Alternatives to HRT after hysterectomy

Q: When I was 35, I had a hysterectomy. I don’t want to take HRT. Is there an alternative?

A: The first question we need to discuss is are your ovaries in or out? When a doctor performs a total abdominaly hysterectomy, that refers to taking out the uterus and cervix. When the ovaries are out, that is referred to as a bilateral salpingooophorectomy. Most gynecologists do not routinely remove ovaries if the hysterectomy is done vaginally. If your ovaries are in place, you most likely will not need estrogen replacement for quite a while.

If indeed your ovaries are removed, then you need to consider the issue of estrogen replacement therapy. Women whose ovaries are removed very early in life and are not given estrogen replacement therapy are at high risk for atherosclerotic heart disease and osteoporosis. Remember: Since your uterus is out, you do not need to take any progesterone with your estrogen.

Of course, most women who take estrogen are concerned about breast cancer development. You need to remember that studies showing a link between ERT and breast cancer do not focus on the young woman of 35 taking estrogen for 10-plus years, through age 45; those studies are talking about women with natural menopause at age 50 developing breast cancer at age 60. And the data is very controversial. More than 40 good studies in the literature do not show any increased risk of breast cancer over time with long-term estrogen replacement therapy.

However, there are options. If you smoke, stop now – smoking greatly increases risks of osteoporosis and coronary artery disease. Make sure you exercise regularly, and take in at least 1200 mg. of calcium daily. Some studies show soy protein to be helpful, and alternative therapies such as cohosh may decrease symptomatology. And, if you want osteoporosis protection, and achieve a favorable lipid profile, the new selective estrogen receptor modulator called Evista, or raloxifene, is quite useful. Some emerging data on that drug actually demonstrates protection from breast cancer, as well as osteoporosis protectionm so there certainly are options. Ask your doctor about the feasibility of the treatments I’ve described.

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