Women’s Hormone Replacement Therapy After Hysterectomy

The Effect On Hormones

When a person has both a hysterectomy and their ovaries removed, their estrogen production is dramatically reduced. This hormone is responsible for a number of bodily functions. Chief among them is menstruation. When ovaries are removed, menstruation stops abruptly, and menopause begins if you are not yet postmenopausal.

For people who dont remove their ovaries during a hysterectomy, there is a risk for ovarian failure. In fact, people who do not have an oophorectomy at the time of their hysterectomy are compared to people who have their uteri. This, too, will lead to a decrease in estrogen, though likely more gradually.

Hrt Alleviates Surgically Induced Menopause Symptoms

Hormone replacement therapy has been identified as the most effective treatment for menopause symptoms and is routinely recommended to help women recover hormone balance after hysterectomy. In particular, these medications are effective at relieving the following symptoms:

• Hot flashes and night sweats
• Vaginal atrophy
• Insomnia and other sleep problems
• Urinary tract infections and incontinence
• Dry skin and hair loss

A hysterectomy also has the potential to cause troubling feelings of grief or loss for some women, and these emotions can be profoundly difficult to deal with. Hormone replacement therapy often helps alleviate the mood swings that normally occur with menopause, which may make dealing with these emotions easier. HRT may also reduce the uncomfortable and frustrating physical menopause symptoms that can make daily life more difficult.

Oestrogen Formulations And Modes Of Delivery

Oestrogens are available as tablets, skin patches and gels. These products contain different kinds of oestrogen which are all effective in treating menopausal symptoms. There is no clear consensus about which delivery method is best overall, although there are some circumstances where transdermal therapy is preferred.

Patches or gels are better for those who have high triglyceride concentrations, those with hypertension, those who may not absorb tablets adequately and those at increased risk of venous thromboembolic disease . This includes those women who are overweight or smokers . Patch therapy may be better tolerated by women with migraine .

Vaginal oestrogen in creams, pessaries or tablets is available for women with symptomatic vaginal dryness and can be used either alone or in combination with systemic therapy .

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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.

Potential Benefits Of Bhrt For Hysterectomy Patients

At Biote, we know that hysterectomies can have a drastic effect on women. Biote Certified Providers offer bioidentical hormone replacement therapy, or BHRT, as a form of hormone therapy. Through BHRT therapy, women can potentially reduce the effects of a hysterectomy on their daily life. Read below to learn more about BHRT for possible hysterectomy relief.

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Is Low Estrogen Dangerous

As if hot flashes werent reason enough to correct hormonal imbalances, perhaps the following statistic will.

Getting a hysterectomy has the potential for generating serious consequences in terms of health, says this research study. This includes having 2 to 7 times higher rates of heart disease. This is likely disheartening news for the more than 500,000 American women who get a hysterectomy every year.

The good news is there are a few different options of correcting hormonal imbalances.

Hormone Therapy For Women With Endometriosis And Surgical Menopause

Endometriosis is known to result in variable severity of symptoms. For some women bilateral removal of the ovaries with or without an hysterectomy may be required to manage symptoms. This brings women into premature menopause. It is thought that hormone replacement therapy may enhance the recurrence of the disease due to its effect on the remaining endometriotic deposits in the pelvis. Only two small randomised controlled were identified in the literature that looked at this problem. Further research is required to clarify the effect of different hormone replacement therapy types on the recurrence of the disease and the associated pain including during sex.

Hormone replacement therapy for women with endometriosis in post-surgical menopause could result in pain and disease recurrence. However, the evidence in the literature is not strong enough to suggest depriving severely symptomatic patients from this treatment. There is a need for more randomised controlled studies.

Endometriosis is characterized by the presence of ectopic endometrial tissue that might lead to many distressing and debilitating symptoms. Despite available studies supporting standard hormone therapy for women with endometriosis and post-surgical menopause, there is still a concern that estrogens may induce a recurrence of the disease and its symptoms.

This review aimed to look at pain and disease recurrence in women with endometriosis who used hormone therapy for post-surgical menopause.

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Why Hormone Replacement Therapy Helps

Like Billie, many women experience sudden and severe symptoms following the removal or failure of their ovaries. Theyre experiencing a condition called surgical or induced menopausewhen estrogen plummets to the level seen in women who have already completed natural menopause. For those who do undergo natural menopause, these symptoms appear slowly as the ovaries gradually stop producing hormones, and the transition can be uncomfortable and even unbearable. But women who have surgically induced menopause experience this hormonal change immediately, and often struggle with far more severe symptoms.

Menopause can feel different for different women, and symptoms such as hot flashes, night sweats, mood swings, and other symptoms can last for years following their last period. For young women in their 20s, 30s, or 40s, its safe to assume that surgical menopause may have a serious impact on quality of life due to such symptoms. Having your ovaries removed also increases your risk of osteoporosis, cardiovascular disease, cancer, Parkinsons Disease, and dementia, which are serious side effects that can be prevented through additional medical intervention. Fortunately, hormone therapy can help reduce many of these symptoms and risks.

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

PCOS

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.

Infertility

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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Other Complications Of Estrogen Loss

Estrogen also helps maintain bone strength. In people with a sudden loss of the hormone, low bone mineral density is a risk. This can lead to arthritis and osteoporosis. People who have their ovaries removed early in life should be monitored closely for signs of these conditions.

The loss of estrogen is also connected to the acceleration of tissue loss typically associated with aging. In addition to age-related health issues, a sudden loss of estrogen has been linked to increased risks of:

• pain during sex

If you have both ovaries removed in addition to a hysterectomy, these symptoms will likely come on suddenly and be more severe. For people who have just one ovary removed, the signs may be more gradual or less severe. Your body is still producing estrogen, but it may take some time for your body to align itself with the new, lower levels of the hormone.

Lastly, if you have a hysterectomy without removing your ovaries, odds are you wont experience signs of low estrogen at first, but these symptoms may become more common. This is likely a sign that the ovaries are failing.

How Can I Reduce These Side Effects Of Hormone Therapy

In most cases, these side effects are mild and dont require you to stop your HT. If your symptoms bother you, ask your healthcare provider about adjusting either the dosage or the form of the HT to reduce the side effects. Never make changes in your medication or stop taking it without first consulting your provider.

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Who Needs Hormone Replacement Therapy After A Hysterectomy

Hysterectomies may be performed for a multitude of reasons. Endometriosis, fibroids, prolapse, and cancer are a few of the most common conditions that are treated, in full or in part, by this surgery. Doctors are able to remove all or part of the uterus, fallopian tubes, ovaries, and surrounding tissues in order to resolve these issuesbut only the ovaries have a serious impact on hormone production in the body.

Having your uterus, cervix, fallopian tubes, or surrounding tissue removed does not necessarily mean that you need hormone replacement therapy. Women who undergo these operations will stop menstruating . They will no longer be able to bear children. But their hormone levels may not be impacted like those who undergo oophorectomy . Still, research has shown that its possible for even a hysterectomy which does not include removal of the ovaries to influence ovarian failure.

If your ovaries were removed or compromised as part of a hysterectomy, its very likely that your doctor will prescribe hormone replacement therapy to help restore your bodys hormone balance.

What Happens After A Hysterectomy

Hormones are essential for key brain functions. When you remove your uterus and ovaries, you are no longer producing hormones at the necessary level. Your ovaries make the most estrogen in your body so an oophorectomy causes a large drop.

Depending on the type of hysterectomy you get your side effects may vary. When you get a subtotal hysterectomy youre still producing hormones, just at a lower level.

The loss of hormones can affect your:

Not only that but lack of estrogen can also cause serious long-term effects.

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You Wont Necessarily Go Into Menopause

I expected to have crazy hot flashes, mood swings, and night sweats all the time, and was pleasantly surprised to find out that I barely had any of those symptoms, Cohen says about her experience after hysterectomy.

The myth about hysterectomy Streicher hears most often in her medical practice is that a woman will go into menopause afterward. You wont have periods, and cant get pregnant after your uterus is removed. But that doesnt necessarily mean menopause. Streicher explains: The only one who will have menopause is a woman who has her ovaries removed during the procedure and who was not in menopause already. If surgery is limited to the uterus, timing of natural menopause may not be affected.

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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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Benefits Of Hormone Replacement Therapy After Hysterectomy

While menopause is often a natural byproduct for women going through the aging process, it occurs at different intervals and varies in severity for each individual. For many , this can lead to early menopause. The resulting fluctuation in the ratio of an individuals sex hormones often leads to that person experiencing the familiar menopause symptoms.

HRT has the potential to mitigate the negative symptoms of menopause by correcting the hormonal imbalance that develops as a result of menopause. In addition to allaying these menopausal symptoms, HRT may also reduce the risk of diabetes, tooth loss, and cataracts. By addressing these symptoms, HRT may also be vital in helping an individual reduce their stress level. Diminishing overall stress levels can be vital in avoiding a host of medical issues, especially heart disease.

Hormone Replacement Therapy Following Hysterectomy For Endometriosis

Hysterectomy with or without bilateral oophorectomy often becomes the management of endometriosis in women with severe disease and symptoms who have no desire to retain fertility. Dysmenorrhoea, pelvic pain and bleeding are eliminated and the recurrence rates are significantly lower than after medical or conservative surgery. However, some debate still exists as to the value of oophorectomy in women with endometriosis who undergo hysterectomy. Indications as to the optimal management include the histo-morphological differences that exist between the normal and ectopic endometrium, the response of endometriotic deposits to menopausal hormone levels and the possibility of reactivation of disease by hormone replacement therapy . The compliance of women taking HRT after bilateral salpingo-oophorectomy should also be considered when making this decision.

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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.

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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The Risks Of Oestrogen

Oral oestrogen increases the risk of blood clots . The risk increases with age and other risk factors such as obesity, previous thromboembolism, smoking and immobility. In women less than 60 years, the risk with oral oestrogen alone is 3 per 10,000 per year which is not significantly different from placebo.

• Oral oestrogen increases the risk of stroke and the risk increases with age. Stroke risk is not significantly increased in women younger than 60 years with normal blood pressure. The risk may be lower with lower doses and the use of transdermal oestrogen .
• Oral oestrogen is associated with an increased risk of gallbladder inflammation . There are no data regarding gel or skin patches.
• Oestrogen alone does not appear to increase the risk of breast cancer. The risk of breast cancer is primarily associated with combined oestrogen/progestogen therapy and related to the duration of use. Oestrogen alone has not been shown

to increase breast cancer risk in high quality randomized controlled trials . In a large observational study there was no significant increase in breast cancer with oestrogen only therapy for 20 years .

• Oestrogen alone commenced at the time of menopause does not increase the risk of coronary heart disease and may decrease the risk .
• For a fuller discussion of risk and benefit see the AMS Information Sheet Risks and Benefits of Menopausal Hormone Therapy.

Contact Your Physician For Help With Bioidentical Hormone Replacement Therapy

Whether youre experiencing menopause after a hysterectomy where your ovaries have been kept or removed, you may need bioidentical hormone replacement therapy. Menopause and perimenopause can be very disruptive, especially following a major surgical procedure.

The best way to lessen the symptoms of perimenopause and menopause is through bioidentical hormone replacement therapy. At Nava Health and Vitality Center, we perform evaluations to help people going through hormone changes. Our hormone therapies can help put your body back into balance. To find out more about hormone replacement therapy, weight loss help, diagnostic services and skin care and aesthetics, make an appointment online.

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