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Hysterectomy and Oophorectomy: Should I Use Estrogen Replacement Therapy (ERT)?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Hysterectomy and Oophorectomy: Should I Use Estrogen Replacement Therapy (ERT)?
Get the facts
Your options
- Use estrogen replacement therapy (ERT) after hysterectomy and oophorectomy.
- Don't use ERT. 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 replacement therapy (ERT) 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. ERT lowers your risk by slowing bone thinning and increasing bone thickness.3
- If you are in your 20s, 30s, or 40s, you may want to use ERT to avoid early menopause after oophorectomy. But if you have already gone through menopause, you probably don't need ERT after your ovaries have been removed.
- Early menopause can cause hot flashes and other symptoms. ERT lowers the number of hot flashes you have, and it makes them less severe when you do have them.3 ERT also helps with other early menopause symptoms, such as vaginal dryness and sleep problems.
- ERT does have risks, including a slight risk of stroke, blood clots, and breast cancer. But for most women in their 20s, 30s, or 40s who have had their ovaries removed, the benefits of ERT are stronger than these risks.
- Instead of ERT, 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 and eat foods that are rich in calcium.
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.
What is estrogen replacement therapy (ERT)?
ERT is the use of man-made estrogen to replace the natural estrogen made by your ovaries. ERT is available as a pill, a skin patch, a vaginal ring, 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.
ERT 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 ERT to avoid sudden early menopause after having your ovaries removed. But if you have already gone through menopause, you probably don't need ERT after an oophorectomy.
What are the benefits of ERT after hysterectomy and oophorectomy?
Estrogen replacement therapy (ERT):
- Lowers your risk of osteoporosis. ERT slows bone thinning and helps increase bone thickness.3
- Reduces the number of hot flashes that you have, and it makes them less severe when you do have them.3
- 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.1
What are the risks of ERT?
Estrogen replacement therapy (ERT) 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 ERT is started. Talk with your doctor about these risks. Using ERT may increase your risk of:1
- Stroke.
- Blood clots.
- Breast cancer.
- Gallstones.
- Ovarian cancer.
- Dementia.
You should not take ERT 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, ovarian cancer, a stroke, or blood clots, ERT may not be right for you. Talk with your doctor about the risks and benefits.
What other treatment might you try instead of ERT?
Instead of ERT, 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 women have side effects such as headaches, an upset stomach, and problems sleeping.2 It's not clear how safe this medicine is if it's taken for a long time.
- Clonidine may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent.4 Some women have side effects related to low blood pressure.
- Gabapentin (Neurontin), an antiseizure medicine, may lower the number of hot flashes each day and the intensity of hot flashes.5 Possible side effects include sleepiness, dizziness, and swelling.
You might also try black cohosh 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. For more information, see the topic Osteoporosis.
Why might your doctor recommend ERT after hysterectomy and oophorectomy?
Your doctor might recommend ERT after hysterectomy and oophorectomy if:
- You are in your 20s, 30s, or 40s.
- You need treatment to prevent early bone thinning and osteoporosis.
Compare your options
Compare
What is usually involved? |
| |
What are the benefits? |
| |
What are the risks and side effects? |
|
- You take a daily pill, you wear a patch or a vaginal ring, or you use a gel.
- You use ERT until the age of menopause (around 50).
- You have a lower risk of osteoporosis. ERT slows bone thinning and helps increase bone thickness.3
- You have fewer hot flashes. And the ones you do have may not be that bad.
- ERT also helps decrease other menopause symptoms, such as vaginal dryness, sleep problems, and moodiness related to hormone changes.
- ERT slightly increases your risk of stroke, blood clots, and breast cancer.
- Side effects of ERT include breast tenderness, bloating, and upset stomach.
- ERT may increase your risk of gallstones and dementia.
- You should not use ERT if:
- You have unexplained vaginal bleeding.
- You have liver disease or other problems with your liver.
- You have breast cancer, ovarian cancer, or uterine cancer.
- You can try other prescription medicines to help with early menopause symptoms, such as antidepressants, clonidine, or gabapentin (Neurontin).
- You can try black cohosh or dietary soy for hot flashes.
- You can take vitamin D supplements and eat foods that are rich in calcium to try to prevent bone thinning, or you can try other prescription medicines.
- You may be able to lower your risk of osteoporosis without ERT.
- You avoid the risks of ERT.
- You avoid the costs of ERT.
- If other treatments don't work, you can try ERT later.
- Other prescription
medicines have side effects, such as:
- Headaches, upset stomach, and problems sleeping (antidepressants).
- Problems linked to low blood pressure (clonidine).
- Sleepiness, dizziness, and swelling (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 replacement 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 ERT. 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 ERT 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 ERT 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. However, 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 ERT. 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 ERT 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
For more information, see the topics:
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 estrogen replacement therapy (ERT)
Reasons not to use ERT
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 ERT are worth the risks.
I'm very worried about the risks of ERT.
I feel that ERT offers me the best protection against thinning bones.
I think I can reduce my risk for thinning bones without ERT.
The thought of using ERT 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:
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 ERT
NOT using ERT
What else do you need to make your decision?
Check the facts
Can ERT lower your risk for osteoporosis?
- YesYou're right. Without estrogen, you are at risk for weak bones later in life, which can lead to osteoporosis. ERT lowers your risk by slowing bone thinning and increasing bone thickness.
- NoSorry, that's not right. Without estrogen, you are at risk for weak bones later in life, which can lead to osteoporosis. ERT lowers your risk.
- I'm not sureIt may help to go back and read "What are the benefits of ERT after hysterectomy and oophorectomy?" ERT lowers your risk of bone thinning.
Is ERT the only way to treat early menopause symptoms and prevent bone thinning?
- YesSorry, that's not right. Other prescription medicines may ease menopause symptoms and prevent osteoporosis. And you may prevent bone thinning if you take vitamin D supplements and eat foods that are rich in calcium.
- NoYou're right. Other prescription medicines may ease menopause symptoms and prevent osteoporosis. And you may prevent bone thinning if you take vitamin D supplements and eat foods that are rich in calcium.
- I'm not sureIt may help to go back and read "What other treatment might you try instead of ERT?" There are prescription medicines and other things that may help ease menopause symptoms and prevent osteoporosis.
For younger women, do the benefits of ERT outweigh the risks?
- YesYou're right. Taking ERT does have risks, including a slight risk of stroke, blood clots, and breast cancer. But for most women in their 20s, 30s, and 40s, the benefits of ERT are stronger than these risks.
- NoSorry, that's not right. Taking ERT does have risks, including a slight risk of stroke, blood clots, and breast cancer. But for most women in their 20s, 30s, and 40s, the benefits of ERT are stronger than these risks.
- I'm not sureIt may help to go back and read "Key points to remember." Taking ERT does have risks. But for most women in their 20s, 30s, and 40s, the benefits of ERT are stronger than these risks.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Credits | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Primary Medical Reviewer | Brian D. O'Brien, MD - Internal Medicine |
| Specialist Medical Reviewer | Carla J. Herman, MD, MD, MPH - Geriatric Medicine |
- 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.
- Stearns V, et al. (2003). Paroxetine controlled release in the treatment of menopausal hot flashes: A randomized controlled trial. JAMA, 289(21): 2827–2834.
- Speroff L, Fritz MA (2005). Menopause and the perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 621–688. Philadelphia: Lippincott Williams and Wilkins.
- Morris E, Rymer J (2007). Menopausal symptoms, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
- Pandya KJ, et al. (2005). Gabapentin for hot flashes in 420 women with breast cancer: A randomised double-blind placebo-controlled trial. Lancet, 366(9488): 818–824.
Hysterectomy and Oophorectomy: Should I Use Estrogen Replacement Therapy (ERT)?
- 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 replacement therapy (ERT) after hysterectomy and oophorectomy.
- Don't use ERT. 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 replacement therapy (ERT) 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. ERT lowers your risk by slowing bone thinning and increasing bone thickness.3
- If you are in your 20s, 30s, or 40s, you may want to use ERT to avoid early menopause after oophorectomy. But if you have already gone through menopause, you probably don't need ERT after your ovaries have been removed.
- Early menopause can cause hot flashes and other symptoms. ERT lowers the number of hot flashes you have, and it makes them less severe when you do have them.3 ERT also helps with other early menopause symptoms, such as vaginal dryness and sleep problems.
- ERT does have risks, including a slight risk of stroke, blood clots, and breast cancer. But for most women in their 20s, 30s, or 40s who have had their ovaries removed, the benefits of ERT are stronger than these risks.
- Instead of ERT, 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 and eat foods that are rich in calcium.
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.
What is estrogen replacement therapy (ERT)?
ERT is the use of man-made estrogen to replace the natural estrogen made by your ovaries. ERT is available as a pill, a skin patch, a vaginal ring, 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.
ERT 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 ERT to avoid sudden early menopause after having your ovaries removed. But if you have already gone through menopause, you probably don't need ERT after an oophorectomy.
What are the benefits of ERT after hysterectomy and oophorectomy?
Estrogen replacement therapy (ERT):
- Lowers your risk of osteoporosis. ERT slows bone thinning and helps increase bone thickness.3
- Reduces the number of hot flashes that you have, and it makes them less severe when you do have them.3
- 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.1
What are the risks of ERT?
Estrogen replacement therapy (ERT) 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 ERT is started. Talk with your doctor about these risks. Using ERT may increase your risk of:1
- Stroke.
- Blood clots.
- Breast cancer.
- Gallstones.
- Ovarian cancer.
- Dementia.
You should not take ERT 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, ovarian cancer, a stroke, or blood clots, ERT may not be right for you. Talk with your doctor about the risks and benefits.
What other treatment might you try instead of ERT?
Instead of ERT, 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 women have side effects such as headaches, an upset stomach, and problems sleeping.2 It's not clear how safe this medicine is if it's taken for a long time.
- Clonidine may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent.4 Some women have side effects related to low blood pressure.
- Gabapentin (Neurontin), an antiseizure medicine, may lower the number of hot flashes each day and the intensity of hot flashes.5 Possible side effects include sleepiness, dizziness, and swelling.
You might also try black cohosh 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. For more information, see the topic Osteoporosis.
Why might your doctor recommend ERT after hysterectomy and oophorectomy?
Your doctor might recommend ERT 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 estrogen replacement therapy (ERT) | Don't take ERT | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
For more information, see the topics:
Personal stories about deciding to use estrogen replacement 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 ERT. 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 ERT 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 ERT 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. However, 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 ERT. 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 ERT 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 estrogen replacement therapy (ERT)
Reasons not to use ERT
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 ERT are worth the risks.
I'm very worried about the risks of ERT.
I feel that ERT offers me the best protection against thinning bones.
I think I can reduce my risk for thinning bones without ERT.
The thought of using ERT 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:
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 ERT
NOT using ERT
5. What else do you need to make your decision?
Check the facts
1. Can ERT lower your risk for osteoporosis?
- Yes
- No
- I'm not sure
2. Is ERT the only way to treat early menopause symptoms and prevent bone thinning?
- Yes
- No
- I'm not sure
3. For younger women, do the benefits of ERT outweigh the risks?
- Yes
- No
- I'm not sure
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?
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.
3. Use the following space to list questions, concerns, and next steps.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Primary Medical Reviewer | Brian D. O'Brien, MD - Internal Medicine |
| Specialist Medical Reviewer | Carla J. Herman, MD, MD, MPH - Geriatric Medicine |
- 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.
- Stearns V, et al. (2003). Paroxetine controlled release in the treatment of menopausal hot flashes: A randomized controlled trial. JAMA, 289(21): 2827–2834.
- Speroff L, Fritz MA (2005). Menopause and the perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 621–688. Philadelphia: Lippincott Williams and Wilkins.
- Morris E, Rymer J (2007). Menopausal symptoms, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
- Pandya KJ, et al. (2005). Gabapentin for hot flashes in 420 women with breast cancer: A randomised double-blind placebo-controlled trial. Lancet, 366(9488): 818–824.
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Last Revised: June 30, 2010
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