Do you need hormone replacement after a total hysterectomy?

Total hysterectomy involves surgical removal of the uterus and sometimes other parts of the female reproductive system like the ovaries and fallopian tubes. It is generally performed for a range of medical reasons including cancer, uterine fibroids and abnormal bleeding.
After total hysterectomy, estrogen hormones may be produced by the remaining ovaries, although levels may be lower. Decreased hormone levels can lead to potentially unpleasant symptoms like hot flashes, mood swings and vaginal dryness in the years immediately following surgery.

Hormone replacement therapy (HRT) supplements the body with the hormones it is missing after surgical menopause, including estrogen and sometimes progesterone. HRT:

• Relieves hot flashes, night sweats and other menopause symptoms


• Prevents bone loss (osteoporosis)


• Improves sleep


• Reduces joint pain

When HRT May Be Recommended

Every woman's situation is different, but there are some general guidelines for when HRT may be recommended after hysterectomy:

• Women who had their uterus and both ovaries removed before natural menopause are typically prescribed at least some form of estrogen replacement. This helps make up for the loss of hormones that would normally be present until menopause.


• Women who had an ovary (or part of one) left after hysterectomy may produce enough hormones on their own. But it depends on the women's age and other factors. These women may try managing without HRT first, then start it if unpleasant symptoms develop.


• Women who already reached natural menopause before hysterectomy may not need HRT. However, some still choose short-term HRT for quality of life reasons.

The overall benefits and risks need to be weighed carefully with your doctor based on your age, health history and preferences.

Types of HRT

HRT may involve just estrogen therapy ("ET") or combined estrogen and progesterone therapy ("EPT" or "HRT"):

• ET involves estrogen supplementation only. This is often sufficient for women who had no uterus prior to hysterectomy or do not have an intact uterus.


• EPT involves both estrogen and progesterone. EPT helps balance the stimulation from estrogen for those with an intact uterus to prevent overgrowth.


• *Bioidentical or natural hormone products also exist and may offer unique benefits. However, more research is still needed on their safety and effectiveness.

HRT is available in forms including pills, skin patches, gel, rings or injections. Your doctor can help determine which option makes the most sense for your situation and needs.

Risks and Other Considerations

While HRT offers meaningful benefits for many women after hysterectomy, some risks and considerations include:

• Increased risk of blood clots and stroke (especially with oral estrogen)


• *Breast cancer risk may also increase slightly with over 5 years of HRT use


• *Not all symptoms improve with HRT and other solutions may be needed


• Effects diminish when HRT is stopped

Staying up to date with recommended health screenings like mammograms remains important for early detection of any issues. Lifestyle approaches (e.g. regular exercise, healthy diet) also help support hormone balance and overall wellbeing.

Women should have an open discussion with their doctor about whether HRT makes sense given their history and preferences. If opting for HRT, the lowest effective dose should be taken, and therapy should last for the shortest duration needed to manage troubling symptoms.

I hope this gives helpful background on when and why HRT may be considered after hysterectomy! Let me know if you have any other questions.

If you are looking for an expert hormone clinic to evaluate your hormone levels and HRT options after hysterectomy, I highly recommend Second Spring Hormone Clinic. Their caring doctors and nurse practitioners specialize in hormone replacement therapy (HRT) after gynecological procedures. Convenient virtual and in-person visits are available. Visit to learn more or book an appointment to address your unique hormonal needs and goals!