Hormone Replacement Therapy, HRT / ERT

Hormone Replacement Therapy is the substitution of naturally occurring hormones in the human body with those that are manufactured. In the case of women that 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 the 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 an 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 alzheimers 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 climateric 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 Alzheimers 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

Recommended Reading:

star buy The New Natural Alternatives to HRT – £10.99 from The Hysterectomy Association. is essential reading for everyone going through the menopause who prefers not to use hormone replacement therapy.

Recommended Resources:

More Information:

176 thoughts on “Hormone Replacement Therapy, HRT / ERT

  1. I have underlying conditions called Ehelers-Danlos type 3, Postural Orthostatic Tachycardia Syndrome, Chronic Fatigue, Neuropathy, Mast Cell Activation and all related symptoms. I had a hysterectomy and one ovary removed at 38 and I went on Oestrogen only patch (full patch). I am now 56 and I my health has deteriorated. Of late I seem to be having the worst menopausal symptoms and I don’t know why, as I am still on the full patch.

  2. Had a total hysterectomy and ovaries removed 7 years ago due to several fibroids, inflammation, adhesions and cysts. Was 46, now 53. Initially took 2mg oestrogen tablet per day. Reduced this 2 years later to 1mg. Doctor suggested I withdraw treatmet 2 years ago. Managed to reduce to 1mg on alternative days but symptoms returned and were so bad I had to go back on it. Have now reduced again to 1mg on alternate days but afraid to withdraw altogether. Symptoms include violent hot flushes (they’re terrible and can occur every half hour when I first withdraw) insomnia, joint pain , foul mood and cognitive impairment. Don’t want any of those again. Any ideas?

  3. Nov 2004: Total Hysterectomy w/ Bilateral Oophorectomy (both ovaries taken out), @same time.
    I was 36. Now am 48.
    Voluntarily removed due to Severe Endometriosis, Heavy Periods, Rupturing Ovarian Cysts rushing to E.R.–every month, a different side ovulating, & causing excruciatingggg pain, with ensuing pelvic adhesions, on top of my ‘2001 #TubalLigation, aka my ping-pong ball of hell game of pain.
    On #AloraPatch=0.05mg estrogen patch, that it is applied to skin and swapped out twice a week. Also take (1) Prometrium 100mg pill for hot flashes/sleep/hormone balance.
    Hypothyroid: Take a T3-T4 Special-Formula 15.5mcg + 50mcg, for boosting my low thyroid function. Thyroid Compound@Pharmacy.

  4. I had a full hysterectomy 16 years ago. On climival 2mgs daily. Sweating all day and waking up covered in sweat even if it’s cold. Constantly living by a fan. Any ideas please xx

    1. Hi there Theresa I like you take 2mgs of climival daily. I had a complete full hysterectomy at the age of 32 due to endometriosis. I had it lasered away twice to enable my husband and I to go down the IVF route. We actually tried every avenue but everything failed until the day came where I had to make the sad decision. Sadly my husband left me after 25yrs of marriage & as soon as our divorce came through, he married a younger women & he now has his daughter with her that he longed for leaving me in a very very bad way. I have now just hit 50 & two weeks ago I noticed I was having terrible sweats & was having to throw my quilt off me all night. This was then obviously waking me up all night & I am tired all day ! I am very down & short tempered even though I am on antidepressants. I have also lost alot of my appetite. I have got the attitude that I just can’t be bothered doing anything or not even going out. I am very confused as I didn’t think we could go through the menopause while taking HRT. Have I got this totally wrong or do you agree that I probably am going through the change. I would love to hear back from you if you get 5 mins kind regards Andrea x

  5. I had a radical hysterectomy almost 2 years ago. GP prescribed patches but they have started to cause irritation so I’ve stopped using them. I am waking a lot during the night feeling really hot on the inside but no sweats. Is this an effect of the hysterectomy? Also my calves and feet having started aching, don’t know if this too is an effect? Or just cos I’m getting older. Almost 53 now.

  6. Had hysterectomy when I was 35 I’m 47 now elleste solo 2mg not helping with hot flushes can anyone help me

  7. I have a full hysterectomy Nov’15 aged 47yrs, I thought taking HRT the ending would come back and was told No, it’s gone it gone.
    Taking 1mg HRT past 6mths but now I’m weepy, lost confidence and it’s effecting my work. I have a lot on at home. I was thinking today if I needed an increase in HRT?

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