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:

157 thoughts on “Hormone Replacement Therapy, HRT / ERT

  1. I had a total hysterectomy at 33 following many surgeries for endometriosis. I have been using hrt patches since (last 4 years) but recently I have found I have not been having menopausal symptoms if I don’t use then for weeks at a time. Can anybody shed any light on as to why not?

    1. I also had a total hysterectomy last year and I also take hrt but recently found myself to have run out of medication and didn’t take any for a couple of weeks. I also haven’t had any menopausal symptoms. I have restarted taking the hrt again since and don’t feel quite as good as I did without it. Would also like to now why????

  2. I’m just turned 48 and had TAH BSO and large benign mucousinal cystendenoma (21x17x11cm)removed. HRT on my request at GP – elleste 1mg now increased to 2mg.
    Weight gain since starting HRT now 1.5 stone. Abdomen (vertical incision) more swollen than before surgery/restricting activity and bending. Mood is generally low, lost my sparkle – feel I have been transformed into a 90 year old and my remaining years in misery.
    GP states “to be expected”
    Surely there should be some follow ups ? Some help groups? Some advice – to help women thru post operative choices re HRT/ bio-identical etc. Rather than being left to surf through web pages and chat rooms ( which have been invaluable) but it’s a big deal when your head is not in the best of places.

  3. In 1992 at the age of 46 I had a full hysterectomy. It was recomended that I use HRT which I did for approx 8 – 10 years. However the GP’s then advised that I reduce and stop using HRT, which I did. Since then I have developed osteperosis and have long episodes of fatigue – weariness & depression. I am now thinking that even at my age of 69 my body may need oestrogen to combat mainly the regular bouts of depression and deteriating osteperosis. Can anyone advise

    1. I had a complete hysterectomy at age 38 and I am now almost 62. I’ve been on HRT continuously; premarin for 20 years (I don’t recommend) and then switched 4 years ago to Estrogel 0.06 with good results. I don’t see myself ever going off the estrogen, so I keep myself fit and try and eat good food in my overall hormone management program. Just as a side note, the premarin caused bouts of depression and awful headaches. Estrogel was completely different. My world changed and became much clearer. I would rather take the estrogen, then not. Doesn’t seem like a good idea to go without…but that’s just me. I’m healthy and feel great, so why mess with screwing up things at this point???

    2. My mom took HRT from age 45 to 75 (Premarin) with no side effects. She’s 85 now…so go figure! I’ve been taking HRT since I was 38 and had a complete hysterectomy (Premarin for 20yrs and then switched to Estrogel). I’m 62 now and I feel great. Listen to your body’s needs. No one knows you like you know you.

  4. I am 47yrs old. At 36 I had an hysterectomy and part colon removal due to endo and was never given HRT. Last year I had both ovaries removed because of cysts. Although my consultant advised I should be taking HRT my GP advised against this as the endo could return. I am now experiencing debilitating hot flushes and night sweats. I am confused and hoping for guidance if possible.

    1. Take the HRT…life is too short and painful as it is to suffer more than we have to. Listen to your body on this.

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