shorter than those for abdominal hysterectomy.

The Benefits Of Progesterone Treatment After Hysterectomy

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A hysterectomy is both sudden and prolonged. Thesurgery itself can leave a woman in the hospital for 2-3 days. The recoveryperiod can be up to eight weeks, and rarely fewer than six. But unlike withsome surgeries, the effects often dont fade into memory. Particularly when youhave a hysterectomy that includes removal of the ovaries before you enternatural menopause, you can experience sudden and lasting hormonalupheaval.

This can be a significant challenge, both mentally and physically. The impact of surgical menopause can not only complicate recovery, but fundamentally change the way you live your life. For some women, it is devastating. When a hysterectomy is coupled with a removal of ovaries, the aftermath can be uncomfortable, painful, emotionally distressing, and even dangerous. For this reason, many women seek hormone replacement therapy.

Hormone replacement therapy for women without a uterus has traditionally been estrogen-only. However, there may be meaningful benefits of progesterone treatment after hysterectomy. Both approaches have pros and cons, risks and rewards, and taking a closer look at your options is essential to developing a treatment plan that works for you.

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Just A Few Of The Hormonal Conditions Our Doctors Specialize In Treating


Polycystic ovarian syndrome is estimated to affect 1 in 10 women of childbearing age and is one of the most common causes of infertility. Symptoms include irregular periods or no periods, excessive hair growth, weight gain, and acne.

Hashimotos thyroiditis

More common in women, Hashimotos involves antibodies that attack the thyroid gland so it cant function properly. Symptoms include fatigue and sluggishness, increased sensitivity to cold, constipation, and hair loss.

Adrenal dysfunction

This stress-related condition stems from chronic elevation of adrenal hormone levels. Symptoms might include chronic fatigue, allergies, and insomnia.

Insulin resistance

This condition occurs when cells in your muscles, fat, and liver dont respond well to insulin and cant use glucose from your blood for energy, causing your blood sugar levels to go up over time. Symptoms might include weight gain and high blood pressure.


Millions of women are misdiagnosed with infertility every year because few doctors are doing the advanced testing needed to discover the root cause of their inability to get pregnant, which can be hormonal.

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Reasons For Having A Hysterectomy

There are many different reasons why hysterectomy may be necessary. These include:

  • Painful, heavy or frequent periods which are not improved with medical treatments
  • Fibroids Swellings of abnormal muscle that grow in the uterus, which can cause painful, heavy periods or pressure on other pelvic organs
  • A prolapsed womb, which is caused by the dropping of the uterus.
  • Endometriosis, a condition where tissue segments from the womb attach and grow in the wrong place, causing pain
  • Adenomyosis the same problem as endometriosis, but affecting the muscle of the womb
  • Severe, recurrent or untreatable pelvic infection

Very rarely, hysterectomy is performed as an emergency procedure, such as if bleeding becomes uncontrollable during childbirth. Usually though, the operation is planned.

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Endometriosis What Can Be Done About It

The disease is believed to be dependent on oestrogen which is a hormone produced from a womans ovaries. Common treatments aim to prevent cyclical fluctuation in these hormones by inhibiting ovulation and the most readily used treatment is the combined contraceptive pill. A Cochrane Review found that the effects of the progesterone releasing coil, Mirena, on pain are uncertain. Like other coils, it prevents conception. Surgically treating these cells via keyhole surgery with techniques to burn or cut out the lesions of endometriosis may have a beneficial effect on pain and fertility. However, the recurrence rateThe speed or frequency of occurrence of an event, usually expressed with respect to time. For instance, a mortality rate might be the number of deaths per year, per 100,000 people. of pain following surgery is up to 30% within the first 12 months. For some women, these treatments are ineffective and stronger more invasive methods are required to stop the pain. Surgically removing the ovaries and inducing permanent menopause or medically inducing temporary menopause is often the final option for many women. These induce a dramatic fall in a womans oestrogen levels and improve pain.

Does Having Or Not Having A Uterus Make A Difference In Deciding What Type Of Hormone Therapy I Should Take

Pharmacotherapy of endometrial hyperplasion/Fertilitypedia

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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What You Can Expect Emotionally

Whatever feelings or emotions arise during this time, honor them and share them with someone you trust.

If you were looking forward to the relief that a hysterectomy was going to bring to you, you might be surprised by feelings of grief. Its not uncommon to feel a sense of loss. If you feel grief over the loss of your uterus and your ability to have children, thats normal.

If your surgery was motivated by illness or cancer, you might feel depressed. This is normal too. Enlisting the support of your doctor or a mental health therapist will help you make your way through them and back to the lighter side.

Many women feel happy after their hysterectomy. Thats normal too!

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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,

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Endometriosis Recurrence In Women On Hrt

Thirteen case reports and case series were identified reporting endometriosis recurrence in menopausal women given HRT for the treatment or prevention of menopausal symptoms. These included 17 patients between the ages of 3065 .II). All of the included women had undergone treatment with exogenous oestrogens in some form. Skor et al. was the earliest report retrieved by our search. This case was a 48-year-old Caucasian woman who presented with a 2-month history of painless haematuria and decreased urinary stream on voiding. She had undergone a total abdominal hysterectomy with bilateral salpingo-oophorectomy with endometriosis found in the specimen and confirmed by histology. She had been prescribed conjugated oestrogens following surgery and continued these for 6 years until her presentation. On physical examination, a 7 cm × 8 cm mass starting in the midline and extending to the left pelvic wall was palpated and the patient underwent cystoscopy. Postmenopausal bladder endometriosis was diagnosed histologically. Oestrogens were discontinued and intramuscular medroxyprogesterone acetate was administered for 2 months. Despite this, there was no significant alteration in the size of the mass. Shortly afterwards, due to symptom recurrence, the endometriotic lesion was removed surgically. The patient had no complaints 1-year post treatment. The authors commented that exogenous oestrogens play a role in the stimulation and development of postmenopausal endometriosis.

Breast Cancer Benefit May Not Apply To All

Common hysterectomy procedure may spread uterine cancer

Several other important warnings also apply.

The first is that estrogen did not appear to help some women. Those were women at higher risk for breast cancer because they had a family history or history of having benign breast disease. Estrogen may even increase the risk of breast cancer in women who already have other risk factors.

âFor women who are most in need of a breast cancer reduction strategy, this approach isnât going to work,â says researcher Garnet L. Anderson, MD, principle investigator of the Womenâs Health Initiative Clinical Coordinating Center in Seattle.

âThese agents should not be used for breast cancer prevention, even though we clearly show a lower risk of breast cancer in these women taking hormones,â says Anderson, who is also a member of the Fred Hutchinson Cancer Research Center.

The second important consideration is that the study tested a kind of estrogen called conjugated equine estrogen, which is sold under the brand name Premarin. In recent years, that formulation has become less popular. More women have moved toward using estradiol, which is chemically closer to the bodyâs own estrogen. But researchers say they arenât sure if the two kinds of estrogen work the same way.

âConjugated equine estrogens are very complex pills,â Anderson says. âThere are a lot of different estrogen compounds in them. We really donât know what the active agents are. To make a leap to another form is really hard to say.â

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Starting Hormone Replacement Therapy After Hysterectomy

Because hormone replacement therapy is so effective at relieving symptoms, doctors often prescribe estrogen medications or a combination of estrogen and progesterone/progestin for women to take until the average onset age of menopause unless there is a medical reason not to proceed with treatment. Younger women tend to experience fewer side effects when taking hormone medications than those who begin taking hormones in their later years. Of course, like any pharmaceutical, hormone replacement therapy comes with side effects and risks that youll want to discuss with your doctor and monitor closely.

There are many hormone treatments available on the market, but many women prefer to pursue bioidentical hormone replacement therapy a plant-based alternative to conventional hormonesin order to treat their symptoms after hysterectomy. BHRT works by administering hormones that are chemically identical to those produced by the female body, in a ratio thats fully customized to your needs. These medications are typically well-tolerated and often provide powerful relief for menopause symptoms.

If youve recently had a hysterectomy and youre struggling with difficult symptoms of surgical menopause, its time to consult with an expert hormone health practitioner to achieve balance once again. With the right treatment, you can optimize both your health and your comfort as you enter this new stage of life.

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