HRT After Hysterectomy
If HRT is commenced following hysterectomy, it is usually prescribed as an oestrogen only preparation. This can be taken as a daily tablet, a weekly or twice weekly patch, a daily gel, a daily nasal spray, a 3 monthly vaginal ring or a 6 monthly implant. The particular type of prescription is tailored to suit your individual needs and is chosen after consideration of your preference, past history and cost. The most common prescription is oestrogen HRT in a tablet form.HRT using a combination of oestrogen and progestogen (which is recommended when the uterus is still present) is often used after a hysterectomy if widespread endometriosis is found at the time of surgery.
Combined HRT can be described as either sequential or continuous.
Sequential combined HRT is suitable for women who are perimenopausal, ie still experiencing erratic menstrual bleeding. Most preparations are designed to mimic the menstrual cycle and result in monthly periods. They are based around a 28-day cycle in which oestrogen is taken every day and a progesterone is added for the last 12 to 14 days of the cycle. For women who are borderline postmenopausal and have very infrequent bleeds, there is also a sequential preparation available that results in three-monthly bleeds.
Once a woman has not had a natural period for a year and is described as postmenopausal, continuous combined HRT is more suitable. This form of HRT does not produce periods and involves taking a daily dose of oestrogen and progesterone.
The most important result of these research studies has been the confirmation that HRT increases the risk of developing breast cancer and endometrial cancer (cancer of the lining of the womb).
The risks with HRT
To put into perspective the magnitude of these risks, it helps to put together some figures.
For purposes of comparison, the risks are stated as the number of people affected per 10,000 women-years of observation. This can mean one thousand women observed over 10 years or five thousand women over two years, etc.
The Women’s Health Initiative (WHI) study showed the following risks.
Some evidence suggests sequential HRT is associated with a slightly higher risk of endometrial cancer.
Sequential HRT is the sort associated with a monthly or three-monthly bleed.
It is recommended for use in the climacteric phase.
Other breast problems related to HRT
Women in the pre-menopause who take HRT often get breast pain and benign breast lumps, including cysts (fluid-filled lumps).
HRT is known to increase the density of breast tissue, which makes it harder for the X-rays used in mammography to penetrate the breast. It is therefore of concern that HRT can make it more difficult to detect breast cancer by mammography.