Billie struggled with painful periods throughout her adult years. She felt at the mercy of her monthly cycles, which were irregular, heavy, and came with crippling cramps. At age 23 her doctor finally put a name on her discomfort: endometriosis. But even with an accurate diagnosis, she struggled for years to find the right treatment. Relief only came after her second pregnancy when doctors urged her toward surgery to finally address her painful symptoms; thanks to a radical hysterectomy, Billie’s life changed forever. But while the hysterectomy brought welcome relief from her pain, it also introduced new complications.
Like many women, Billie was shocked to experience the changes brought on by surgical menopause. The mood swings, hot flashes, and sleep disturbances made her question her decision to have surgery, and she felt lost as she faced her new reality. Meanwhile, the increased risk of osteoporosis and cardiovascular disease introduced by hysterectomy began to worry her. So when her doctor suggested hormone replacement therapy (HRT) to address her most uncomfortable symptoms and potentially protect her health, Billie jumped at the chance to make her life normal again.
Hysterectomies are the second most common surgery for women in the United States, following cesarean sections. Not everyone who undergoes this particular gynecological surgery needs hormone replacement therapy but for those who do, HRT can be a powerful and life-altering treatment option. Before deciding whether hormone replacement therapy is right for you, it’s important to understand which organs of your reproductive system were affected by the operation your surgeon performed and how they impact your hormonal health.
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 issues—but 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 (although cramps or PMS may continue for some time after surgery due to ovulation). They will no longer be able to bear children. But their hormone levels may not be impacted like those who undergo oophorectomy (the removal of the ovaries). Still, research has shown that it’s 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, it’s very likely that your doctor will prescribe hormone replacement therapy to help restore your body’s hormone balance.
Why Hormone Replacement Therapy Helps
Like Billie, many women experience sudden and severe symptoms following the removal or failure of their ovaries. They’re experiencing a condition called surgical or induced menopause—when 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, it’s 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, Parkinson’s 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.
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 (dryness, irritation, painful intercourse)
- Insomnia and other sleep problems
- Low libido
- Mood disturbances
- Urinary tract infections and incontinence
- Dry skin and hair loss
- Decreased bone density and increased risk for fractures
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.
Starting Hormone Replacement Therapy After Hysterectomy
Because hormone replacement therapy is so effective at relieving symptoms, doctors often prescribe estrogen medications or a combination of estrogen and progesterone/progestin for women to take until the average onset age of menopause (51) unless there is a medical reason not to proceed with treatment. Younger women tend to experience fewer side effects when taking hormone medications than those who begin taking hormones in their later years. Of course, like any pharmaceutical, hormone replacement therapy comes with side effects and risks that you’ll want to discuss with your doctor and monitor closely.
There are many hormone treatments available on the market, but many women prefer to pursue bioidentical hormone replacement therapy (BHRT)—a plant-based alternative to conventional hormones—in order to treat their symptoms after hysterectomy. BHRT works by administering hormones that are chemically identical to those produced by the female body, in a ratio that’s fully customized to your needs. These medications are typically well-tolerated and often provide powerful relief for menopause symptoms.
If you’ve recently had a hysterectomy and you’re struggling with difficult symptoms of surgical menopause, it’s time to consult with an expert hormone health practitioner to achieve balance once again. With the right treatment, you can optimize both your health and your comfort as you enter this new stage of life.
If you want to learn more about bioidentical hormone replacement therapy and how this treatment can help after hysterectomy, the BodyLogicMD network is here to help. The practitioners within our network are among the top medical professionals in the country and certified experts in hormone health. With an emphasis on integrative medicine and holistic wellness, your practitioner will work with you to create a comprehensive treatment plan that addresses your symptoms and incorporates nutrition and lifestyle changes that will help preserve your health for the long term. Contact a local practitioner in your area to start the conversation about hormone therapy after hysterectomy, or take the BodyLogicMD Hormone Balance Quiz to learn more about your symptoms and how hormones interact in the post-hysterectomy body.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.