Hrt After Surgical Menopause: Pros And Cons
To give you a better sense of what to consider in your decision, here’s a list of reasons you might lean toward getting HRT, along with a list of reasons against. Keep in mind that few if any of these pros or cons are definitive. Instead, you and your doctor have to consider them all and decide which apply.
How Long Do Symptoms Last
Perimenopausal symptoms can last four years on average. The symptoms associated with this phase will gradually ease during menopause and postmenopause. Women whove gone an entire year without a period are considered postmenopausal.
Hot flashes, also known as hot flushes, are a common symptom of perimenopause. One study found that moderate to severe hot flashes could continue past perimenopause and last for a
Researchers also found that Black women and women of average weight experience hot flashes for a longer period than white women and women who are considered overweight.
Its possible for a woman to experience menopause before the age of 55. Early menopause occurs in women who go through menopause before theyre 45 years old. Its considered premature menopause if youre menopausal and are 40 years old or younger.
Early or premature menopause can happen for many reasons. Some women can go through early or premature menopause because of surgical intervention, like a hysterectomy. It can also happen if the ovaries are damaged by chemotherapy or other conditions and treatments.
Maggie Chose Surgery To Avoid Cancer
Maggie Gaines is a 44-year-old mom of two who inherited a mutated BRCA2 gene, which increased her risk of developing breast cancer and ovarian cancer. According to the stats for my mutation, I had up to a 20 percent chance of getting ovarian cancer, she explained, adding it felt like playing Russian roulette to keep my ovaries. Im not a gambler so I just wanted them out.
At 42, she elected to remove her uterus and both ovaries. She recommends not relying on a gynecologic oncologist for information about what happens after surgery. The truth is that the gynecological surgeon is likely not an expert on menopause, she said. His or her job is to get the cancer out or to mitigate cancer with a preventive surgery like mine. So my advice is, find a surgeon who you know will do the best job doing what he or she is good at, and find someone else who specializes in managing menopausal symptoms following surgery.;
Gaines found a clinic at University of Penn that specializes in BRCA patients. An oncologist there referred her to a gynecologist, who specializes in menopause. Today, she takes hormone replacement therapy and has been surprised by minimal side effects.
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Why Perform An Oophorectomy
An oophorectomy causes surgical menopause. In most cases, removing the ovaries is a preventive measure against disease. Sometimes its performed alongside a hysterectomy, a procedure that removes the uterus.
Some women are predisposed to cancer from family history. To reduce the risk of developing cancers affecting their reproductive health, doctors may suggest removing one or both ovaries. In some cases, they may also need their uterus removed.
Other women may elect to have their ovaries removed to reduce symptoms from endometriosis and chronic pelvic pain. While there are some success stories in oophorectomy pain management, this procedure may not always be effective.
In general however, if your ovaries are normal, its highly recommended not to have them removed as a remedy for other pelvic conditions.
Other reasons women may want to remove both ovaries and induce surgical menopause are:
- ovary torsion, or twisted ovaries that affect blood flow
Can We Reduce Our Cardiovascular Danger
Yes, by maintaining a healthy way of life, battling versus smoking cigarettes as well as overweight, practicing routine exercise, and also carefully checking blood pressure, the look of feasible diabetic issues, and cholesterol degrees.Allows not forget that heart diseases are the leading cause of death among women.
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Prevention Of Ovarian Cancer
In low risk patients, according to a study by Jacoby et al. 2014, the global risk for developing ovarian cancer in low risk patients was 1.4% and was influenced by numerous factors. In low risk patients, performing SO is considered to completely eliminate the risk of ovarian cancer development . However, there have been reports in the literature of cases of epithelial ovarian cancer after bilateral salpingo-oophorectomy or primary peritoneal carcinomatosis after bilateral salpingo-oophorectomy .
In high risk patients, risk reducing bilateral SO is reported to reduce by 7080% the risk of ovarian cancer, mortality by cancer and mortality in general .
Regarding prophylactic salpingectomy, meaningful conclusions are not yet available. It was introduced in 2010 following evidence of the origin of epithelial ovarian cancer with a starting point in the fallopian tube. Numerous associations have positive opinions regarding the procedure . On the other hand, some authors have reported possible disadvantages of the procedure, such as alteration of the ovarian reserve , prolonged operative time and technical difficulties in the case of vaginal hysterectomy or caesarean section .
Surgical Menopause Symptoms And Side Effects
The symptoms of surgical menopause are much like the symptoms of natural menopause, and you can expect the same side effects. Instead of a gradual lessening of hormones, however, surgical menopause stops hormones quite suddenly, causing the symptoms to also appear suddenly and sometimes more severely.;
- The most common symptoms of surgical menopause are hot flashes, night sweats, and vaginal dryness.
- Lack of estrogen can result in decreased bone density and increase your risk of developing osteoporosis. Fractures are also more common.
- Vaginal dryness can make intercourse uncomfortable and sometimes painful, leading to a lack of interest in sex.
- With a loss of ovarian testosterone, you may experience a drop in libido.
- The removal of your ovaries with surgical menopause will mean a loss of fertility, which may impact your emotional and mental health.
- Estrogen plays an important role in the vitality of your tissues. Low levels of this hormone can affect your cardiovascular system and make you more susceptible to heart disease.
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Management & Treatment After Surgical Menopause
Because symptoms of a surgical menopause are likely to be more severe, often the best way to manage and treat symptoms is with menopausal hormone therapy, or MHT . Your doctor can advise you about the risks and benefits of using MHT.
If the ovaries have been removed but not the uterus , MHT will include both oestrogen and progestogen, with or without testosterone. Progestogen is used to protect against uterine cancer. When a woman is on oestrogen therapy, she needs a progestogen to stabilise the lining of the uterus, which reduces her risk of cancer of the uterus.
If both an oophorectomy and hysterectomy are performed, oestrogen and possibly testosterone are needed. Progestogen is not needed, as there is no risk of cancer of the uterus. The hormone therapy is best started within 2448 hours after surgery.
Sometimes MHT is not an option after surgical menopause, perhaps because of a woman’s increased risk of breast cancer, or a clotting condition such as Factor V Leiden mutation, which increases the risk of deep vein thrombosis .
The alternatives to MHT may include:
- some complementary therapies, although there is no evidence to support their use in surgical menopause for more information go to Menopause & herbs
- some antidepressant, anticonvulsant and migraine/blood pressure medications, which work to reduce hot flushes.
Menopause Treatments And Surgery
Are the long term benefits of HRT or ERT any different in women who have undergone surgical versus spontaneous menopause?
With regard to osteoporosis, the rate of bone loss right after surgical menopause is higher than it is for natural menopause. Presumably this is because women with natural menopause have already lost a fair amount of bone mineral density already. We know that women who underwent surgical menopause and take ERT will prevent the usual loss of bone density that takes place in a natural menopause and that women undergoing natural menopause who take HRT will replace most of the previously lost bone mass.
With a surgical menopause, estrogen replacement needs to be at higher levels, eg., conjugated estrogens 1.25 mg or estradiol 2 mg, than it does for later in a natural or surgical menopause in which a woman’s body has already become used to lower levels. This is also true to prevent bone loss. A dose of .625 mg conjugated estrogens may not be enough to prevent bone loss in the first year after menopause, whereas a higher dose, or a 0.625 mg dose combined with a phytoestrogen dose of ipriflavone from red clover such as found in Promensil Â®, can prevent that initial menopausal high rate of bone loss.
How do hormones change over time in natural menopause versus surgical menopause?
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Are The Symptoms Of Treatment
Unfortunately, you can expect to experience the same symptoms youve heard older women going through menopause talk about. Even though your menopause is medically-induced, you are still experiencing the same hormone drops that other women in menopause are experiencing. These symptoms can include:
- Hot flashes, redness and sweating
- Irritability and mood changes
Why Are Surgically Induced Menopause Symptoms So Severe
Induced menopause often results in harsher symptoms because of the abrupt cessation of the hormones produced in the reproductive system. Many hormones, like estrogen, are produced in the ovaries . With the sudden removal of the ovaries, the body is confused by the change in its customary level of estrogen. As a result of the unexpected hormone fluctuation, symptoms like vaginal dryness, hot flashes, and mood swings occur and are often more severe than if the body is given time to adjust to a gradual decrease of estrogen, as is the case with natural menopause.
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Are The Symptoms Of Menopause More Severe Or Last Longer With Surgical Menopause Or Natural Menopause
Women who are retrospectively asked about their menopausal symptom severity and duration years after undergoing menopause and who had surgical menopause will have a more positive view of their energy level, sexual libido and general well-being than women undergoing natural menopause. This may be because of the relief they obtained from the surgical problem they were having that led to the hysterectomy and ovarian removal, a higher incidence of having been replaced with estrogens without having to take progestins or just simply a different perception, but it argues against surgical menopause producing worse symptoms than natural menopause. It is almost impossible to separate effects since about 85-90% of women undergoing surgical menopause receive estrogen replacement versus about 50% of women with a natural menopause in some studies.
It seems clinically that there is a much higher incidence of hot flashes with surgical menopause than with natural menopause although how high the incidence is may vary by a woman’s ethnic background. If given estrogen replacement right away, however, the hot flashes seem to be controlled.
Is There A Risk Of Worsening Endometriosis By Taking Hrt After Having An Oophorectomy Or Taking Medications To Cause Menopause
There is a theory that HRT contains just enough hormone to keep your bones healthy and to help with menopause symptoms and contains a low enough dose to not have an effect on endometriosis. This is called the estrogen threshold theory.
This means that it is rare for endometriosis to recur or get worse when on HRT but it is possible. It is more likely if there is a residual endometriosis and your HRT only contains estrogen.
Putting The Risks And Benefits Of Hrt In Perspective
If you’re just glancing at list above, some of the risks of HRT might seem to overwhelm the benefits. Could a reduction in vaginal dryness possibly be worth an increased risk of cancer?
But look at the details. The risks of HRT — while real — are quite small for an individual person. For example, the 2002 Women’s Health Initiative study found that ERT increased the risk of strokes by 39%. That sounds frighteningly high. But the actual number of people affected is very small. Out of 10,000 women who are not taking ERT, 32 have strokes each year. Out of 10,000 who are taking ERT, 44 have strokes each year. That’s an increase of just 12 people out of 10,000.
On the other hand, when it comes to controlling the symptoms of surgical menopause, a huge number of women feel the benefits. One out of four menopausal women has severe hot flashes. Treatment with hormone therapy cuts down the number of hot flashes per week by 75%. So if a woman had 24 hot flashes per week, HRT would drop that number to six. That could make a big difference in the quality of their day-to-day life.
Things Everyone Experiencing Medically
For most people who get periods, menopause may seem like a far-off cloud on the horizon an unpleasant experience we all know well go through someday, but until then, its easier not to think too hard about it.
Menopause is the term for the time when your body starts producing less estrogen, which causes you to stop menstruating. It usually starts in your 40s or 50s. If you have an illness that affects your reproductive organs, however, your treatment might cause menopause earlier than normal. This process is called medication-induced menopause , and it can be a confusing, frustrating experience, made more difficult by the fact that it piggybacks on top of your other medical issues.
There are a few ways medical treatment could induce menopause. One way is to have surgery to remove your ovaries, which is called oophorectomy. If both your ovaries are removed, you will enter menopause. Or, you could undergo treatment that prevents your ovaries from working correctly and producing estrogen, thus stopping you from ovulating and having a period.
Some reasons for either of these scenarios could be:
Deciding to undergo treatment-induced menopause can be a scary experience, and fill you with more questions than answers. We spoke to Leena Nathan, an OB/GYN at UCLA, to answer some of the most common questions you might have about surgical or medication-induced menopause.
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Why An Oophorectomy Might Be Necessary
An oophorectomy is often recommended by doctors to inhibit the development of chronic diseases. Patients at greater risk for breast or ovarian cancer based on family history may be advised to have one or both ovaries removed. In many cases, an oophorectomy is performed alongside a hysterectomy, which would similarly induce surgical menopause.
The relief of chronic and persistent pelvic pain or symptoms of endometriosis have also been cited as reasons for undergoing an oophorectomy. Others include:
- Ovarian torsion
- Weight gain
To control the adverse effects of surgical menopause, your doctor might suggest hormone replacement therapy. HRT addresses the sometimes severe hormonal imbalances in your body brought on by surgical menopause.;
Menopause symptoms can be painful and disrupt your daily activities. HRT helps alleviate those symptoms while simultaneously curbing bone loss and aiding in the prevention of osteoporosis and cardiovascular disease.;
This is particularly critical for women under 45 years of age who have an oophorectomy prior to experiencing natural menopause. They possess a greater chance of developing heart disease, neurological issues, and cancer without HRT.;
Surgical menopause symptoms aside, dont start HRT if you have:
- A personal or family history of ovarian, uterine, or breast cancer;
- A personal history of thrombosis, or blood clots
- Untreated high blood pressure;
- Liver disease
Reasons To Undergo Surgical Menopause
Surgical menopause is induced mainly for two reasons: either to treat an already diagnosed condition and prevent related complications or to reduce the odds of developing a serious condition in women at high inherited risk.
They include, but are not limited to, the following conditions:
- Extreme premenstrual dysphoric disorder
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What My Surgical Menopause Can Teach Pharmacists About Hrt
A few years ago, I was in a cycle of extreme abdominal pain, fatigue and bloating that was seriously affecting my quality of life.
I was referred for various medical investigations: an ultrasound, blood tests, an investigative laparoscopy but none of them found anything of significance.
The pain was constant and my GP suggested referring me for pain management, but I was determined to find the underlying cause.
My symptom diary revealed that my pain was worse at certain times of my menstrual cycle. I tried a combined oral contraceptive, but I felt worse than before, so I stopped. I tried the Mirena coil; my periods stopped, but my pain only slightly reduced.
My gynaecologist then prescribed me triptorelin, which stops the ovaries from producing oestrogen. Within a month of having my first injection, it felt like a black cloud was lifting. I was no longer in excruciating pain, I just had mild hot flushes.
Ovary removal was recommended for a more permanent solution. This was not a decision to take lightly, but, having already had two children I agreed, although I also requested a full hysterectomy. During the procedure, the surgeons found significant adhesions between my womb and bladder, along with some endometriosis finally, I knew the reason for my pain.
A surgical menopause is not like a natural one it can feel like your hormone levels drop overnight. It felt like I had changed as a person and it took a while to adjust.
What Are The Common Symptoms Women Can Experience In Induced Menopause
The symptoms women experience are wide ranging but may include:
- Vasomotor symptoms including hot flushes and night sweats
- Musculoskeletal symptoms including joint and muscle pains
- Low or changed mood and loss of libido
- Memory loss and anxiety
- Urogenital symptoms including vaginal dryness and recurrent urinary tract infections
- Hair loss
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