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.

Question: Should all women use hormones after menopause to prevent osteoporosis?
Women should consider their options at the time of the menopause and discuss them with their doctor. Generally, all women should be on hormone replacement therapy (HRT) after the menopause, not only to prevent osteoporosis, but to also prevent heart disease, strokes, premature ageing of the skin, Alzheimer’s disease and generally protect the body from ageing too quickly.
It always necessary to exclude any contra-indications to HRT, such as liver disease or blood clots.
If a woman is small boned and has a family history of osteoporosis, she has an increased risk of osteoporosis, and HRT is even more important.
The main problem most women complain of with HRT is the continuation of their periods beyond the normal time for their cessation. These periods are usually very light though, and often cease with time. Other side effects are usually related to an incorrect hormone dosage. They include headaches, depression, flushes and pelvic discomfort. As all women are different, finding the correct dosage can sometimes be a matter of trial and error.

Question: I have had breast cancer and a total hysterectomy at a relatively early aqe. I am concerned about premature aqeinq but my doctor says I cannot take hormones. What can I do?
This is an extraordinarily difficult problem to deal with. Most women who have a total hysterectomy take oestrogen to prevent the problems of menopause, but if you have had breast cancer, most doctors believe that you should not use this hormone because it may result in a recurrence of the cancer. More recently, some doctors are using oestrogen in this situation as they argue that oestrogen does not cause breast cancer. I would suggest that you avoid oestrogen unless it is absolutely necessary to use it.
To prevent osteoporosis you should eat plenty of dairy products and take calcium tablets. The premature growth of facial hair can be controlled by a medication called spironolactone. Exercise is important to keep your body toned up as much as possible. A well-fitted bra and possibly plastic surgery may help the sagging breasts and can replace a breast removed for cancer. Skin moisturizers and plastic surgery can be used to control premature skin ageing in all parts of the body.
By being careful with your body and taking the appropriate medical advice there is no reason why anyone should place you in an older age group than you are, and you should live a full and normal life well into your 80s.