HRT After Hysterectomy: Is it right for you?

Considering hormone replacement therapy? Here’s what you need to know to make the best decision.

There’s a lot of conflicting information out there when it comes to HRT.

“Hormone replacement therapy? No problem! You’ll instantly feel better.”

“Hormone replacement therapy? Are you sure you want to risk breast cancer?”

“Hormone replacement therapy? Which hormones are you trying to replace?”

Questions abound, as do opinions.

First, let’s revisit some facts from our last post, “Your Hormones After Hysterectomy” Starting with: what is a hysterectomy, exactly?

A “pure” hysterectomy involves the removal of your uterus, an organ that does not produce hormones (your ovaries, however, do). In the case of a hysterectomy and oophorectomy – the removal of your ovaries – you can definitely expect hormone change, and that’s why HRT is top-of-mind for many women who have just had, or are considering, these procedures.

Now let’s talk about HRT. What is it, and how is it administered? We like this definition from HysterSisters:

“Hormone Replacement Therapy (HRT) is therapy (pills, patches, creams, etc.) given to replace missing hormones from the slow down or loss of ovaries during menopause. Menopause can come naturally (usually around the age of 50), or it can be caused by the removal of the ovaries (surgical menopause). Either way, keeping a healthy balance of hormones helps fight menopause symptoms, prevents osteoporosis, and generally keeps your body functioning well.”


Often, a doctor will advise his or her female patients to take single hormones following hysterectomy, be it estrogen or progesterone (depending on what surgery they had). Rarely though are women given both – a big problem, since (as we shall soon see) these two critical hormones are so dependent on each other. As a result, many women suffer in silence even during HRT, be it the recurrence of thyroid problems, fatigue, weight gain, or just a general feeling of being “off,” because they don’t have a complete picture of hormone balance.

There’s another set of women out there who have had, or are about to have, a hysterectomy, who are afraid to embark on hormone therapy. Whether reports of cancer have spooked them, or they just prefer a more natural approach to hormone balance, these women are also suffering – but they are suspicious of prescription hormones.


According to Harvard Medical School, bioidentical hormones show a lot of promise for restoring hormone levels that might drop after hysterectomy:

“If you want to use FDA-approved bioidentical hormones for menopausal symptom relief, you can be confident that they are safe and effective, and contain what their labels say they do.”


“If you want custom-compounded bioidentical hormones, get them through your clinician and not from the Internet. If you plan to rely on saliva or blood testing to establish the dose, bear in mind that you’re venturing into scientifically uncharted territory. And any prescription that adds testosterone or DHEA to your hormonal mix is taking you even farther from the tested path. In effect, you’re experimenting with your body and your health.”

The reason this is critical is because while replacing just estrogen, for example, will result in increased estrogen levels, your body in fact relies on a delicate dance of hormones: not just strong estrogen levels, but healthy progesterone and testosterone levels, too.

This is why conversations on HRT can get so confusing: HRT can, in fact, be safe. And even effective for the short-term relief of menopausal symptoms. But long-term, women are often frustrated to see old hormone imbalances return, and are perplexed as to why. More on that in a moment.


Now, let’s talk now about the “c word:” cancer.

According to Cancer Research UK, “the evidence that HRT can cause some types of cancer (breast, womb and ovarian) is strong…but it’s important to remember that the increased cancer risk with HRT is small compared to many other risk factors, like smoking or being overweight, as shown below. HRT is only responsible for a very small proportion of cancer cases.”

In a study run by Cancer Research UK scientists, looking at the health outcomes of one million women, HRT was found to be an effective short-term for menopausal treatment, but has risks as well as benefits. Here were some of the findings:

If 1,000 women start taking HRT at age 50 for five years, 2 more women get breast cancer, and 1 more woman gets ovarian cancer,
Avoiding HRT could prevent 1,700 cancer cases a year. (But to put this in perspective, keeping a healthy weight could prevent 18,100 cancer cases per year.)

But there’s also been research that mitigates these findings. Pam Harrison at the oncology channel of Medscape shares this:

“The increased risk for breast cancer with combination HRT was first reported in 2002 from the Women’s Health Initiative and in 2003 from the Million Women study, and at the time, the news led to a dramatic fall in the use of HRT. Since then, however, some more recent studies have suggested there is no increase, or little increase, in breast cancer risk.”

Moreover, whether or not HRT will affect you adversely depends a lot on your family medical history, and your own personal medical history. The elements of your health that may make you susceptible to disease could be absent from another woman’s body, and vice versa.

So, bottom line: the research linking HRT and cancer is ongoing, and when it comes to your long-term health, it’s important to stay up-to-date with the latest science and findings.


As we’ve discussed before on this blog, a woman’s hormone balance is delicate, cyclic, and a powerful influence on her sense of well being (by now, you’re probably going “duh” to that last one!). The main hormones that must be in balance are progesterone, estrogen, and testosterone. In particular, progesterone and estrogen counteract each other and in an ideal menstrual cycle they work in harmony.

Progesterone is the key youth hormone for women, and this is where knowledge is power when it comes to hysterectomy, and how to proceed afterwards.

Similar to the youthful effect testosterone has in men, progesterone in women is responsible for nearly all the mental and physical traits associated with youth and vitality in a younger woman. Progesterone impacts nearly all cells of a woman’s body and has multiple effects and functions. Some of the most important include serotonin production, memory, bone strength, and conversion of stored fat to energy.

The most important effects of properly balanced progesterone in women include reduction of mood swings, improvement of brain functioning, (especially memory and thought development processes), helps to maintain vascular and cardiovascular health, lower risk of endometrial cancer, increased strength and resilience of bones to help reduce risk of osteoporosis, reduces risk of gallbladder disease and promoting a healthy digestive tract, contributes to a healthy immune system and helps convert stored fat into energy. And this is the piece of the puzzle that’s often missed with estrogen-only HRT: it doesn’t incorporate progesterone, which has such an enormous effect on a woman’s overall health.


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