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Hysterectomy Hormone Replacement Therapy

For many years prescribing hormone replacement therapy (HRT) after a hysterectomy was almost automatic. Not only were HRT prescriptions widely written, they were accepted almost without question by the patients to whom they were given. However, in the last decade many women and their doctors have begun to question the near universal use of post hysterectomy hormone replacement therapy. As questions continue to arise on both sides of the issue it is important for women who have had or will be having hysterectomies to make sure they are well informed about HRT.

Just exactly what is hormone replacement therapy?

HRT can consist of either an estrogen/progestin combination or the hormones taken individually. Estrogen is a female hormone. Progestin is a synthetic version of the female hormone progesterone. Hormone replacement therapy may be administered orally, via a skin patch or as a cream. It is used not only after a hysterectomy but may also be suggested for women who are suffering severe symptoms of natural menopause.

Why was hormone replacement therapy routinely prescribed for women who had undergone hysterectomies?

If a woman has a hysterectomy in which both of ovaries are removed she will immediately be thrown into surgically induced menopause. For some women, this sudden onset of menopause will feature symptoms more severe than those experienced during natural menopause. Women who are left with at least one ovary may not find themselves menopausal until near the normal time when menopause would have occurred. There may, however, be some menopausal symptoms due to diminished blood flow to the ovary or due to ovarian failure at a later date. Women who have only their uteruses or uteruses and cervixes removed will generally not experience any symptoms of menopause post hysterectomy; however they may suffer from vaginal dryness and/or reduced sexual desire and/or reduced sexual response. Since many of these post hysterectomy indications are thought to be alleviated by HRT it became a standard post operative prescription. In addition to addressing hysterectomy induced menopausal maladies there was also some thought that hormone replacement therapy protected women from illnesses such as osteoporosis and heart disease.

Why has hormone replacement therapy come under question?

Over the last fifteen years many have come to believe that the risks related to HRT outweigh the benefits. Diminished vulnerability to osteoporosis is still viewed as the main advantage to hormone replacement therapy although this benefit appears to decrease as a woman ages. HRT may also be valuable in helping women deal with menopausal depression; here again though there are other therapies which may be more effective. While hormone replacement therapy may precipitate a decline in so called “bad” cholesterol, the increased risks of heart attack and stroke which emanate from HRT are greater than the benefit of the reduction in “bad” cholesterol. There is also a marked increase in several cancers particularly breast cancer amongst women who used hormone replacement therapy.

The unexpected medical findings concerning HRT caused many ongoing hormone replacement therapy studies to be halted prior to their completions. There was fear that the women involved in the studies were being subjected to unnecessary risks. As a result, many doctors chose to stop prescribing HRT as a matter of course. Women also became reluctant to use estrogen and progesterone as their primary methods for relief of post hysterectomy menopause symptoms.

Despite the fact that hormone replace therapy is now under intense scrutiny there are individual cases where its advantages may preclude its disadvantages. A woman facing hysterectomy should not reject or accept HRT out of hand; rather she should make a well researched and considered decision in consultation with her doctor. As with most important medical decisions, the choice to take hormone replacement therapy should be based on the specific circumstances of the woman involved.

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