What is a hysterectomy, and why is it done?
hysterectomy is the surgical removal of the
uterus. Hysterectomy is sometimes used for
gynecological problems that haven't improved with other treatment. These
problems include abnormally heavy menstrual bleeding,
chronic pelvic pain, and
uterine prolapse. Less commonly, hysterectomy is a
lifesaving treatment for uncontrollable bleeding during childbirth or for
What is an oophorectomy, and why is it done?
oophorectomy is the surgical removal of the
ovaries. About half of American women who have a
hysterectomy also have their ovaries removed (bilateral oophorectomy).3
hormone therapy after an oophorectomy only (the uterus
is not removed), it's important to take estrogen plus
progestin (hormone replacement therapy, or HRT). The progestin protects the
uterus from the increased risk of estrogen-related
oophorectomy is intended to treat a condition that is triggered or made worse
by the ovaries' hormone changes, such as severe, untreatable
premenstrual syndrome (PMS), endometriosis, or
premenopausal breast cancer. In other cases, ovary removal is done to reduce
the possibility of
ovarian cancer (which is rare but difficult to
detect). Oophorectomy may also be performed to remove a growth from one ovary
or both ovaries.
What is estrogen replacement therapy (ERT)?
Estrogen replacement therapy (ERT) is the use of man-made (synthetic)
estrogen to replace the natural estrogen normally produced by your ovaries. ERT
is available in pill form (oral form) or as a skin patch, vaginal ring, or skin
cream or gel (transdermal form).
Why is ERT prescribed?
Until menopause (usually
around age 50), the ovaries make most of your body's estrogen. When the ovaries
are removed (oophorectomy), estrogen levels suddenly drop. This change causes
early menopause and increased
osteoporosis risk (your body's estrogen helps keep
Historically, women in their 20s, 30s, and early
40s-before menopausal age-have been prescribed ERT after hysterectomy with
oophorectomy or ERT with progestin after oophorectomy alone. (Without
progestin, ERT can lead to uterine cancer.)
causes a sudden drop in estrogen, hysterectomy alone can lead to a more
gradual, yet early decline of estrogen (premature ovarian failure) in some women. In either case, keeping estrogen levels up
protects against early bone density loss and helps prevent menopausal symptoms.
ERT may not be necessary for most women after the age of natural
menopause (around age 50). Until further research clarifies this question,
there are no current ERT treatment guidelines for older women to follow. Women
taking ERT can consider:
- Continuing ERT beyond menopausal age to treat
menopausal symptoms (using as low a dose as possible).
- Stopping ERT
and using other symptom treatments that don't use hormones.
For more information, see the topic Menopause and
What are the benefits of ERT after hysterectomy with oophorectomy?
Estrogen replacement therapy reverses the effect of
low estrogen and therefore:
osteoporosis risk. ERT slows bone loss and promotes
some increase in bone density.4
the frequency and severity of
- Prevents or reverses vaginal dryness and
irritation caused by low estrogen.
- Slows the decline in skin
collagen levels. Collagen is responsible for the
stretch in skin and muscle.
- Reduces the risk of dental problems,
such as tooth loss and gum disease.
- May help prevent
depression and sleep problems related to hormone
What are the risks of ERT?
therapy increases your risk of:6
- Stroke. ERT use slightly increases the risk of stroke, similar
to estrogen-progestin stroke risk.1
- Blood clots. ERT may increase the risk of
life-threatening blood clots (deep vein thrombosis or
- Breast cancer. The Million Women Study has shown that, in women
using ERT for 10 years, the number of breast cancers is slightly higher than
normal. It appears that ERT causes breast cancer in 5 out of 1,000
women.2 Although the
Women's Health Initiative (WHI) trial found no
increase in breast cancer over 7 years of ERT use, experts continue to take the
breast cancer risk seriously.1
Gallstones. Women who use estrogen replacement therapy
are more likely to have gallstones that cause symptoms than women who do not
use ERT. (High estrogen levels are linked to gallbladder disease.)
Ovarian cancer (which is rare). In women using ERT
over 5 years, the number of ovarian cancers is slightly higher. Using ERT
causes ovarian cancer in about 0.4 out of 1,000 women. (This is the same as 1
out of 2,500 women.) This risk only applies to women who have their ovaries and
are taking estrogen.
may increase the risk of dementia.
Do not use estrogen treatment if
- Have unexplained vaginal
- Have active liver disease or long-term impaired liver
function. (Estrogen applied to the skin via cream, gel, or patch does not
stress the liver to the same degree as estrogen pills).
- Have a
personal history of breast cancer, ovarian cancer, blood clots, or
If you are a smoker, try to quit smoking.
Talk to your doctor about your risks versus benefits if you have a family history of breast cancer, ovarian cancer,
stroke, or blood clots.
If you need more information, see the topic
Menopause and Perimenopause or