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.
About half of American women who have a hysterectomy also have their ovaries removed during the same surgery.2
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 skin 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.
Estrogen therapy may increase the risk of health problems in a small number of women. 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:3
You should not take ET if:
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.
Instead of ET, you might try other prescription medicines for menopause symptoms.
You might also try black cohosh, which is a medicinal root, or dietary soy to manage hot flashes.
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.
Your doctor might recommend ET after hysterectomy and oophorectomy if:
|Take ET||Don't take ET|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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. I figured I'd take it for the rest of my life, since that is what my doctor said I should do. But I recently heard about the latest research on the risks of taking hormones, and my doctor and I decided that I really don't need to take ET. If I had risks for osteoporosis and needed the estrogen to keep my bones strong, I'd take a low dose, but I don't have any worries about weak bones."
— Anna, age 64
"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
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 need something to help me manage hot flashes and other menopause symptoms.
I think I can handle my menopause symptoms on my own.
I feel that the benefits of ET are worth the risks.
I'm very worried about the risks of ET.
I feel that ET offers me the best protection against thinning bones.
I think I can reduce my risk for thinning bones without ET.
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.
My other important reasons:
My other important reasons:
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.
NOT using ET
1. Can ET lower your risk for osteoporosis?
2. Is ET the only way to treat early menopause symptoms and prevent bone thinning?
3. For younger women, do the benefits of ET outweigh the risks?
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?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Carla J. Herman, MD, MPH - Geriatric Medicine|
American College of Obstetricians and Gynecologists (2008, reaffirmed 2010). Elective and risk-reducing Salpingo-oophorectomy. ACOG Practice Bulletin No. 89. Obstetrics and Gynecology, 111(1): 231–241.
North American Menopause Society (2010). Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause, 17(2): 242–255. Also available online: http://www.menopause.org/PSht10.pdf.