Natural Medicine: Taking care after a hysterectomy
So you’ve had a hysterectomy. What now? The good news is that hysterectomy is a permanent solution for the constant bleeding and/or pelvic pain you’ve been suffering. The bad news is that these are often replaced by new symptoms such as insomnia, hot flashes, night sweats, low libido, memory loss and depression; all indicators of hormonal imbalance.
If you’ve had a complete hysterectomy (removal of the uterus, ovaries and tubes), it doesn’t matter how old you are, you’ll be thrown into menopause. With your ovaries gone, you can’t make any hormones (except for small amounts in the adrenal glands). Your hormones drop dramatically with no chance for gradual adjustment. Symptoms can be sudden, severe and debilitating.
A prevailing belief is that after a partial hysterectomy (removal of the uterus only), your ovaries will keep producing optimal levels of hormones until menopause.
Gynecologist Dr. C.W. Randolph, M.D., explains that this is not the case: “The ovaries are significantly impacted by partial hysterectomy. When the uterus is removed, the flow of blood to the ovaries lessens, and consequently, the production of hormones is reduced.” Menopause symptoms can come earlier.
Following a complete hysterectomy, you will need a brand new supply of sex hormones, ASAP. Estrogen is not enough. Progesterone is mandatory and testosterone may be necessary. No testing is required until you’ve been on hormone therapy for a couple of months. Then it’s time to assess and adjust doses.
Hormone imbalance is not as pronounced and does not usually come on as suddenly after a partial hysterectomy.
Symptoms can still be significant, however, and bio-identical hormone therapy is needed to restore normal, physiological levels. Testing is undertaken to determine baselines before developing an individual regimen.
Compounded, bio-identical hormones are the therapy of choice with respect to safety and effectiveness. They are exact duplicates of what your body makes naturally. Horse estrogens (Premarin) and Provera, a synthetic progestin (not a progesterone) are not recommended. Diet, lifestyle and stress also need to be addressed for optimal balancing.
Unfortunately, the only hormone most women are prescribed after complete hysterectomy is estrogen. You may have been told that you don’t need progesterone because with no uterus there is no worry about uterine cancer. Dr. John Lee, M.D., a pioneer in progesterone therapy, wrote that, “This is an outdated approach to hormone replacement therapy (1960s). It was assumed that women without a uterus didn’t need progesterone, but the research hadn’t been done long term to assess the risk of breast cancer and stroke in women who took estrogen alone.” Dr. David Brownstein, M.D., author of four books on hormones, agrees “I believe that the use of unopposed estrogens (estrogen without progesterone) in conventional hormone replacement therapy has been partially to blame for the epidemic rates of breast cancer.”
Years of estrogen only therapy may also increase the risk of blood clotting, fluid retention and weight gain. When you take estrogen, you should always take progesterone to counteract the negative effects.
Safeguarding one organ (your uterus) by opposing the cancer causing properties of estrogen is not the only role progesterone plays in your body. There are progesterone receptors throughout your entire body. Progesterone is crucial for everything from brain function to bone building. It is good for your heart and blood vessels, and a major protective hormone for the breast.
You just got relief with a hysterectomy and now you have a whole new challenge. If you don’t put back the hormones your body is missing, you could be exposing yourself to unnecessary symptoms and increased risk of cancer and future illness. But don’t despair, through careful monitoring and adjustment, optimal hormone replacement can be achieved and you can get back to feeling like yourself again.
Dr. Denise De Monte is a naturopathic physician in Vernon at the De Monte Centre Natural Medicine.