Hysterectomies are the second most common surgery among women in the United States. Approximately 500,000 hysterectomies are performed in the U.S. every year, in order to treat various medical conditions such as uterine fibroids, endometriosis, adenomyosis, uterine prolapse, heavy bleeding, and cancers affecting the female organs. A hysterectomy is classified as either total, partial, or radical, based on how much of the uterus and surrounding organs and tissues are removed. The fallopian tubes and ovaries may or may not be removed during a hysterectomy depending on individual circumstances. Any major surgery is associated with risks and hysterectomies are no exception. But these risks go beyond short-term surgical complications to include possible serious health ramifications down the road.
We all know that sex hormones like estrogen and progesterone, and the balance between the two, play a crucial role in reproduction. But you may not know that they also help stabilize mood and emotions, maintain healthy bones and skin, keep heart disease at bay, and protect the function of other internal organs. So anything that alters sex hormones will inevitably alter and affect overall health and well-being.
All women who undergo a hysterectomy will stop having a menstrual cycle. Some will also get symptoms of menopause such as hot flashes, depending on how much the ovaries are affected. Ovaries produce estrogen, so their removal (or decreased function due to less blood flow available to them even if they are not removed) sends women prematurely spiraling toward menopause. For many years, the solution for managing “surgically induced medical menopause” was hormone replacement therapy – the use of synthetic, hormone-like pharmaceuticals intended to act as a substitute for what the body is no longer producing.
Problems with Synthetic Hormones
In the 80s, even the well-known natural health physician, Dr. Joseph Mercola, was touting the benefits of hormone replacement therapy. Then a major research study revealed a problem – a serious one. The Women’s Health Initiative, a 15-year study on combination estrogen/progestin therapy in women, ended three years early because of the significantly increased rates of breast cancer, stroke, heart attacks, and blood clots in the experimental group. Other studies showed problems with estrogen-only therapy as well. In addition to adverse effects seen with combination therapy in the Women’s Health Initiative, dementia, urinary incontinence, gallbladder disease, osteoporosis, high blood pressure, vaginal bleeding, skin rashes, and weight gain were also noted in various studies on synthetic hormone replacement. As a result of these findings, prescriptions for hormone replacement therapy dropped dramatically in the decade that followed.
By 2013, the percentage of women taking synthetic hormones following a hysterectomy went from 90% to only 10%. The problems associated with this type of hormone replacement is thought to be at least partly due to the synthetic nature of the hormones, which are molecularly different than the ones made naturally by the body. For example, the most commonly used synthetic estrogen, called Premarin, is formulated from the urine of a pregnant horse. And synthetic progestins such as Provera, help prevent pregnancy when used in oral contraceptives, yet natural progesterone is needed for conception to occur. Clearly, the body does not recognize these substances as being identical to those produced naturally.
Dangers of Doing Nothing
Despite the concerns over synthetic hormones, not doing anything at all to replace hormones after a hysterectomy may not be a wise choice either, particularly in younger women. A study published in the American Journal of Public Health in 2013 stated that estrogen-only therapy in younger post-menopausal women significantly decreased all-cause mortality rates. Data showed that thousands of women who had not taken hormone replacement after surgical menopause died (mainly of breast cancer and heart attacks) between the ages of 50 and 59. This is most likely due to the premature decrease in estrogen, which was not being replaced because of concerns over pharmaceutical hormone replacement. In healthy amounts, estrogen in the body helps protect women from these and other age and hormone-related diseases.
A Better Option
Thankfully, another option for maintaining and balancing hormones does exist. It’s called (bioidentical hormone replacement therapy BHRT). Bioidentical hormones are just what they sound like – hormones that are molecularly identical to those found naturally in the body. They are so similar in fact, that drug companies are unable to patent and sell them, which might be a reason you haven’t heard about them from your doctor. No patent means no big profits for pharmaceutical companies, and therefore no advertising to doctors (or consumers). Bioidentical hormones are derived from plants and made in a compounding pharmacy. They can be tailored to the individual’s needs, with various dosages and delivery modes available.
A doctor well-versed in endocrinology and BHRT will test your hormones, take a thorough history, and make a decision about a hormone replacement plan that best fits your situation. BHRT can benefit not only younger women in surgical menopause, but also older women with symptoms of menopause, those with fluctuating hormones due to perimenopause, and even younger women with hormone imbalances. Hormone imbalances in women of all ages are becoming more and more common due to exposure to endocrine-disrupting chemicals in the environment, diets heavy in processed foods, and oral contraceptive use.
Symptoms of hormone imbalances that BHRT can improve include:
- Hot Flashes
- Vaginal Dryness
- Painful intercourse
- Brain fog/memory problems
- Sleep difficulties
- Dry skin
Bioidentical Hormone Replacement Therapy has been shown to greatly reduce the risk of osteoporosis, breast and colon cancer, heart disease, periodontal disease, and Alzheimer’s. Some studies have also shown that those who use BHRT look younger than their same-age counterparts who don’t.
1. Holtorf Medical Group. BHRT. Available at:
https://www.holtorfmed.com/bhrt/ Accessed on April 19, 2016.
2. Holtorf Medical Group. Bioidentical Hormone Replacement for Women. Available at:
https://www.holtorfmed.com/hormonal-imbalance-for-women/ Accessed on April 19, 2016.
3. Mercola, J. Estrogen Could Have Prevented Almost 50,000 Deaths. Available at:
http://articles.mercola.com/sites/articles/archive/2013/08/05/hormone-replacement-therapy.aspx Accessed on April 20, 2016.
4. Office on Women’s Health: U.S. Department of Health and Human Services. Hysterectomy. Available at:
http://www.womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.html Accessed on April 20, 2016.