Doctors do not recommend hormone replacement therapy (HRT) following a hysterectomy unless a person has had their ovaries removed or experiences menopausal symptoms that affect their quality of life.

A doctor typically prescribes HRT to people with declining ovarian hormones during menopause. HRT can help reduce vasomotor symptoms, such as night sweats and hot flashes. It may also reduce other menopause and perimenopause symptoms.

A person who has a hysterectomy may or may not require HRT following surgery. This article discusses instances when it may be necessary after a hysterectomy as well as HRT’s benefits, risks, and how to take it.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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A hysterectomy involves removing the uterus and, in some cases, the cervix. Often, surgeons also remove one or both ovaries through a procedure called an oophrectomy. An oophrectomy can be unilateral (one ovary) or bilateral (both ovaries).

The ovaries are the primary source of estrogen in the female body, so removing them leads to a sudden decrease in estrogen levels. This means people may require HRT immediately after surgery to prevent experiencing unwanted symptoms. When surgeons remove both ovaries, a person experiences surgical menopause.

If the ovaries remain intact, there is less of an effect on estrogen levels. However, estrogen levels may decline sooner than they would without a hysterectomy.

HRT can have the following benefits after a hysterectomy:

Symptom relief

HRT can reduce the following symptoms a person may experience after a hysterectomy:

Bone health

Estrogen therapy may help slow bone thinning, reducingTrusted Source the risk of osteoporosis and bone fractures.

Cardiovascular protection

A decline in estrogen levels causesTrusted Source the body to store fat around the belly and contributes to insulin resisatnce. This raises the risk of type 2 diabetes.

Endothelial cells in blood vessels that help regulate blood pressure and other functions may also become impaired, raising the risk of cardiovascular problems.

Supplementing with estrogen may help reduce these risks.

For people with a uterus, doctors recommend HRT that includes estrogen and progesterone.

People without a uterus do not require progesterone, as its main purpose is to preventTrusted Source the uterine lining from growing out of control. In this case, doctors recommend estrogen-only therapy (ET).

HRT recommendations following a hysterectomy differ depending on individual circumstances.

People without a uterus with one or both ovaries

A person who does not have a uterus any more but retains their ovaries may not need HRT following surgery, because their ovaries will continue to produce estrogen.

However, these people may experience a decline in estrogen sooner than if they had not had a hysterectomy. If people experience menopausal symptoms that affect their quality of life, they can talk with a doctor about the possible benefits and risks of taking HRT.

People without a uterus or ovaries

Ovary removal leads to a rapid decline in estrogen and the onset of menopausal symptoms. For this reason, a person who has undergone removal of their uterus and ovaries will usually require HRT soon after surgery to prevent symptoms such as hot flashes and night sweats, which doctors call vasomotor symptoms.

Learn more about female reproductive anatomy.

A doctor can give advice about how to take HRT after a hysterectomy.

According to The Menopause Society, administering the following types of HRT involves the processes below:

  • Systemic: Hormones enter the body via the bloodstream, meaning they can have a widespread effect. Systemic forms of HRT include:
  • Low dose: This is localized ET, also called vaginal estrogen therapy. Doctors recommend it for genitourinary syndrome of menopause (GSM), which leads to symptoms such as vaginal dryness and atrophy. This form of HRT leads to very little estrogen circulating in the blood, so it has fewer associated risks.

Most experts agree that the benefits of HRT outweigh the risks for females within 10 years of menopause and up to the age of 59 years.

To minimize risks, they recommend a person takes the lowest dose of HRT for the shortest amount of time necessary to manage symptoms.

HRT is associated with the following risks:

  • Stroke: Estrogen therapy increases stroke risk, but the risk goes away after stopping HRT.
  • Blood clots: The risk of blood clots is higher when a person takes HRT by mouth and lower with transdermal forms, such as gels, patches, and sprays.
  • Breast cancer: The risk of breast cancer in females who use ET does not increase until they have been taking it for more than 7 years.

Doctors may not prescribe HRT for people with:

Learn more about the side effects of HRT.

If a person has surgery to remove their ovaries and their uterus, a doctor will typically suggest starting HRT following surgery.

There is no need for people who retain their ovaries after a hysterectomy to contact a doctor about starting HRT unless they experience menopausal symptoms that affect their quality of life.

A doctor will consider someone’s risk factors when making recommendations for HRT, and ongoing evaluations will be necessary.

People who have had a hysterectomy do not necessarily need to take HRT unless they also had their ovaries removed. If they begin to experience menopausal symptoms, they can talk with a doctor about the benefits and risks of taking hormone replacement therapy (HRT). Doctors recommend estrogen-only therapy for people without a uterus.