Question: I heard recently that women who could not produce hormones naturally, either due to the change of life or after a total hysterectomy should have hormone replacement therapy to prevent osteoporosis. What is your opinion?
Women who have a total hysterectomy (removal of the womb and both ovaries) will age prematurely, and have an increased risk of osteoporosis, particularly if the surgery is performed at an early age. Unfortunately, the most common reason for a total (as opposed to sub-total) hysterectomy is cancer in the area of the ovaries or womb.
Any hormones given to these women in the future may rarely cause a recurrence of their cancer. These women are therefore caught in a cleft stick, and will need to discuss their individual problems carefully with their gynecologist. The treatment will depend on what type of cancer they had, where it was, how advanced it was, and how severe the symptoms caused by the lack of hormones. Fortunately, most women who have a hysterectomy have a sub-total one, where at least one ovary is left behind. These women can be treated the same way as those who have never had any surgery.
Women who are going through the menopause and who are suffering from significant effects of this natural change can be helped by regular hormone supplements. This usually involves taking estrogen either constantly or for three weeks a month, and those who have not had a hysterectomy will need a course of progesterone for ten days or so every month.
If the symptoms of the menopause are not severe, the family history should be checked, and if the patient’s mother or grandmothers suffered from osteoporosis, again hormone supplementation is advisable. If there is no history of osteoporosis, and no significant effects from the menopause, hormone supplementation can still be beneficial by reducing the incidence of strokes and heart attacks, and improving skin tone and appearance.

Question: If you have a hysterectomy, do you still go through menopause?
In a hysterectomy, it is normal to remove the cervix, uterus (womb), both Fallopian tubes and sometimes one of the two ovaries. The remaining ovary will produce sufficient hormone, in most cases, to maintain the woman’s normal sexual functions and prevent the menopause.
In due course, this remaining ovary will cease its production of female hormone, and the woman will develop the hot flushes, depression, irritability and headaches characteristic of the menopause. Because her uterus has been removed, she will not suffer from the heavy and irregular bleeding or the uterine cramps that can also occur with menopause. If during the hysterectomy it is necessary to remove both ovaries because of disease, the woman will lose her female hormones instantly and go through a premature menopause. It is important for these women to take hormone supplements until they are in their early sixties to prevent premature ageing, bone weakness, facial hair, sagging breasts and the other unpleasant effects of the menopause.
Women who have had cancer of the ovaries that has resulted in both ovaries being removed may not be able to use hormone replacement, but should carefully discuss this option with their gynecologist.

Question: I am 62 and on treatment for blood pressure. I am concerned about osteoporosis and heart disease and I am considering using the oestrogen patch. I finished my menopause 9 years ago. Are hormones going to help me now? What effect will it have on blood pressure?
Hormone replacement therapy (HRT) using oestrogen and progestogen is very beneficial to women during and after the menopause. If you have had your uterus removed in a hysterectomy, only the oestrogen hormone is required.
These female sex hormones not only relieve the symptoms of the menopause such as hot flushes, irritability, irregular bleeding, breast tenderness etc., but protect women against osteoporosis (weakening of the bones), hardening of the arteries and heart disease. It is a treatment that I highly commend to all women, and may be taken until you are well into your seventies. There is absolutely no evidence that it will cause any increase in the incidence of breast cancer.
Your blood pressure may actually improve using HRT, but there is no guarantee of this. It will certainly not get worse or interact with your medication. Both oestrogen and progestogen can be taken as a tablet, a stick-on patch that is replaced twice a week, or as an implant every three months. Oestrogen is also available as a vaginal cream that is used once or twice a week.
I strongly suggest that after further discussion with your general practitioner you commence hormone replacement therapy.