Hormone Replacement Therapy after Hysterectomy

Why is Hormone Replacement Therapy Needed After Hysterectomy?

Hysterectomy refers to the surgical removal of the uterus. If accompanied by the removal of the ovaries, this procedure can induce menopause. Hormone replacement therapy is often recommended for women affected by surgical menopause. The following HerHaleness write-up provides information on the health risks and benefits associated with hormone replacement therapy after hysterectomy.
HerHaleness Staff
Last Updated: Feb 8, 2018
Prior to 2002, hormone replacement therapy was often recommended for menopausal women, as it was believed that the use of synthetic hormones could lower the risk of heart disease, weak bones, and dementia. However, an extensive study conducted by the Women's Health Initiative (WHI) debunked some of these health benefits, and brought to light certain health risks associated with HRT. In general, hormone replacement therapy is recommended when women begin to experience distressing symptoms associated with menopause. A woman is said to enter menopause, when an entire year goes by without menstruation. Perimenopause is the transitional period before menopause, wherein irregularities in the menstrual cycle are observed. Hormone therapy is also required in case of a surgically induced menopause, which is observed in case of women who undergo total hysterectomy (removal of the uterus and the cervix) with bilateral salpingo-oophorectomy (removal of the Fallopian tubes and the ovaries). Since the ovaries produce estrogen and progesterone, HRT is recommended for maintaining the balance of hormones after this surgical procedure.
Need for HRT after Hysterectomy

The surgical removal of the uterus is recommended in case of menopausal women, who are in great discomfort due to abnormal vaginal bleeding, hot flashes, vaginal dryness, or other distressing symptoms associated with menopause. At times, the decision to remove the uterus and/or the ovaries might be due to other existing medical conditions such as uterine fibroids, endometriosis, uterine prolapse, or cancer of the uterus, ovary, or cervix. Since the ovaries are primarily responsible for producing estrogen and progesterone, the decision to remove ovaries is taken only if the benefits outweigh the risks. In fact, women who experience mild symptoms during menopause are urged not to opt for hormone therapy. However, women who have had the uterus and ovaries removed need to take synthetic hormones. Synthetic hormones can be taken in the form of pills, patch, sprays, or gels. The onset of surgical menopause is not observed in women who undergo surgery for the removal of uterus alone, as the ovaries are still producing the female sex hormone estrogen. However, in some cases, the onset of menopause might be earlier than usual.
HRT after Hysterectomy

The aim of hormone replacement therapy is to tackle the hormonal imbalance in a woman's body post hysterectomy. While estrogen replacement therapy is recommended for women who have undergone a hysterectomy, combined hormone therapy (Estrogen and progestin) is recommended for women who still have a uterus. This is due to the fact that estrogen-only therapy can put women at an increased risk of developing uterine cancer. Combined hormone therapy might be recommended in case of women affected by endometriosis, or those who have undergone partial hysterectomy.
There are certain aspects that doctors look into, before recommending hormone therapy. These include:
➞ Age at the time of hysterectomy
➞ Medical history
➞ Family history
➞ Health issues that can interfere with HRT
Here are some guidelines that doctors follow with reference to hormone replacement therapy.
➞ It is best to start hormone replacement therapy in case of women who have recently entered menopause.
➞ The administration of synthetic hormones should be avoided in case of women who entered menopause several years ago.
➞ HRT (either EPT or ET) is not suitable for women with a high risk for stroke, heart disease, liver disease, blood clots, or breast cancer.
The long-term use of synthetic hormones may put women at a risk of developing certain health problems. The health risks might be related to the time duration for which the synthetic hormones are taken.
➞ Combined hormone therapy (Estrogen and Progestin) should not be administered for more than 3 - 5 years, due to the risk for breast cancer.
➞ Though studies suggest that estrogen replacement therapy appears to be safe for a duration of 7 years, it's always best to take these hormones in the lowest possible dose for the shortest period of time.
Bioidentical Hormones

Until the year 2000, HRT was looked upon as an ideal treatment option for women suffering from post menopause symptoms like hot flashes, mood swings, decreased sex drive, aching muscles, and joints, etc. Though HRT does reduce the risk of osteoporosis and colorectal cancer in postmenopausal women, the long-term use of synthetic hormones has been linked to an increased risk of certain medical conditions. This is the reason behind the need to look for safer alternative. Certain drug companies are manufacturing bioidentical hormones, which are believed to be chemically identical to the hormones that our body produces. Certain compounding pharmacies are also creating customized formulations, which are based on the individual hormone levels, which in turn, are determined after a saliva test. It must be noted that these formulations are not regulated by the FDA, and the FDA does not have evidence that bioidentical hormones are safer or more effective than other hormone products.
On a concluding note, each woman experiences menopause (natural or surgically-induced) in a unique manner. Therefore, the duration, route of delivery, and dosage for hormone therapy would vary, depending on the risks and benefits in individual cases. Your health care provider would be in the best position to assess if you need to take synthetic hormones. Hormone therapy can certainly improve the quality of life in case of women who experience severe menopause symptoms, but therapy must be continued if the benefits outweigh the risks. All in all, neither is HRT an excellent treatment option nor it is something that should be neglected completely if the need arises. You should make an informed decision, by focusing on your respective health conditions and expert medical recommendation.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.