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Hysterectomy and Oophorectomy: Should I Use Estrogen Therapy (ET)?

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.

Non-Interactive Decision Point

Hysterectomy and Oophorectomy: Should I Use Estrogen Therapy (ET)?

Get the facts

Your options

  • Use estrogen therapy (ET) after hysterectomy and oophorectomy.
  • Don't use ET. 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 therapy (ET) 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. ET lowers your risk by slowing bone thinning and increasing bone thickness.footnote 1
  • If you are in your 20s, 30s, or 40s, you may want to use ET to avoid early menopause after oophorectomy. But if you have already gone through menopause, you probably don't need ET after your ovaries have been removed.
  • Early menopause can cause hot flashes and other symptoms. ET lowers the number of hot flashes you have, and it makes them less severe when you do have them. ET also helps with other early menopause symptoms, such as vaginal dryness and sleep problems.
  • ET does have risks, including a slight risk of stroke and blood clots. But for most women in their 20s, 30s, or 40s who have had their ovaries removed, the benefits of ET are stronger than these risks.
  • Instead of ET, 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, eat foods that are rich in calcium, and do weight-bearing exercises.
FAQs

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.

About half of American women who have a hysterectomy also have their ovaries removed during the same surgery.footnote 2

What is estrogen therapy (ET)?

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.

What are the benefits of ET after hysterectomy and oophorectomy?

Estrogen therapy:

  • Lowers your risk of osteoporosis. ET slows bone thinning and helps increase bone thickness.
  • Reduces the number of hot flashes that you have, and it makes them less severe when you do have them.
  • 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.footnote 3
  • May reduce the risk of colon cancer.footnote 4

What are the risks of ET?

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:footnote 3

  • Stroke.
  • Blood clots.
  • Gallstones.

You should not take ET 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, ET may not be right for you. Talk with your doctor about the risks and benefits.

What other treatment might you try instead of ET?

Instead of ET, 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. It's not clear how safe this medicine is if it's taken for a long time.
  • Clonidine, a blood pressure medicine, may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent. 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. Possible side effects include sleepiness, dizziness, and swelling.

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.

Why might your doctor recommend ET after hysterectomy and oophorectomy?

Your doctor might recommend ET 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?









Take ET Take ET
  • You take a daily pill, you wear a patch or a vaginal ring, or you use a skin cream or gel.
  • You use ET until the age of menopause (around 50).
  • You have a lower risk of osteoporosis. ET slows bone thinning and helps increase bone thickness.footnote 1
  • You have fewer hot flashes. And the ones you do have may not be that bad.
  • ET also helps decrease other menopause symptoms, such as vaginal dryness, sleep problems, and moodiness related to hormone changes.
  • ET slightly increases your risk of stroke and blood clots.
  • Side effects of ET may include breast tenderness, bloating, and upset stomach.
  • ET may increase your risk of gallstones.
  • You should not use ET 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.
Don't take ET Don't take ET
  • 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, eat foods that are rich in calcium, and do weight-bearing exercises to try to prevent bone thinning, or you can try other prescription medicines.
  • You may be able to lower your risk of osteoporosis without ET.
  • You avoid the risks of ET.
  • You avoid the costs of ET.
  • If other treatments don't work, you can try ET 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 about deciding to use estrogen 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 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 right now 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

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 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.

More important
Equally important
More important

I feel that the benefits of ET are worth the risks.

I'm very worried about the risks of ET.

More important
Equally important
More important

I feel that ET offers me the best protection against thinning bones.

I think I can reduce my risk for thinning bones without ET.

More important
Equally important
More important

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.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

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 ET

NOT using ET

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

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?

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?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

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

What matters to you 

Print Summary

Credits and References

Credits
AuthorHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Specialist Medical ReviewerCarla J. Herman, MD, MPH - Geriatric Medicine
References
Citations
  1. Fritz MA, Speroff L (2011). Menopause and perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 673-748. Philadelphia: Lippincott Williams and Wilkins.
  2. 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.
  3. Nelson HD, et al. (2012). Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendations. Annals of Internal Medicine, 157(2): 104-113.
  4. LaCroix AZ, et al. (2011). Health outcomes after stopping conjugated estrogens among postmenopausal women with prior hysterectomy. JAMA, 305(13): 1305-1314.
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 Therapy (ET)?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Use estrogen therapy (ET) after hysterectomy and oophorectomy.
  • Don't use ET. 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 therapy (ET) 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. ET lowers your risk by slowing bone thinning and increasing bone thickness.1
  • If you are in your 20s, 30s, or 40s, you may want to use ET to avoid early menopause after oophorectomy. But if you have already gone through menopause, you probably don't need ET after your ovaries have been removed.
  • Early menopause can cause hot flashes and other symptoms. ET lowers the number of hot flashes you have, and it makes them less severe when you do have them. ET also helps with other early menopause symptoms, such as vaginal dryness and sleep problems.
  • ET does have risks, including a slight risk of stroke and blood clots. But for most women in their 20s, 30s, or 40s who have had their ovaries removed, the benefits of ET are stronger than these risks.
  • Instead of ET, 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, eat foods that are rich in calcium, and do weight-bearing exercises.
FAQs

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.

About half of American women who have a hysterectomy also have their ovaries removed during the same surgery.2

What is estrogen therapy (ET)?

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.

What are the benefits of ET after hysterectomy and oophorectomy?

Estrogen therapy:

  • Lowers your risk of osteoporosis. ET slows bone thinning and helps increase bone thickness.
  • Reduces the number of hot flashes that you have, and it makes them less severe when you do have them.
  • 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.3
  • May reduce the risk of colon cancer.4

What are the risks of ET?

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

  • Stroke.
  • Blood clots.
  • Gallstones.

You should not take ET 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, ET may not be right for you. Talk with your doctor about the risks and benefits.

What other treatment might you try instead of ET?

Instead of ET, 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. It's not clear how safe this medicine is if it's taken for a long time.
  • Clonidine, a blood pressure medicine, may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent. 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. Possible side effects include sleepiness, dizziness, and swelling.

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.

Why might your doctor recommend ET after hysterectomy and oophorectomy?

Your doctor might recommend ET 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 ET Don't take ET
What is usually involved?
  • You take a daily pill, you wear a patch or a vaginal ring, or you use a skin cream or gel.
  • You use ET until the age of menopause (around 50).
  • 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, eat foods that are rich in calcium, and do weight-bearing exercises to try to prevent bone thinning, or you can try other prescription medicines.
What are the benefits?
  • You have a lower risk of osteoporosis. ET slows bone thinning and helps increase bone thickness.1
  • You have fewer hot flashes. And the ones you do have may not be that bad.
  • ET also helps decrease other menopause symptoms, such as vaginal dryness, sleep problems, and moodiness related to hormone changes.
  • You may be able to lower your risk of osteoporosis without ET.
  • You avoid the risks of ET.
  • You avoid the costs of ET.
  • If other treatments don't work, you can try ET later.
What are the risks and side effects?
  • ET slightly increases your risk of stroke and blood clots.
  • Side effects of ET may include breast tenderness, bloating, and upset stomach.
  • ET may increase your risk of gallstones.
  • You should not use ET 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.
  • 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

Personal stories about deciding to use estrogen 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 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 right now 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

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 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.

       
More important
Equally important
More important

I feel that the benefits of ET are worth the risks.

I'm very worried about the risks of ET.

       
More important
Equally important
More important

I feel that ET offers me the best protection against thinning bones.

I think I can reduce my risk for thinning bones without ET.

       
More important
Equally important
More important

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.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

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 ET

NOT using ET

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Can ET lower your risk for osteoporosis?

  • Yes
  • No
  • I'm not sure
You're right. Without estrogen, you are at risk for weak bones later in life, which can lead to osteoporosis. ET lowers your risk by slowing bone thinning and increasing bone thickness.

2. Is ET the only way to treat early menopause symptoms and prevent bone thinning?

  • Yes
  • No
  • I'm not sure
You're right. Other prescription medicines may ease menopause symptoms and prevent osteoporosis. And you may prevent bone thinning if you take vitamin D supplements, eat foods that are rich in calcium, and do weight-bearing exercises.

3. For younger women, do the benefits of ET outweigh the risks?

  • Yes
  • No
  • I'm not sure
You're right. Taking ET does have risks, including a slight risk of stroke and blood clots. But for most women in their 20s, 30s, and 40s, the benefits of ET are stronger than these risks.

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?

     
Not sure at all
Somewhat sure
Very sure

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.
 
Credits
ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Specialist Medical ReviewerCarla J. Herman, MD, MPH - Geriatric Medicine
References
Citations
  1. Fritz MA, Speroff L (2011). Menopause and perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 673-748. Philadelphia: Lippincott Williams and Wilkins.
  2. 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.
  3. Nelson HD, et al. (2012). Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendations. Annals of Internal Medicine, 157(2): 104-113.
  4. LaCroix AZ, et al. (2011). Health outcomes after stopping conjugated estrogens among postmenopausal women with prior hysterectomy. JAMA, 305(13): 1305-1314.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Current as of: October 6, 2017

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine