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Should Postmenopausal Women Having Undergone Total Hysterectomy Take Hormone Replacement Therapy?

Menopause is a biological process that starts at a woman’s early 50s, marking the end of monthly menstrual cycles and reproductive abilities. If bleeding continues over the age of 60, a hysterectomy involving the surgical removal of the uterus is performed to avoid potential health risks.

So should postmenopausal women who have undergone total hysterectomy take hormone replacement therapy? These women can still experience aftereffects of unbalanced hormones such as hot flashes, increased anxiety, mood swings, and even severe conditions like bone loss and fracture. To prevent this, doctors suggest menopausal hormone therapy to provide balance to the low hormone levels after menopause.

Why Women Undergo Hysterectomy 

Hysterectomy is the second most performed surgical procedure (following cesarean section for pregnancies) for women in the United States. The Centers for Disease and Prevention (CDC) reports that about 600,000 hysterectomies are done annually, with one-third of women having done the surgery by the age of 60.

Women who are between the ages of 40 and 45 are at high risk for needing hysterectomies because they are the most prone to chronic illnesses that involve the uterus, ovary, and cervix. This surgery reduces ovarian cancer and breast cancer risk among patients and is usually recommended as a treatment for the following health conditions:


Abnormal post-menopausal bleeding is typically the most important symptom to watch out for upon reaching the age of postmenopause. The ovaries and uterus, which are the cause of bleeding, cease their normal function once a woman has started menopause. This can be triggered either by an infection or overgrowth of lining which can be a precursor to uterine or ovarian cancer.

Uterine cancer occurs when abnormal cells begin growing out of control. It can be classified as either endometrial cancer, which is the most common form of uterine cancer and is found in the inner lining of the uterus (endometrium), or uterine sarcomas, which develops in the muscle tissue (myometrium) and is a rare form of uterine cancer.

When chemotherapy and radiation stop working for these conditions, a hysterectomy may pose as a treatment option depending on the diagnosis of the doctor.

Uterine fibroids 

Fibroids in the uterus are usually noncancerous or benign tumors among women. They’re identified as the growths of smooth muscle cells and connective tissues in the walls of the uterus. It’s common among women who have started their menopause phase and typically shrink when entering postmenopause.

While they are considered benign, these uterine fibroids can cause discomfort such as pain and cramps during menstruation, abnormal bleeding, and abdominal swelling. Larger fibroids can affect normal bladder function and even cause back pain. In rare cases, postmenopausal bleeding may indicate the presence of cancerous fibroid which is identified as leiomyosarcoma.

Uterine prolapse

Uterine prolapse can be diagnosed from painful or increased frequency of urination and difficulty in passing stools. This happens due to a shift or prolapse in the position of the uterus, bladder, or rectum. In this condition, the ligaments that support the pelvis become too weak to hold up the uterus, thus causing abnormalities in bowel or urine movement. 

The normal position of the pelvic organs can also loosen and protrude due to aging. Uterine prolapse is common to those who have reached menopause and can be treated in less invasive ways such as doing Kegel exercises to strengthen their pelvic muscles or wearing a rubber disk to provide support for the uterus.


This happens when the endometrial lining in the uterus becomes thick with tissue and blood vessels and grows beyond areas outside the uterus. They may be found on the ovaries or other organs inside the pelvis. This typically results in heavy bleeding, scarring, and adhesions that can lead to severe damage.

The thickened endometrium may sometimes also refer to endometrial hyperplasia which is the excessive growth of lining and is considered premalignant. A biopsy is commonly used to diagnose the severity of this condition upon which a treatment such as a hysterectomy may be recommended.


Adenomyosis occurs when the tissue that normally grows inside the uterus walls develops where it doesn’t belong. The displaced tissue can cause severe pain and heavy bleeding during a normal menstrual cycle. Doctors believe that adenomyosis usually disappears after menopause. However, for those who experience serious discomfort from this condition, the removal of the uterus typically alleviates its symptoms.


Carcinoma is a common type of cancer that starts with the tissues that line the skin or internal organs. It may spread to other parts of the body and cause severe health risks. An individual with a family history of breast cancer, ovarian cancer, or endometrial cancer is generally a good candidate for hysterectomy to treat its symptoms. Usually, it requires hysterectomy with bilateral salpingo-oophorectomy to remove both ovaries and fallopian tubes to get the cancerous cells out of the body, lessening cancer risk.

Chronic pelvic pain 

Chronic pelvic pain is pain felt in the pelvic region which is usually just below the belly and the hips. Its symptoms vary among women but typically include intermittent pain, cramping during periods, and heaviness in the pelvis. Sometimes, chronic pelvic pain is also a sign of pre-existing medical conditions or can be caused by an abnormality in the function of the nervous system. Treatments like hysterectomy can help relieve the condition when the symptoms become unbearable.

What to Expect After a Hysterectomy 

Before identifying how to remove the uterus, the doctor must determine the type of hysterectomy needed by the patient: 

  • Partial hysterectomy — This procedure is also known as supracervical hysterectomy. It involves the removal of the upper part of the uterus while keeping the cervix in its place. In this treatment, the blood stops its circulation in the ovaries and puts a halt to its normal functioning. A surgeon may choose to perform this laparoscopically (where small incisions are made in the abdomen to reach the internal organs) or abdominally (where the whole abdomen is cut open). 
  • Total hysterectomy — Unlike partial hysterectomy, the whole uterus and cervix are removed in a total hysterectomy. In cases where endometriosis has advanced, the fallopian tubes and ovaries may also be taken out (referred to as prophylactic oophorectomy), which can stop the overall production of the ovarian hormone. 
  • Radical hysterectomy — This is the removal of the entire uterus and its tissues along with the cervix and part of the vagina. It’s a treatment option for advanced stages of uterus cancer and may also involve the removal of lymph nodes and fallopian tubes. Younger women who have not had menopause may also be considered for radical hysterectomy to prevent cancer risk.
  • Hysterectomy with bilateral oophorectomy — This is a surgical procedure that removes the ovaries. The estrogen hormone is produced in the ovaries, and when this procedure is performed on young women, they may enter what’s called surgical menopause where they experience common menopause symptoms.

A doctor may choose to perform the hysterectomy via different approaches such as:

  • Abdominal hysterectomy — The removal is done through the abdomen with a surgical incision that’s typically about 6 to 8 inches long.
  • Vaginal hysterectomy — The surgery is performed through the vagina opening.
  • Laparoscopic hysterectomy — The doctor inserts a thin flexible tube that has a camera through a small incision created in the lower abdomen. The removal is done through the laparoscope tube or the vagina.

Hysterectomies are considered a safe surgical procedure for a menopausal woman, including those who have entered the postmenopausal stage. As with all surgeries, hysterectomy patients may experience common side effects such as hot flashes and body pain which can be managed with prescription medicines.

There may also be symptoms of constipation, temporary difficulty with urinating (which happens because of fluctuations in estrogen which is responsible for keeping the bladder healthy), vaginal discharge, and bleeding. Psychological changes such as emotional disturbances, anxiety, and mood swings are also common for women who went through hysterectomies. 

In a total hysterectomy, the patient may also experience certain symptoms of premature menopause or early menopause. This condition is called surgical menopause and is predominant in hysterectomy patients who have not yet experienced menopause naturally. These menopausal symptoms typically occur after an oophorectomy where the ovaries are also extracted from the body.

Estrogen is an essential hormone in women that’s responsible for keeping the body’s normal menstrual and reproductive functions. It’s typically produced by the ovaries, adrenal glands, and fat tissues. Some of the important roles of estrogen are:

  • It helps stimulate the growth of egg follicles to encourage a normal menstrual cycle. 
  • It develops and maintains the thickness of the vaginal wall as well as the lubrication which can prevent vaginal dryness.
  • It’s responsible for the development of breast tissues and helps stop the flow of milk when breastfeeding. 
  • It manages the mucous membranes in the uterine lining and controls the flow of mucous secretions.

When the ovaries are removed during hysterectomy, there’s a significant hormonal imbalance which can produce symptoms of natural menopause such as:

  • Hot flashes 
  • Night sweats 
  • Weight gain 
  • Hair thinning 
  • Dry skin 
  • Vaginal dryness 
  • Chills
  • Sleep problems 
  • Mood changes 

Hormone Replacement Therapy After Hysterectomy for Postmenopausal Women 

Postmenopausal patients who receive hysterectomies are at risk for possible major health problems and may require further invasive surgeries if estrogen levels are not managed. Some of the rare but serious negative effects that come with hysterectomy after menopause are:

  1. Cardiovascular disease 

Estrogen is believed to have a role in helping regulate blood flow in the inner layer of the artery wall. When there’s a decline in estrogen levels, heart disease and complications are likely to increase for women after menopause. It’s important to exercise regularly and have a healthy diet to manage and reduce chances for heart attacks, strokes, or high blood pressure. 

  1. Osteoporosis or bone problems 

The estrogen hormone is also linked to helping promote strong bones. Osteoporosis is a disorder that causes bones to get thin and weaken, most likely as a result when the osteoblasts (responsible for rebuilding) and osteoclasts (responsible for breaking down bones) lose their ability to work together.

Estrogen powers the osteoclasts to absorb bones. The lack of this hormone can lead to bone loss or make the vulnerable parts of the body such as the spine and hips more prone to fractures.

  1. Neuropathy 

Postmenopausal women are also at risk for neurological problems after hysterectomy. This is commonly known as peripheral neuropathy which is a condition where nerves are damaged and can cause numbness, pain, and weakness in the hands and feet.

Neuropathy disorders for women after menopause happen because low estrogen hormones hinder the body’s ability to regulate visceral pain. They experience this mostly in the pelvis, abdomen, and chest during menstruation. Patients may be advised to take hormone therapy to maintain hormonal balance to minimize risks of neuropathy. 

  1. Vaginal atrophy 

Also known as atrophic vaginitis, this is a condition characterized by thinning, drying, and inflammation of walls in the vagina that happens when estrogen levels drop. Women who experience this report pain during intercourse and urinary discomfort and infections (UTI). Other symptoms that may require a consultation with a doctor are vaginal spotting, bleeding, unusual discharge, and soreness. 

Understanding Hormone Replacement Therapy 

The best course of treatment to relieve the negative side effects and symptoms of hysterectomy for postmenopausal women is menopausal hormone therapy (MHT). Nowadays, it’s better known as hormone replacement therapy (HRT) and is a popular treatment for women with low hormone levels.

Hormone therapy is a process where women take estrogen and progestin (a synthetic progestogen with similar effects to a female’s natural sex hormones) to help reduce symptoms of hormonal imbalance. It works by introducing new hormones through systemic hormone therapy or low-dose vaginal products.

To differentiate, systemic hormone therapy usually contains higher doses of estrogen and progestin and is the go-to treatment for common signs of menopause. On the other hand, low-dose vaginal products minimize the amount of estrogen and are only used to treat vaginal and urinary problems due to menopause.

Long-term estrogen therapy is recommended for women who are nearing menopause and have undergone a hysterectomy. Hormone therapy can be administered in different forms by registered physicians depending on their diagnosis on the individual. It comes in: 

  • Tablets or pills — These are the most common forms of progestin and estrogen therapy and are usually taken orally once a day.
  • Skin patches — They’re known by their generic name Estradiol patch and are usually applied on the skin for at least a few days. 
  • Gels or creams — This is a topical alternative that can be rubbed onto the skin once a day. Estrogen creams are popular for helping relieve vaginal dryness specifically. There are also testosterone gels that are applied onto the skin to help increase low levels of sex drive during postmenopause.
  • Pellets/implants — These consist of pure estrogen which is commonly inserted beneath the skin and fatty layer of the abdomen or buttocks. It’s good for long-term hormone therapy as most pellets release estrogen that lasts for 4 to 8 months. It’s taken with the guidance of a doctor, and the patient is usually under local anesthesia as a small incision is created to insert the pellet under the skin.

Today, bioidentical hormones are used for most estrogen therapies. These are natural hormones derived from plants and vegetables like yam and soy and are preferred because they produce hormones that are similar to those already present in the body. 

Most bioidentical products include a variety of estrogens (usually estradiol, estriol, and estrone), progesterone, and testosterone. Unlike traditional hormone therapy which uses manufactured hormones, bioidentical products are safer and more compatible with the body. They present lesser risks as long as they’re regulated and prescribed by trusted doctors. 

Overall, getting estrogen therapy for postmenopausal women prevents the outbreak of more serious health conditions. It’s also discovered that taking HRT after hysterectomy can reduce the risk of dying due to heart diseases. It brings back balance to the hormones in the body and improves the quality of life after menopause.

Learn more: Which Side Effects Are Most Common among Women Taking Hormone Replacement Therapy for Menopause?

Learn More About Hormone Replacement Therapy at Revitalize You MD 

Hysterectomies and menopause can cause drastic changes to the hormones in the body. These negative side effects can greatly impact the way of living and may even cause severe health problems for a postmenopausal woman. The best way to restore the lost estrogen and maintain the body’s normal functions while minimizing possible health risks from postmenopause is through hormone therapy.

At Revitalize You MD, we give hormone replacement treatments that are tailor-fit according to your needs. Our professional and skilled medical staff take careful measures before administering you with bioidentical hormone products. To ensure a safe procedure, we can formulate a custom dosage for your hormone therapy. Aside from hormone replacements, we also offer other medical and cosmetic procedures to help achieve total wellness living.


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