Hormone Replacement Therapy is the substitution of naturally occurring hormones in the human body with those that are manufactured. In the case of women who have had a hysterectomy, we are talking about oestrogen and possibly testosterone replacement therapy.
When a woman has had a hysterectomy that removes her ovaries she will no longer produce oestrogen from her ovaries although she will continue to produce small amounts of oestrogen from the adrenal glands and fatty tissues. However, this will not be enough to counteract the possible effects of oestrogen deficiency that we see begin with the onset of menopause. If a woman has a hysterectomy that leaves her ovaries in place, she has a 50% chance of suffering ovarian failure within five years of surgery. This is not age-dependent.
There are many things that women need to consider when they are faced with surgical menopause and one of the major issues is whether or not to take Hormone Replacement Therapy (HRT). HRT can be beneficial in alleviating the symptoms of the menopause. Women should also consider the fact that they will be longer without the female sex hormones than their age-related peers and that some of the natural protections that are offered by the sex hormones are lost. These may include protection against heart disease, osteoporosis and Alzheimer’s disease.
Factors in favour of taking HRT include:
- family history of osteoporosis
- high risk category related to osteoporosis
- family history of heart disease
- high risk category related to heart disease
- Severe climacteric symptoms
All HRT given to women that have had a hysterectomy is oestrogen only although you may also receive additional treatment to replace testosterone. The usual method of administering HRT is to start with the lowest dose and to gradually increase it until the menopausal symptoms are relieved. However, this may not provide enough oestrogen to protect the bones and heart. Women that have their hysterectomies before the age of 40 will need more oestrogen as they will have been producing more before their operation.
HRT can be administered in a variety of ways, including tablets, patches, implants, vaginal pessaries, gels and creams. Not all types of HRT will suit all women and it is important to work with your GP to find the most suitable form of treatment for your own particular circumstances.
There seems to be some consensus that women who have an early menopause through surgery should take HRT at least until the age that they would naturally have gone through the menopause, this is so that they reduce the risk of suffering from age related conditions earlier than they would have done. Women naturally produce oestrogen up to the age of the menopause and it would appear to be sensible to replace what would be there naturally. What a woman decides to do after the age of 50ish will be determined by looking at the same factors that affect all women and will again be a matter of choice. At the very least women who still have ovaries after surgery should be having regular blood tests to check the amount of oestrogen they are producing so that they can make an informed choice. There seems to be little argument that HRT taken for up to five years after a natural menopause does not adversely affect the body and there seems to be some evidence that women who do develop breast cancer have a better prognosis if they have taken HRT than if they had not, although this may of course be related to the type of cancer that they have.
Some early studies have also indicated that oestrogen supplementation in the form of HRT may also help to delay the onset and risk of developing Alzheimer’s Disease. A study based in New York found that women who had taken oestrogen, after a natural menopause, for more than ten years were between 30 – 40% less likely to develop the disease than those women who had never taken HRT. The effects of HRT may be due to oestrogen regulating neurochemical transmitters and thus positively affecting neuronal atrophy
You may decide NOT to take HRT for the following reasons:
- history of breast cancer
- family history of breast cancer
- high risk category related to breast cancer
- history of thrombosis
- family history of thrombosis
- high risk category of thrombosis