Q& a: Benefits Harms Of Estrogen Therapy In Women Who Had Ovaries Removed
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For women who had a hysterectomy and their ovaries removed, estrogen therapy was associated with long-term benefits if the therapy began before the age of 60 years, but it led to adverse events in those aged 70 years or older, according to a study published in the Annals of Internal Medicine.
Researchers conducted a subgroup analysis of 9,939 women in a randomized trial who had previously undergone a hysterectomy from the Womens Health Initiative Estrogen-Alone Trial.
Participants in the study were randomly assigned to receive estrogen therapy or placebo at ages 50 to 79 years and were followed up for a median of 7.2 years of treatment and 18 years in total.
Overall, the effects of estrogen therapy did not significantly differ between those who did and did not have their ovaries removed. However, when stratifying by age, researchers found that estrogen therapy was significantly associated with adverse events in women aged 70 years and older , but not in younger women.
Women aged 50 to 59 years who had their ovaries removed and received hormone therapy experienced a reduced risk for all-cause mortality over long-term follow up . Older women did not have a reduced risk for all-cause mortality.
Q: How do the findings from this study compare with previous research?
Q: How might the study findings influence clinical practice?
Bilateral Oophorectomy And The Risk Of Incident Diabetes In Postmenopausal Women
Commonly Asked Questions: At Home
Whats the Recovery Tracker?
We want to know how youre feeling after you leave the hospital. To help us continue caring for you, well send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker.
Fill out your Recovery Tracker every day before midnight . It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how youre feeling and what you need.
Based on your answers, we may reach out to you for more information or ask you to call your surgeons office. You can always contact your surgeons office if you have any questions. For more information, read the resource About Your Recovery Tracker .
Will I have pain when I am home?
People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication.
Follow the guidelines below to help manage your pain at home.
Some prescription pain medications may cause constipation .
How can I prevent constipation?
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Within 30 Days Of Your Surgery
Before your surgery, youll have an appointment for presurgical testing . The date, time, and location will be printed on the appointment reminder from your surgeons office. Its helpful to bring the following things to your PST appointment:
- A list of all the medications youre taking, including prescription and over-the-counter medications, patches, and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name and telephone number of your healthcare provider.
You can eat and take your usual medications the day of your appointment.
During your PST appointment, youll meet with a nurse practitioner . They work closely with anesthesiology staff . Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.
Your NP will talk with you about which medications you should take the morning of your surgery.
Identify your caregiver
Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when youre discharged from the hospital. Theyll also help you care for yourself at home.
Hysterectomy For Women Of Childbearing Age
Once a woman has had a hysterectomy of any kind, she cannot become pregnant. If the ovaries of a premenopausal woman are removed, she has had a surgical menopause. This means she will have a drop in production of the sex hormones oestrogen, progesterone and testosterone. Vaginal dryness, hot flushes, sweating and other symptoms of natural menopause may occur.
Women who undergo bilateral oophorectomy usually take hormone replacement therapy ,This is also known as oestrogen replacement therapy, as usually only oestrogens are required to maintain their hormone levels and prevent the long-term risks of premature menopause.
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Sandy Celebrates Being Able To Wear White Pants Anytime
Sandy from St. Louis, Mo., was a healthy, active 47-year-old when her doctor identified a pelvic mass and reported elevated CA-125 levels. She had a radical hysterectomy, part of her colon and multiple size tumors removed. Doctors diagnosed her with stage 3c ovarian cancer. The word menopause was the last thing on her mind.
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I was so focused on hearing I had cancer it was hard to think about what I could expect after surgery, she said. They talked a lot about side effects of the treatments but not about what would be happening to my body as I started to heal from the surgery.
At 47 when she had surgery, Sandy said she was only a few years away from menopause. Before surgery, I still had regular periods. I have to say, it is nice not to have periods anymore. I can wear white pants whenever I want!
Her most annoying side effects were hot flashes every hour and 50 minutes and a lack of good night sleep due to waking up so often. While a ceiling fan helps at night, Sandy recommended having an additional fan that blows over you to help cool you down.
What Causes Hot Flashes After A Hysterectomy
Declines and fluctuations in the level of the hormone estrogen after a hysterectomy affects the function of the body, especially the hypothalamus the part of the brain that regulates body temperature.
Falling estrogen levels caused by a hysterectomy can cause the hypothalamus to falsely detect an increased body temperature and release chemicals that make skin blood vessels dilate so that heat can be released and the body cooled down. This results in a hot flash.
Hot flashes and other menopausal symptoms usually subside when a woman is postmenopausal. Experiencing menopause that is induced by a hysterectomy can be a little different than natural menopause.
This is because when a woman naturally goes through menopause her body has more time to adjust as the levels of hormones in her body decrease. With a hysterectomy, the ovaries are removed, which is where estrogen is produced. This means there is a rapid cutoff of estrogen production which can result in more severe menopausal symptoms.
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What Resources Are Available For Those Going Through An Oophorectomy
An oophorectomy can be a scary procedure, especially if you are not done having children or are worried about menopause.
For this reason, it is important to work with a team of doctors who will recommend the best type of surgery for your conditionand also deal with the after-effects of an oophorectomy.
The Cleveland Clinic Center for Womens Health and Departments of Obstetrics and Gynecology and fertility specialists can provide more information and advice on oophorectomies.
The Surgery Itself: Getting Prepared
A hysterectomy lasts around 1-2 hours and is performed in a hospital under general anesthesia. Your doctor will advise you on how to prepare in the days building up to your procedure. This might include:
Consuming soft foods for several days prior to surgery and then fasting in the 12 hours immediately beforehand.
You may be instructed to shower using soap provided by your doctor on the morning before surgery in order to reduce the risk of infection.
You might benefit from making extra effort to maintain a nutritious diet in the weeks leading up to surgery.
Once your surgery is complete, the recovery process beings. Your stay in hospital will generally last from between a day up to a few days.
Recovering at Home
At this stage youll be advised to avoid any strenuous or even moderate physical activity for the first 4-6 weeks. Since youll be spending a significant amount of time in bed at first, you might benefit from purchasing a wedge pillow to improve your comfort whilst sitting.
Women have also reported benefit from using a hospital-style table. This allows you to write, read, or use a computer without having to rest the object on your abdominal area.
And, remember, dont feel ashamed to call in help and assistance from family and friends. You deserve all the support you can get while you recuperate from surgery.
Things to be Aware of
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How Will I Know I Am In Menopause After My Hysterectomy
No periods for 12 months is the common sign that menopause has arrived. But what about for you? Youve had a hysterectomy, so you have hadnt periods in years. How are you going to know when menopause arrives?
No worries. More than likely, menopause is going to arrive with plenty of notice. More than you want.
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What Are Hot Flashes
Hysterectomy can often trigger the onset of menopausal symptoms such as hot flashes. Hot flashes are sensations of intense heat in the upper body, and are usually accompanied by a rapid heart rate, a reddening of the chest, neck, and face and sometimes intense perspiration. When hot flashes occur at night they are often referred to as night sweats.
The duration of hot flashes is different for every woman, but a typical episode lasts between thirty seconds and five minutes. After a hysterectomy, women will experience variations in the intensity and frequency of hot flashes.
Hysterectomy With Ovaries Left Intact
People who have their ovaries intact, but without their uterus, won’t get their period anymore. They may, however, still experience premenstrual syndrome or premenstrual dysphoric disorder because the hormones made by the ovaries cause the body to continue to “cycle” monthly.
Occasionally, people whose ovaries were not removed during a hysterectomy experience hot flashes and other menopausal symptoms. This is mostly due to the disturbance of the blood supply to the ovaries during surgery.
In addition, some people may undergo menopause a few years sooner than they normally would if they never underwent a hysterectomy .
Days Before Your Surgery
Follow your healthcare providers instructions for taking aspirin
If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.
Follow your healthcare providers instructions. Dont stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.
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Benefits Of Surgical Menopause
For some women, removing the ovaries and experiencing surgical menopause can be lifesaving.
Some cancers thrive on estrogen, which can cause women to develop cancer at an earlier age. Women who have a history of ovarian or breast cancer in their families have a greater risk of developing these diseases because their genes may be unable to suppress tumor growth.
In this case, oophorectomy can be used as a preventive measure to reduce the risk of developing cancer.
Surgical menopause can also help to reduce pain from endometriosis. This condition causes uterine tissues to growth outside the uterus. This irregular tissue can affect the ovaries, fallopian tubes, or lymph nodes and cause significant pelvic pain.
Removing the ovaries can stop or slow estrogen production and reduce pain symptoms. Estrogen replacement therapy usually isnt an option for women with this history.
Management Of Surgical Menopause
Ideally, a menopause specialist should review younger women prior to surgical menopause to explain the potential consequences of surgery and to make a plan for symptom management and long-term health.
Current international guidelines advise use of MHT for all women who undergo menopause under the age of 45 years provided that they do not have other contraindications to MHT . Treatment should continue until the average age of menopause and then be reviewed. Those with a personal history of breast cancer should avoid both MHT and tibolone, as they have been associated with an increased risk of breast cancer recurrence . For high risk women without a personal history of breast cancer, observational data suggest that MHT appears to be safe . Women should be aware that discontinuation of MHT will be associated with a recurrence of hot flushes and night sweats in around 50% of cases.
Use of MHT will resolve hot flushes and sweats in 80-90% of women, although there is evidence that hot flushes and night sweats as well as vaginal dryness may persist despite MHT use in younger women . There are no specific guidelines on the type of MHT to use but oestrogen only MHT is generally prescribed for those women who have had a hysterectomy . Women who retain their uterus should use an oestrogen and progestogen combination preparation
In those without contraindications to MHT, suggest starting treatment within a week following oophorectomy.
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Why Is An Oophorectomy Performed
A surgeon may remove one or both of your ovaries for several reasons, including:
- A disease known as endometriosis, when cells from inside the womb travel and grow elsewhere.
- Benign growths known as cysts.
- Preventative surgery for patients with a high risk of cancer of the breast or ovaries.
- Cancer of the ovary.
- A condition known as torsion of the ovary. This condition happens when the ovary twists around the blood supply, causing severe pain.
- An infection of the ovary or the area around it, also known as pelvic inflammatory disease or a tubo-ovarian abscess .
Pso Surgical Menopause And Increased Cardiovascular Risk
Although PSO may lower cancer risk, the effect of surgical menopause leads not only to more severe menopausal symptoms , but also elevated risks in cardiovascular disease particularly in younger pre-menopausal women . The abrupt drop of serum sex hormones , is associated with a doubled risk of myocardial infarction, an increase in the relative risk for fatal & nonfatal coronary heart disease, stroke, as well as higher incidence of metabolic syndrome . There are also increased concerns regarding an accelerated risk of dementia in women who have undergone PSO at young, pre-menopausal ages . Post-menopausal dementia may be a form of vascular cognitive impairment, possibly attributable to inflammatory cytokines . Recent epidemiological studies have associated bilateral oophorectomy to increased rates of multimorbidity suggesting that PSO can accelerate the aging process.
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Hrt And Surgical Menopause
So what is surgical menopause? It’s menopause that develops suddenly after the ovaries — the main producers of the hormone estrogen — are surgically removed.
The removal of the ovaries is called an oophorectomy. The procedure is often combined with a hysterectomy — removal of the uterus — but not always. And in fact, women who only have their uterus removed will not go into surgical menopause. Their ovaries are still making estrogen. They’ll go into menopause naturally when they get older, although sometimes a bit earlier than usual.
Estrogen plays a key role throughout the body. It affects the brain, the bones, the skin, the heart, the blood vessels, and more. While estrogen levels lower gradually during natural menopause, they plummet with surgical menopause. That sudden drop in estrogen can lead to menopausal symptoms that can be quite severe.
Hormone therapy after surgery — either with estrogen and progestin or with estrogen alone — is a way to counteract the supply of estrogen you’ve lost. Women who have both the uterus and ovaries removed usually just get estrogen replacement therapy alone. But women who have only the ovaries removed need both estrogen and progestin. That’s because estrogen alone can increase the risk of cancer in the uterus. Adding progestin removes this risk.
Rarely, if ever, will both ovaries be removed without the uterus. Often, only one ovary may be removed, which will negate the need for HRT at the time of surgery,
Is There A Test That Can Help
One of the things that you can do is that you can go and ask your doctor for a hormone test. Now, the further through the menopause you go, the more accurate this test is going to be. But if your hormones have just started to change, then very often the test can come back negative purely because your hormones have been a little bit high on that particular day, and therefore you will think that youre not in the menopause.
So, if you think to yourself, Im sure Im starting the menopause. Im getting some of the usual symptoms, but the test comes back negative, then just go again in six months and ask to be retested. And you might find things have changed at that particular point.
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