Hysterectomy and Oophorectomy: Should I Use Estrogen Therapy (ET)?

Hysterectomy and Oophorectomy: Should I Use Estrogen Therapy (ET)?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the facts

Your options

Use estrogen therapy (ET) after hysterectomy and oophorectomy.
Don't use ET. Try other treatment for menopause symptoms and to prevent osteoporosis.

Key points to remember

Until menopause, the ovaries make most of your body's estrogen. When your ovaries are removed (oophorectomy) during a hysterectomy, your estrogen levels drop. Estrogen therapy (ET) replaces some or all of the estrogen that your ovaries would be making until menopause.
Without estrogen, you are at risk for weak bones later in life, which can lead to osteoporosis. ET lowers your risk by slowing bone thinning and increasing bone strength.
If you are in your 20s, 30s, or 40s, you may want to use ET to avoid early menopause after oophorectomy. But if you have already gone through menopause, you probably don't need ET after your ovaries have been removed.
Early menopause can cause hot flashes and other symptoms. ET lowers the number of hot flashes you have, and it makes them less severe when you do have them. ET also helps with other early menopause symptoms, such as vaginal dryness and sleep problems.
ET does have risks, including a slight risk of stroke and blood clots. But for most people in their 20s, 30s, or 40s who have had their ovaries removed, the benefits of ET are stronger than these risks.
Instead of ET, you might try other prescription medicines to help with early menopause symptoms and to prevent osteoporosis. And you may be able to prevent bone thinning if you take vitamin D supplements, eat foods that are rich in calcium, and do weight-bearing exercises.

FAQs

What are hysterectomy and oophorectomy?

A hysterectomy is surgery to remove the uterus. Most of the time, a hysterectomy is done to treat a problem with the uterus, such as heavy menstrual bleeding, uterine fibroids, or endometriosis.

An oophorectomy is surgery to remove the ovaries. Oophorectomy (say "oh-uh-fuh-REK-tuh-mee") may be done because of a growth on one or both ovaries, or to treat severe endometriosis, or breast cancer. It may also be done to lower the risk of ovarian cancer or breast cancer.

Sometimes the ovaries are removed at the same time as a hysterectomy.

What is estrogen therapy (ET)?

ET is the use of man-made estrogen to replace the natural estrogen made by your ovaries. ET is available as a pill, a skin patch, a vaginal ring, or a cream or gel.

Until menopause (around age 50), the ovaries make most of your body's estrogen. When your ovaries are removed, your estrogen levels suddenly drop. This causes early menopause. It can also increase your risk of osteoporosis and bone fractures, because estrogen helps your bones stay strong.

ET keeps estrogen levels up, which protects against bone thinning and helps prevent menopause symptoms.

If you are in your 20s, 30s, or 40s, you may want to use ET to avoid sudden early menopause after having your ovaries removed. But if you have already gone through menopause, you probably don't need ET after an oophorectomy.

What are the benefits of ET after hysterectomy and oophorectomy?

Estrogen therapy:

Lowers your risk of osteoporosis. ET slows bone thinning and helps increase bone strength.
Reduces the number of hot flashes that you have, and it makes them less severe when you do have them.
Prevents vaginal dryness and soreness caused by low estrogen.
Slows the loss of skin collagen. Collagen puts the stretch in skin and muscle.
Reduces the risk of dental problems, such as gum disease and tooth loss.
May help sleep problems and moodiness linked to hormone changes.
May reduce the risk of colon cancer.

What are the risks of ET?

Estrogen therapy may increase the risk of health problems in a small number of people. This increase in risk depends on your age, your personal risk, and when ET is started. Talk with your doctor about these risks. Using ET may increase your risk of:

Stroke.
Blood clots.
Gallstones.

You should not take ET if:

You have unexplained vaginal bleeding.
You have liver disease or other problems with your liver.
You have breast cancer, ovarian cancer, uterine cancer, or blood clots or have had a stroke.

If a close family relative has had breast cancer, ET may not be right for you. Talk with your doctor about the risks and benefits.

What other treatment might you try instead of ET?

Instead of ET, you might try other prescription medicines for menopause symptoms.

Antidepressant medicines can lower the number of hot flashes you have. And they can make hot flashes less severe when you do have them. Some people have side effects such as headaches, an upset stomach, and problems sleeping.
Clonidine, a blood pressure medicine, may relieve hot flashes. Some people have side effects related to low blood pressure.
Gabapentin, an antiseizure medicine, may lower the number of hot flashes each day and the intensity of hot flashes. Possible side effects include sleepiness and dizziness.

You might also try cognitive-behavioral therapy or mind and body relaxation to help with symptoms.

To reduce your risk of osteoporosis, eat foods that are rich in calcium, and take vitamin D supplements.

You might also try other medicines to prevent bone thinning.

Why might your doctor recommend ET after hysterectomy and oophorectomy?

Your doctor might recommend ET after hysterectomy and oophorectomy if:

You are in your 20s, 30s, or 40s.
You need treatment to prevent early bone thinning and osteoporosis.

2. Compare your options

	Take ET	Don't take ET
	What is usually involved? You take a daily pill, you wear a patch or a vaginal ring, or you use a cream or gel. You use ET until the age of menopause (around 50).	What is usually involved? You can try other prescription medicines to help with early menopause symptoms, such as antidepressants, clonidine, or gabapentin. You can try cognitive-behavioral therapy or mind and body relaxation to help with symptoms. You can take vitamin D supplements, eat foods that are rich in calcium, and do weight-bearing exercises to try to prevent bone thinning, or you can try other prescription medicines.
	What are the benefits? You have a lower risk of osteoporosis. ET slows bone thinning and helps increase bone strength. You have fewer hot flashes. And the ones you do have may not be that bad. ET also helps decrease other menopause symptoms, such as vaginal dryness, sleep problems, and moodiness related to hormone changes.	What are the benefits? You may be able to lower your risk of osteoporosis without ET. You avoid the risks of ET. You avoid the costs of ET. If other treatments don't work, you can try ET later.
	What are the risks and side effects? ET slightly increases your risk of stroke and blood clots. Side effects of ET may include breast tenderness, bloating, and upset stomach. ET may increase your risk of gallstones.	What are the risks and side effects? Other prescription medicines have side effects, such as: Headaches, upset stomach, and problems sleeping (antidepressants). Problems linked to low blood pressure (clonidine). Sleepiness and dizziness (gabapentin). You may be at risk for bone thinning and osteoporosis because of the loss of estrogen. Your menopause symptoms may be hard to live with.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about deciding to use estrogen therapy

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Since having my uterus and ovaries removed, I've been taking ET. This makes a lot of sense to me, because my ovaries would be producing estrogen until I hit menopause. When I'm the age I'd expect to be menopausal, around age 50, I expect I'll stop or reduce the estrogen I'm taking. That'll depend on what experts recommend by then."

— Josie, age 35

"I started taking ET after a radical hysterectomy and spent a number of months struggling with moodiness and feeling depressed. It was probably because of the big changes in hormones after my ovaries were removed. I worked closely with my doctor to make adjustments to my hormone replacement. She replaced the oral estrogen with a patch. Now, I've been doing well for more than 5 years."

— Carla, age 28

"I took ET for many years after having my uterus and ovaries removed in my 30s. Recently, my doctor and I decided that I really don't need to take ET anymore. I'm doing other things to help keep my bones strong."

— Anna, age 52

"I had a hysterectomy and oophorectomy in my early 40s, but I didn't take ET because my family has a history of breast cancer that's linked to estrogen. The sudden menopause after having my ovaries removed was pretty bad, but I took really good care of myself with exercise, a good diet, and a lot of tricks for handling hot flashes, and I got through it after a while."

— Estella, age 58

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to use ET

Reasons not to use ET

I want to avoid early menopause symptoms.

I want to try other things to manage menopause symptoms.

More important

Equally important

More important

I feel that the benefits of ET are worth the risks.

I'm very worried about the risks of ET.

More important

Equally important

More important

I feel that ET offers me the best protection against thinning bones.

I think I can reduce my risk for thinning bones without ET.

More important

Equally important

More important

The thought of using ET for many years doesn't bother me.

I'm not sure I want to take any medicine for many years.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using ET

NOT using ET

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Can ET lower your risk for osteoporosis?

Yes
No
I'm not sure

You're right. Without estrogen, you are at risk for weak bones later in life, which can lead to osteoporosis. ET lowers your risk by slowing bone thinning and increasing bone strength.

2. Is ET the only way to treat early menopause symptoms and prevent bone thinning?

Yes
No
I'm not sure

You're right. Other prescription medicines may ease menopause symptoms and prevent osteoporosis. And you may prevent bone thinning if you take vitamin D supplements, eat foods that are rich in calcium, and do weight-bearing exercises.

3. For most younger people, do the benefits of ET outweigh the risks?

Yes
No
I'm not sure

You're right. Taking ET does have risks, including a slight risk of stroke and blood clots. But for most people in their 20s, 30s, and 40s, the benefits of ET are stronger than these risks.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

Use the following space to list questions, concerns, and next steps.

Credits

By	Healthwise Staff
Primary Medical Reviewer	Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Carla J. Herman MD, MPH - Geriatric Medicine
Primary Medical Reviewer	JoLynn Montgomery PA - Family Medicine