All about Hysterectomy HRT

What is hysterectomy HRT?

Hysterectomy is the surgical removal of the uterus or womb for various gynecological reasons like intolerable periods not controlled by medical means, fibroids, endometriosis, prolapse, and malignant or pre-malignant changes of the uterus, cervix or ovary.

Hormone replacement therapy is considered for symptom control and/or for its protective effect on bone. The decision of whether or not to commence treatment should be taken after a discussion between the woman and a health professional.

Type of treatment following hysterectomy -

If treatment is commenced following hysterectomy, it is generally prescribed as an oestrogen only preparation. This is usually as a daily tablet, a weekly or twice weekly patch, a daily gel, a daily nasal spray, a 3 monthly vaginal ring or a 6 monthly implant. This particular type of prescription is tailored to suit the needs of a woman and is chosen after consideration of individual preference, past history and cost.

Using a combination of estrogen and progestogen, which is recommended when the uterus is still present), is often used after a hysterectomy if widespread endometriosis is found at the time of surgery.

Sub-total hysterectomy HRT

If the main part of the uterus has been removed but the cervix has been retained, it is uncertain whether treatment can be given in the form of estrogen only or estrogen combined with progestogen. The slight concern of using only estrogen is that there may be some of the cells of the lining of the uterus in the cervical canal, which can become thickened from the estrogen. Adding in progestogen prevents this thickening.

Duration of treatment-

If treatment is started because of an early menopause after surgery, it can be continued until the age of 50 years without any concern about the increased risk of breast cancer. At around the age of 50 years, the decision regarding whether or not to continue HRT should be made. This is the same decision that any woman becoming menopausal at the normal menopausal age would have to make, i.e. should or should not HRT be started.

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