Surgical Menopause: Should You Take Estrogen After Your Hysterectomy?
The Pros: Reasons to Consider HRT After Surgical Menopause
You're young. By definition, women who go into menopause as a result of surgery aren't that old -- they're at least young enough to be premenopausal. And while the risks of getting hormone therapy in older postmenopausal women have grabbed headlines, there may be risks for younger women who don't get it.
Estrogen affects the body in many ways. Many experts believe that it plays an important role in protecting younger women from disease. Doctors have long known that the risk of heart disease is much higher in women who had their ovaries removed before menopause. A 2006 study showed that women who had their ovaries removed before age 45 were 1.7 times as likely to die -- from any cause -- than average. Removal of the ovaries before menopause has also been linked to a doubled risk of Parkinson's disease and dementia. There's growing evidence that hormone therapy helps prevent these problems in young women.
But how do these benefits fit with all we heard about the risks of hormone therapy? One of the studies that sent people into a panic about the dangers of HRT was the 2002 Women's Health Initiative. Critics point out that the average age of a woman in that study was 63. Hormone therapy may just have a different effect depending on the age at which you start it.
So, many women who go into surgical menopause when they're under 50 go onto HRT. Then, when they hit the average age of menopause (51), they can decide whether to stay on it or not.
Your menopausal symptoms are severe and other treatments haven't worked. Some women find that their menopausal symptoms -- the hot flashes, the vaginal dryness, the sleep problems -- are unbearable and nothing seems to work. HRT can be quite effective in preventing and reversing many symptoms. For example, some studies show that it can cut the number of hot flashes by 75%.
Other health benefits. While perhaps not enough to justify getting HRT on their own, there are some other modest health benefits from hormone therapy. For one, it can slow down osteoporosis and increase bone density. Treatment with both estrogen and progestin seems to slightly reduce the risk of developing colorectal cancer.
The Cons: Reasons to Lean Against HRT after Surgical Menopause
Your menopausal symptoms aren't bothering you, or other treatments work fine. Some women don't have very severe symptoms after surgical menopause and don't want or need treatment. Even if you do have acute symptoms, HRT is not the only way to control them. Other drugs or lifestyle changes can help. Talk to your doctor.
You're 50 or older. Many women who go into surgical menopause at 50 or older -- the natural time of menopause – decide not to get HRT. That's because their supply of estrogen would naturally drop during menopause anyway. There is some evidence that the older you are when you start HRT, the higher the cardiovascular risks – at least initially.
You have liver disease. Estrogen pills can put a lot of stress on the liver. So if you have liver disease, your doctor may not want you to take oral HRT. Other ways of getting estrogen – like patches and gels – bypass the liver and are safer options.
You're concerned about the side effects. HRT can also cause symptoms of its own. Many resemble the symptoms of premenstrual syndrome -- swollen and painful breasts, headaches, and nausea.