Surgical Menopause: Should You Take Estrogen After Your Hysterectomy?

Should you get hormone replacement therapy (HRT) after surgical menopause? The answer used to be very simple: yes. Until the early 2000s, hormone therapy was routinely recommended not just for women who had their ovaries surgically removed, but for any woman entering menopause.

But things have changed in recent years, as the risks of estrogen therapy grabbed headlines -- and many supposed benefits seemed to disappear in further studies. For many women experiencing surgical menopause, doctors still recommend hormone therapy. But finding a simple right answer isn't so easy anymore.

To help guide your decision, here are the pros and the cons of getting HRT after surgical menopause.

HRT and Surgical Menopause

So what is surgical menopause? It's menopause that develops suddenly after the ovaries -- the main producers of the hormone estrogen -- are surgically removed.

The removal of the ovaries is called an oophorectomy. The procedure is often combined with a hysterectomy -- removal of the uterus -- but not always. And in fact, women who only get a hysterectomy will not go into surgical menopause. Their ovaries are still making estrogen. They'll go into menopause naturally when they get older, although sometimes a bit earlier than usual.

Estrogen plays key roles throughout the body. It affects the brain, the bones, the skin, the heart, the blood vessels, and more. While estrogen levels lower gradually during natural menopause, they plummet with surgical menopause. That sudden drop in estrogen can lead to menopausal symptoms that can be quite severe.

Hormone therapy after surgery -- either with estrogen and progestin or with estrogen alone -- is a way to counteract the supply of estrogen you've lost. Women who have both the uterus and ovaries removed just get estrogen replacement therapy (ERT) alone. But women who have only had only the ovaries removed need both estrogen and progestin. That's because estrogen alone can increase the risk of cancer in the uterus. Adding progestin negates this risk.

HRT After Surgical Menopause: Pros and Cons

To give you a better sense of what to consider in your decision, here's a list of reasons you might lean toward getting HRT, along with a list of reasons against. Keep in mind that few if any of these pros or cons are definitive. Instead, you and your doctor have to consider them all and decide which apply.