Debbie GonzalezDoctor's Corner, Pelvic Health

What hormones should I take after a Hysterectomy?

Question: I had a total hysterectomy. What hormones should I take?

Answer from Dr. Daniel Gruber, urogynecologist from Sibley Memorial Hospital in Washington D.C., part of John Hopkins medicine.

The hormones you should take depends on various factors. First of all, age is important. Are you post-menopausal or premenopausal? What are your reasons for taking it? Were your ovaries left in? Most of the time, especially under the age of 55-65, we do recommend to leave the ovaries in. This is what we prefer in most situations, unless there’s cancer or some sort of genetic issues. 

Then, if you have at least one ovary, you usually don’t need to take a hormone replacement. There’s enough estrogen in one ovary to accommodate that. 

If somebody is after menopause, they may be having a lot of menopausal symptoms, like hot flashes, night sweats and irritability, all of which are very common. There’s lots of different treatments for these, some of them are non-hormonal. The hormonal ones typically work really well. 

The current guidelines in general are to take the hormones for hormone replacement after menopause for a short time to help with the symptoms. There are a few percentage of patients who continue to suffer tremendously with menopausal symptoms, even for many, many years or the rest of their life. In those cases, it’s very reasonable to talk to your doctor (typically an OB/GYN would be the best person to discuss this with) about the pros and cons of hormone replacement, and your specific situation. 

If somebody’s had a hysterectomy, they can just do estrogen alone, and they don’t need the progesterone part. If you haven’t had a hysterectomy, then it is important to do both. When it comes to a lot of the negative side effects, the progesterone is really the culprit in many of them. For years estrogen got a bad name, but in the end it is progesterone that causes most of the problems. 

So, women who’ve had a hysterectomy, whether their ovaries are in or out, can do estrogen alone and that can be very helpful for a lot of conditions. There is some downside, but it is pretty minimal.