Short Answer: Yes, people in surgical menopause almost always need to take estrogen because surgical menopause causes very low levels of estrogen (lower than in natural menopause), which leads to major health risks without estrogen therapy.

Most people undergoing natural menopause can avoid HRT without much consequence to their long-term health, this is not the cause in surgical menopause.

If you are entering surgical menopause before the typical age of natural menopause (before age 51), experts from a variety of leading societies (linked below) strongly recommend taking estrogen at least until the age of 51, the average age of natural menopause, and to speak with your doctor to reevaluate the risks and benefits of estrogen use around that time. Most individuals in surgical menopause choose to continue estrogen therapy through age 60.

Expert Consensus indicating that estrogen is critical in surgical menopause:

Please note that these recommendations for estrogen in surgical menopause differ greatly from those in natural menopause, where estrogen is considered an optional method for controlling menopausal symptoms.

  • Need for estrogen to control symptoms in surgical vs. natural menopause: Surgical menopause is similar to natural menopause in that it can cause bothersome menopausal symptoms (hot flashes, night sweats, joint or muscle pain, increased mood or anxiety symptoms, vaginal dryness, and sexual difficulties).
  • Unique estrogen needs in surgical menopause (why it’s more important to take estrogen in surgical menopause): Estrogen in surgical menopause is about more than controlling the bothersome symptoms above-- it is also needed to protect against the unique long-term health risks associated with oophorectomy/surgical menopause. Because surgical menopause causes a more severe estrogen deficiency, over time it is known to increase the risk of many long-term health problems, including osteoporosis, cardiovascular disease (heart attack, stroke), Parkison’s disease, impairing mood or anxiety disorders, sexual pain or discomfort, vulvar or vaginal atrophy, and dementia. In addition, surgical menopause is linked with greater risk of early death from all causes.

In sum, whereas most people undergoing natural menopause can avoid HRT without much consequence to their long-term health, this is not the cause in surgical menopause.

Therefore, if you choose not to use HRT in surgical menopause, it needs to be a very informed decision with knowledge of potential long term risks, and we highly recommend that you discuss your decision with a trusted health care professional.

Some individuals in surgical menopause have a personal or family history of conditions that can be affected by hormones, and thus are more concerned about HRT risks. This is completely reasonable. Although the scientific research suggests that there are fewer risks of estrogen in surgical menopause than in natural menopause (because baseline levels are so much lower), it is important to speak with a knowledgeable provider about what is best for you. There are many adjustments that can be made (e.g., lower dose, slower titration, use of alternative medications, or supplemental use of local HRT) to ensure that you are both protected from long-term health risks while also avoiding or minimizing any possible HRT risks.

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.

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