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Endometriosis and HRT

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Endometriosis and HRTI have had a hysterectomy and oophorectomy because of endometriosis. Can I use HRT? Should I use estrogen only or a combination of both estrogen and progesterone?

There is not black and white answer to determine if a woman with endometriosis should use hormone replacement therapy (HRT) following an oophorectomy. Endometriosis is complex, and it can depend on your body and the skill of your surgeon as to whether or not you will face endometriosis issues following a hysterectomy and oophorectomy.

A hysterectomy, even with an oophorectomy, does not cure endometriosis. "Endometriosis is an extra-uterine disease, and the aim of treatment should be to remove all the extra-uterine disease while retaining all the healthy tissue including the uterus and ovaries," (BJOG). "Patients are sometimes misled to believe that the only long-term solution is removal of all female reproductive organs - a myth. Endometriosis is not cured by removal of the reproductive organs. This dangerous misconception in the medical field is responsible for countless, needless hysterectomies performed each year," (Endometriosis). Thus, even after a hysterectomy and oophorectomy, endometriosis can remain and cause problems.

As estrogen is the fuel for endometriosis, finding a balance for providing adequate estrogen critical for overall health without creating intense endometriosis issues is a matter of trial and error. The ovaries produce a good deal of estrogen which floods the pelvic region each month. That estrogen can flare endometriosis implants, especially those that are close by. Not having ovaries, however, does not guarantee you will not have endometriosis; endometriosis can actually create its own supply of estrogen. Accordingly, going without estrogen replacement therapy (ERT) does not definitely stop endometriosis; in fact, it can open the door to a wide range of new health issues that can be more serious than endometriosis.

Lack of adequate estrogen can lead to serious health concerns such as heart disease, osteoporosis, and thinning tissues. Further issues can include gum disease, tooth decay, cataracts, colon cancer risk, and bladder concerns. Besides physical health concerns, there can also be mental and emotional ramifications involved. Hence, removing the ovaries and avoiding hormone replacement therapy (HRT) is not the best or right choice for all women, even those with an endometriosis diagnosis.

Doctors who prescribe ERT for women with endometriosis tend to suggest the lowest dose possible. The hope is that the small dose will minimize health risks and eliminate bothersome menopause symptoms such as hot flashes. Other doctors advocate using progesterone or progestin along with any ERT. The theory is that the progesterone/progestin could keep any remaining endometriosis at bay while allowing for the benefits of the ERT. On the other hand, not all doctors will prescribe progesterone/progestin to women without a uterus. Because there is controversy regarding all of these treatment options, each woman will have to work with her medical team to determine what is best for her.

No two women will make the exact same decisions. Each woman should learn all she can so she can make the most informed decision, seeking second opinions as necessary as doctors, too, will have varying opinions based on their own knowledge base. Keeping a symptom diary can help determine if menopausal symptoms are occurring to such a degree that they need treatment, and if adjustments need to be made for endometriosis.

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

04-24-2013 - 11:04 AM


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