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Surgical Menopause: Should You Take Estrogen After Your Hysterectomy?

The Cons: Reasons to Lean Against HRT after Surgical Menopause continued...

o        Strokes. Hormone therapy can increase the risk of stroke, although your odds are still very low.

 

o        Blood clots. Oral estrogen, at least, may also raise the risk of blood clots elsewhere in the body. Estrogen patches and creams may not pose the same risk.

 

o        Heart attacks. Combined estrogen and progestin therapy may slightly raise the risk of heart attack -- at least according to some studies.

 

o        Breast cancer. The possible connection between breast cancer and hormone therapy is scary but uncertain. Several studies have shown that hormone therapy with both estrogen and progestin can cause a small increase in the risk of breast cancer. One large study found an increase of 8 more cases per 10,000 women.

But evidence is mounting that treatment alone with estrogen does not increase the risk of breast cancer unless it is used for well over 10 years.

Doctors tend to be cautious about using HRT in breast cancer survivors. There's concern that estrogen might trigger recurrence. Because of the conflicting information, talk over the latest research with your doctor.

 

o        Ovarian cancer. The evidence is uncertain, but treatment with estrogen alone may increase the risk of ovarian cancer. However, this is a very rare cancer to begin with, so the risks are very low.

 

Putting the Risks and Benefits of HRT in Perspective

If you're just glancing at list above, some of the risks of HRT might seem to overwhelm the benefits.  Could a reduction in vaginal dryness possibly be worth an increased risk of cancer?

But look at the details. The risks of HRT -- while real -- are quite small for an individual person. For example, the 2002 Women's Health Initiative study found that ERT increased the risk of strokes by 39%. That sounds frighteningly high. But the actual number of people affected is very small. Out of 10,000 women who are not taking ERT, 32 have strokes each year. Out of 10,000 who are taking ERT, 44 have strokes each year. That's an increase of just 12 people out of 10,000.

On the other hand, when it comes to controlling the symptoms of surgical menopause, a huge number of women feel the benefits. One out of four menopausal women has severe hot flashes. Treatment with hormone therapy cuts down the number of hot flashes per week by 75%. So if a woman had 24 hot flashes per week, HRT would drop that number to six. That could make a big difference in the quality of her day-to-day life.

Weighing the Hormone Replacement Therapy Pros and Cons

When it comes to getting HRT after surgical menopause, deciding what to do isn't easy. The contradictory headlines in the media in recent years haven't helped. It's easy for a woman to feel like she's making the wrong choice, no matter what she does.

When you're deciding, you have to consider a lot of different factors, including your age, your family history, and your habits. Just take it slowly and don't allow yourself to be rushed into a decision you're not ready to make. Remember that both the potential long-term benefits and risks of hormone therapy are really quite small for any individual person.

You also need to regularly check in with your doctor about the latest research into ERT. Just a few years ago, hormone therapy went from seeming like a miracle cure to a medical fiasco. Now, expert opinion may be changing again.

Finally, don't discount your gut feelings. The decision to get hormone therapy after surgical menopause is personal. The right answer depends as much on your preferences as it does on the facts in your medical chart.

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WebMD Medical Reference

Reviewed by Nivin Todd, MD, FACOG on May 21, 2012

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