As many women have a hysterectomy for reasons such as endometriosis, fibroids and a pre-cancerous womb, all conditions related to oestrogen dominance, it has always seemed strange to me that so many consultants, doctors and gynaecologists do say that only oestrogen is needed after such an operation.
Further that progesterone is not required for a woman who no longer has a womb, this but it is not a view shared by bioidentical doctors. Unopposed oestrogen, which is what is usually prescribed after a hysterectomy, is linked to several serious health concerns including cancer, heart disease and strokes.
Recognising those concerns, the guidelines for how long HRT should be taken have been reconsidered and now short term use of under five years is the generally accepted time frame.
As this issue of oestrogen-only HRT has been raised more frequently, as more women do undergo hysterectomy, I asked Dame Dr Shirley Bond for her comments. She is one of the UK’s foremost private GPs specialising in women’s hormonal health and is the medical advisor to the Natural Menopause Advisory Service.
She has been prescribing, and using bioidentical hormones herself, for many years and worked with the late Dr John Lee and myself on his lectures in London. He visited for several years to speak to the BMA and to give talks to women on the risks of oestrogen dominance and hormone imbalance.
From the desk of Dame Dr Shirley Bond DCmdrSOStj MB BS LRCP MRCS FFARCS
Oestrogen should always be balanced in the body with progesterone to prevent the unwanted effects of oestrogen such as weight gain, fluid retention, depression and many others including breast cancer.
Doctors often tell patients they only need oestrogen after a hysterectomy. This is because they are confusing progesterone and progestogens. In traditional HRT oestrogen is given with progestogens. The only role of the progestogens is to protect the lining of the uterus so of course you don’t need it after a hysterectomy.
Progesterone on the other hand while protecting the uterus also protects the breast and balances other unwanted effects that oestrogen on its own will produce.
Why have bioidentical hormones after a hysterectomy?
Whether or not to take HRT is of course a personal choice, but as Dr Bond has pointed out the risks of unopposed oestrogen are considerable. Many women after hysterectomy do produce oestrogen in their fat cells, this is the reason for the weight gain and bloating that so often occurs. So going on to an oestrogen only HRT means their oestrogen load is considerably increased and very few doctors are knowledgeable about bioidentical hormones, whether progesterone or the new combined creams with bioidentical progesterone and oestrogen.
Progesterone is vital to oppose excess oestrogen because oestrogen dominance needs addressing as it increases the risks for breast cancer as well as for heart disease and strokes.
What is often forgotten is that progesterone is also vital for bone building, and this process takes place throughout our lives. Old bone is broken down by oestrogen and the space is then filled with new bone – but to do this progesterone is essential. This is why many women with osteoporosis continue to supplement with it throughout their menopause and beyond.
After a hysterectomy whether you need progesterone or progesterone and oestrogen will be decided by your symptoms and their severity. Some women need only progesterone, especially if they have put on weight around the middle as they will then still be producing oestrogen from the fat cells there. Others do benefit from a combined cream which has progesterone and a small amount of oestrogen for more severe symptoms or if they are low in oestrogen.