Hormones After Hysterectomy

About hysterectomy

A hysterectomy is a surgical procedure that removes the uterus (womb), usually because of a medical necessity. However, some people choose to undergo the procedure voluntarily. All hysterectomies are major operations and have a long recovery time and some hysterectomies involve the removal of additional reproductive organs, such as the ovaries or the fallopian tubes; this procedure is known as a hysterectomy with salpingo-oophorectomy. The uterus, and other reproductive organs, may need to be removed for medical reasons such as uterine cancer, ovarian cancer, cervical cancer, or the presence of fibroids (non-cancerous tumours). The reproductive organs are important to the production of certain hormones such as oestrogen and progesterone, which are mainly produced and released by the ovaries and have important roles in the regulation of the menstrual cycle. But how does a hysterectomy affect hormone levels? 

Hormones after hysterectomy

After effects of hysterectomy on hormones

When both ovaries are removed the production of oestrogen is reduced significantly causing a surgical menopause, which happens soon after the operation regardless of age. If one or both ovaries are not removed during the procedure, menopause may be experienced sooner than expected. This causes an imbalance in the hormones and it is the reduction of the hormone oestrogen which contributes to the side effects that occur after a hysterectomy. These side effects are the same that are experienced during natural menopause and can change over time. Some of the most common symptoms experienced by menopausal women include hot flushes, vaginal dryness, and heart palpitations. However, not every menopausal woman has the same symptoms, and some menopausal women do not experience any menopause symptoms at all. 

Oestrogen has another important role in the prevention of coronary heart disease (CHD), which reduces the risk of a heart attack. Oestrogen is involved in protecting against CHD by helping to control cholesterol levels, in turn reducing the risk of plaque build-up inside the arteries. The drop in levels of oestrogen in menopausal and postmenopausal women can increase the amount of plaque build-up inside the walls of the arteries which increases the risk of developing CHD. Women who undergo a hysterectomy are more likely to experience menopause before the age of 40 which is considered to be early menopause, making them at a higher risk of premature coronary heart disease. 

Oestrogen is essential for maintaining strong and healthy bones in women’s bodies, meaning the reduced level of the hormone after a hysterectomy directly affects bone density which could increase the risk of developing osteoporosis, which causes the bones to become weaker and more likely to break. This can be treated in a variety of methods including taking Vitamin D and Calcium supplements, but it can also be treated with menopause treatments. 

Oestrogen has also been linked to an increase in the risk of breast cancer as it has been found to stimulate breast cancer cells, causing them to grow. High exposure to oestrogen can occur through natural menopause happening later in life, menstruation starting earlier in life, or hormonal medicine that increases oestrogen. The removal of one or both of the ovaries during a hysterectomy causes the levels of oestrogen to drop significantly and could decrease the breast cancer risk due to oestrogen exposure.   

Progesterone’s role in women’s bodies is to regulate the menstrual cycle by encouraging the lining of the uterus - known as endometrium - to produce special proteins in preparation for the implantation of an egg, when there is no egg implanted progesterone levels drop and the endometrium breaks down causing menstruation. It is believed that high levels of progesterone are involved with symptoms of premenstrual syndrome (PMS) such as breast tenderness and mood changes. Low levels of progesterone can cause symptoms similar to those experienced during menopause, such as hot flushes and changes in mood. After a hysterectomy, menopause occurs, dropping the levels of progesterone and causing the symptoms associated with low levels of the hormone. Low levels of progesterone can be treated with natural methods such as vitamin supplements of vitamins B and C and medicinal treatments. 

All of these changes in hormones due to surgical menopause can be and often are treated using Hormone Replacement Therapy (HRT) in the same way that natural menopause is treated. It is important for a woman who is considering undergoing a hysterectomy to consider if and how they want to treat the symptoms of surgical menopause that they may experience after the procedure. 

Things to consider after hysterectomy

The largest factor to consider after a hysterectomy is the possibility of an early menopause and how they want to manage it. Menopause has a variety of treatments and ensuring that the treatment chosen is correct for each woman is essential to making the management of the symptoms beneficial. 

HRT is a medicinal treatment that helps to reduce many menopause symptoms, such as hot flushes and vaginal dryness, within a few weeks of the first usage. This treatment helps to reduce menopause symptoms by replacing the hormones, e.g., oestrogen and progesterone, which have low levels during menopause. There are various types of HRT, including how the treatment is delivered and the hormones in the treatment, which are decided by the women experiencing menopause with the advice of their GPs. The types of HRT include tablet forms, patches, gels, and vaginal oestrogen. It is generally advised that women experiencing early menopause should take HRT until they reach the average age that natural menopause occurs - typically around the age of 51. Because HRT involves increasing the levels of oestrogen in the body, and women who go through early menopause and take HRT until they are about 51 have a higher exposure to oestrogen, there is an increased chance of breast cancer risk. However, the risk only increases if HRT is taken for more than one year and the risk falls after stopping HRT. Additionally, not all types of HRT increase the risk of breast cancer. Vaginal oestrogen, which comes in the form of a cream or ring, does not increase the risk of breast cancer and can help with symptoms such as vaginal dryness. However, this form of HRT does not help with symptoms such as hot flushes. 

For those who choose not to use HRT, there are non-hormonal medicines that can help manage some of the symptoms of menopause. For example, medicines like gabapentin and clonidine can help with hot flushes and night sweats, and antidepressants can help to regulate changes in mood. 

Some supplements can help with some of the symptoms and risks associated with early menopause, for example, vitamins B and C can help with maintaining levels of progesterone, helping to manage menopausal symptoms such as hot flushes and mood swings. Additionally, vitamin D and calcium can help to maintain bone density and strength, decreasing the risk of osteoporosis.  

Summary

Hysterectomies can cause the reduction of a number of female hormones which have important roles within women’s bodies, including oestrogen and progesterone, causing early menopause. In some cases, the reduction of these hormones can be beneficial by lowering the risk of breast cancer, and in others, they can be detrimental, by increasing the risk of osteoporosis. HRT can help to regulate various menopausal symptoms, but it can also increase the risks of developing breast cancer. It is important for someone who is considering a hysterectomy, as well as the type of hysterectomy, that all factors are discussed with health professionals beforehand.