Hormone Replacement Therapy (HRT)-- also sometimes known as “Menopausal Hormone Therapy” or “MHT”, refers to prescription estrogen (with or without a progestogen) intended to reduce menopausal symptoms and, in the case of surgical menopause, to minimize the various health risks associated with premature menopause (i.e., before 40).
Following a bilateral oophorectomy (both ovaries removed), the patient immediately enters surgical menopause, meaning that they becomes postmenopausal right away.
Although there are some similarities between natural and surgical menopause, the needs for HRT are far greater in surgical menopause, and typical guidelines for HRT often do not apply in surgical menopause. This is because, relative to natural menopause, surgical menopause causes a faster hormone drop and lower overall levels of hormones in the long term.
The ultra-low levels of estrogen in surgical menopause can cause bothersome menopausal symptoms, but more importantly, they can reduce the length and quality of your lifespan by increasing risk of various serious health conditions. We will address each below.
HRT in surgical menopause reduces or eliminates bothersome menopausal symptoms, including:
- vasomotor symptoms (for example, hot flashes or night sweats with sleep disturbance)
- musculoskeletal symptoms (for example, joint and muscle pain)
- effects on mood or anxiety (for example, feeling abnormally sad or worried)
- urogenital symptoms (for example, vaginal dryness)
- sexual difficulties (for example, low sexual desire, painful sex).
For those under the age of 40 entering surgical menopause, using HRT (Hormone Replacement Therapy) also reduces or eliminates the serious long-term health risks associated with surgical menopause, including:
- osteoporosis and broken bones
- cardiovascular disease (for example: heart attack, stroke)
- dementia and Parkinson’s disease
- psychiatric disorders (for example: mood or anxiety disorders)
- vulvar and vaginal atrophy
- sleep disorders (for example: persistent and impairing insomnia)
- higher risk of death by any cause
To summarize, surgical menopause is known to cause all of the above symptoms and health risks-- but these problems can generally be reduced or eliminated by using estrogen therapy following surgery through to the typical age of menopause (51 years). Most individuals in surgical menopause choose to continue some level of estrogen through at least age 60 to maintain symptom relief.
HRT can be taken quite safely by the vast majority of people in surgical menopause. See this section [link] for a discussion of risks, including potential concerns of those with familial cancer or blood clot risk or hormone-sensitive mood symptoms (e.g., Premenstrual Dysphoric Disorder or PMDD).
The type of HRT most suitable for you will depend on a variety of factors, including whether or not you had a hysterectomy as well as ovary removal (bilateral oophorectomy). See this section [link] for a discussion of various ways (patch, pill, ring, etc) to take HRT.
For more information about the specific hormones used in HRT (estrogen, progestogens, and testosterone), including methods of taking them (patches, gels, pills, etc.), and instructions for monitoring appropriate dosages, can be found here.
- NICE guidelines on Menopause Diagnosis and Management (UK)
- NAMS 2017 Hormone Therapy Position Statement (North America)
- American College of Obstetrics and Gynecology (ACOG) Position on Hormone Therapy in Premature Menopause
Visit www.iapmd.org/surgery for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.