Hi, I had a total hysterectomy three weeks ago for severe endometriosis and adenomyosis. I have been offered oestrogen HRT but I’m reluctant to use it because of the endometriosis and bad reactions to the pill and coil in the past. I am trying herbal remedies and don’t feel too bad.
Can anyone tell me: are my symptoms likely to get worse with time (I am just three weeks post surgery)? Has anyone tried to go without HRT and what has their experience been?
Many thanks
Laura
Hi Laura, I hope my experience and what I was told may help you. I was 48 when I had my full hysterectomy (including my ovaries being removed) and the nearer you are to the natural menopause age the better in terms of fewer menopausal symptoms. It would be good to know if you were close to the natural menopause age.
I was informed due to my surgical menopause any symptoms would be immediate (and I was told this by many medical professionals). I have to date not taken any HRT nor herbal remedies either and have not had any menopausal symptoms. It is now nearly three months since my hysterectomy/surgical menopause.
You do not say which herbal remedies you are taking but be careful taking those in case they cause you to have extra oestrogen in your body. I was warned of the risks of some herbal remedies at the hospital if they increase oestrogen.
For various reasons not all women can take HRT (perhaps there is a history of cancer in their family or they have/have had ovarian or endometrial cancer) and have been told of the risks of HRT. For this reason I was advised to not take HRT but also to not take herbal remedies either. They did say that if my quality of life was awful due to menopausal symptoms then I could see my GP and be prescribed it but it's a weighing up of health risks versus quality of life.
You do not say why you chose to take the herbal remedies. Were you experiencing any menopausal symptoms? My suggestion would be stop taking the herbal remedies and see how you feel. You may not actually need them as I don't. If you do need to take them then take the herbal remedies which do not add oestrogen to your body.
I'm sure other women will provide you with their opinions based on what they have been informed but this has been my experience and what I have been told by my consultant.
Hi SarahThanks so much for your reply. It is really good to hear of other experiences. I am 50 but prior to the operation the consultant told me I was ‘nowhere near menopause’ although I have to say I was not feeling well for sometime before with anxiety, insomnia. My only symptom now is hot flushes at night which keep me awake. I am also quite anxious. I didn’t want to take HRT because of my history of endometriosis. I am wary of putting anything into my system which may trigger the disease or perhaps more importantly, cause depression, which has happened in the past with the pill, coil etc.
I am taking red clover (recommended for hot flushes) and organic female herbal complex. I think theses are both quite gentle and I haven’t noticed any discernible difference after a week of taking them. I think I was trying to be proactive but you raise an important point in that I may not need them. I did tell my surgeon I was taking them. He was sceptical I believe but he had no objection to me continuing. He said after three months he would put me on a small dose of oestrogen if I needed it. I’m hoping I won’t. I think I have been very fearful about what would happen to my mood etc after the surgery. I had severe endometriosis but would not have had the surgery but for the fact they found a fibroid that was suspicious for cancer on the MRI and I was put forward for surgery a week later. It was a big shock and I was unable to prepare for what would come after the surgery. It turns out the fibroid was not malignant thankfully, but the surgeon believes it would eventually have become so, so it is probably a good thing that it was removed. However, I think I am still reeling from it all!
Many thanks again for your help, it is very reassuring to know that you are doing well and not suffering symptoms.
Laura
Hi, sorry you had to gi through hysterectomy for you endometriosis. I had full hysterectomy done a few years ago and tried HRT. The HRT made my endo pains come back so I don't take anything at all I avoid red meat and soya. Since I don't take HRT my endo pains are very less I am able to do things I couldn't do before. However I still am in pain but it's not as bad as before. HRT isn't for everyone. I'm glad I don't take it. I do take vitamin D and calcium every day and drink almond milk and eat lactose free cheese.
Sweety.
Hi Sweety
Many thanks for replying. It’s good to know that there are other options. I’m doing research but that can sometimes add to the confusion! I hope your pain continues to be less troublesome and hopefully will go away altogether.
Best wishes
Laura
Hi Laura
If you are looking at your diet I follow a similar diet to Sweety. I avoid red meat and soya and take Vitamin D and calcium supplements too. I also avoid dairy. I've never particularly been a fan of cheese so that's easy for me to leave from my diet. I see that Sweety drinks almond milk and I too avoid cow's milk and I drink rice milk (use it in my coffee and my porridge). There are many non-dairy milk options available. Almond milk is probably the better of the two however it depends on which you prefer the taste of.
Thank you Sweety for your post sharing your diet.
Hi SarahThanks, I will take a look at diet, particularly the milk as you suggest. I am a vegetarian anyway and have been looking at plant based foods so should be able to avoid cheese to a large extent. Many thanks again
Laura
Hi Laura, I would really recommend replacing your hormones by using HRT as the long-term health benefits are huge. Unfortunately gynaecologists aren’t experts in hormones, menopause or HRT and their knowledge and advice is not up-to-date. If you have a history of endo it is now recommended to take a continuous progesterone (even if you no longer have a uterus) in combination with the oestrogen part of HRT. This helps to keep any remaining endo at bay. Please take a look at all of the evidence based info and podcasts on Dr. Louise Newson’s website called Balance. There’s even info on there about endo and HRT. For any women concerned about HRT risks please visit the website as it’s very informative. Body identical, transdermal oestrogen and an oral capsule called Utrogestan are the gold standard in HRT. Don’t rule out HRT until you’ve got all of the facts as a lot of old information (which was based on a flawed study 20 years ago) is still being quoted by many health professionals as they don’t train in menopause or HRT. A menopause specialist is the best person to see, especially after a surgical menopause.
Hi Nikkky
Thank you. This is the information I had read about but when I broached Bioidentical hormones with the surgeon he said it was all just a gimmick, a marketing thing and there is no evidence to support it. I know this is not true as in other countries they are readily available. He also said I don’t need progesterone because I have no ovaries, again this is a contradiction to what I had understood from my research. It’s very frustrating. I just don’t want to take synthetic hormones and that’s why I chose the herbal route. Obviously he has his opinion but as you say, he is not a hormone expert. I will take a look at the website you suggest.
Many thanks for your help.
Hi Laura, Bioidentical HRT is different to body identical HRT and this leads to much confusion. Bioidentical is unregulated and Body identical HRT is only available on prescription and is actually made from the yam root. It’s very safe. If you look at the Balance website it explains everything. I agree with avoiding the synthetic hormones too. It’s odd that your surgeon said you don’t need progesterone because you have no ovaries as progesterones function is just to keep the lining of the uterus thin and healthy. It’s prescribed if you’ve got a uterus and not prescribed if you haven’t got a uterus as it’s thought that it’s not needed. It’s not based on whether you’ve got ovaries or not as you could have ovaries and no uterus but you’d still need a progesterone to keep the uterus lining healthy. More recently the progesterone part of HRT has been recommended for women with a history of endo, even when they’ve had their uterus removed (as it can’t be certain that all endo has been removed).
I had a hysterectomy and one ovary removed 5 years ago due to endo and adenomyosis. I wasn’t offered any HRT and Menopause wasn’t discussed. I struggled on for 3 years not actually knowing that my joint pains, headaches, itchy skin, low mood and general lack of interest and motivation was caused by menopause. Then the severe mood swings, irritability and insomnia came. I didn’t get hot flushes so was told I was not menopausal when I consulted my g.p. Then my hormones suddenly crashed and severe anxiety, palpitations, insomnia and depression arrived. Horrendous. HRT has honestly saved my life and I’d advise every woman to take it if they can. It is known to help protect us against heart disease, dementia, diabetes and osteoporosis too.
Hi Nikkky, thank you for explaining. It does certainly make me think again about HRT because of my history of depression and fibromyalgia. Can I ask who was it who finally prescribed HRT for you? Was it your GP or did you have to seek help privately?Many thanks
Laura
Hi Laura. My g.p prescribed the oestrogen and progesterone but I’ve had to see a private menopause specialist in order to get a higher dose of oestrogen prescribed. I’ve recently started on testosterone replacement too as that is an important hormone for energy, mood and cognitive function. It’s not often prescribed on the NHS. G.p’s don’t do mandatory training in menopause or HRT so it can be a real battle. Best to do your homework and tell the g.p what you want. Best of luck with it!
Thanks Nikkky, you’ve been really helpful. I will start with the GP and go from there. Hopefully I will get lucky! All the best
Laura
Hi Nikkky, do you mind me asking your age when you had the hysterectomy? I’m just putting some notes together from the information i’ve received on here and wanted to see if there was any correlation between age at surgery and the severity of symptoms. Many thanks
Laura
Hi Laura, I was 40 when I had my hysterectomy.
Hi Nikkky, thanks. My surgeon said because I was so close to menopause I wouldn’t need HRT; however, over the last week I have started to feel quite poorly: hot flushes, permanent headache and today I have woken up with pain and stiffness in my joints. I expect this sounds familiar to a lot of people but none of the medics have warned me about this. What a nightmare!
Hi Laura. I wasn’t offered HRT, it wasn’t mentioned at all, even though I was only 40. I’m sorry but your surgeon is wrong-I’m not surprised at his advice though because they’re just not trained in menopause and HRT. We need oestrogen to feel well (physically and mentally) as it’s in every cell in our body. After a surgical menopause you’re not producing any, hence why you are starting with symptoms. Being deficient in oestrogen affects our bones, brain, heart, eyes, bladder, vagina- every organ. Women who have been through a natural menopause still produce hormones just at a lower level. Why do doctors think it’s ‘natural’ to spend possibly half of our lives without essential hormones and expect us to put up with the suffering? Honestly, I wish I’d known what a I know now about menopause. Replacement of oestrogen is so important and you might need testosterone replacement too. I found out the hard way as I was completely floored by menopause symptoms. The severe anxiety, constant heart palpitations, insomnia and depression have been the most debilitating and I don’t want other women to suffer when the answer is so simple- replace the hormones! We wouldn’t be expected to live without other hormones such as thyroxin if we had an under active thyroid. HRT isn’t a drug it’s just replacing hormones we would usually be producing naturally. Don’t put up with the symptoms. You deserve to feel well x
Hi Nikkky, you’re right, regardless of what course I take they shouldn’t have left me flailing around like this. If it hadn’t been such a rush to do the op because of the possibility of cancer, I would have sorted all this beforehand. As it was I was railroaded into it and told everything will be okay, which of course it isn’t and won’t be if we just ignore it. I’m very concerned about my mental health and cannot function like this. I will try to see my GP and if they won’t help, I will have to seek help privately again. I’ll keep you posted but really, many thanks for sharing your experience on here. It makes a huge difference to know that there are people out there who understand, depressing as it is to know that this kind of treatment is commonplace in 2022. Nothing changes does it! x
I know, it’s disgraceful that it is commonplace Laura. Sometimes I blame myself for not asking the right questions before my op and not researching more but I wasn’t well and was so focused on hopefully finally getting rid the endometriosis and adenomyosis. I did think about menopause happening but actually thought I’d feel better- how wrong I was. Nobody tells you that you’re going to feel very ill when your hormones suddenly fall off a cliff. I have to remind myself that it’s not my fault, I was the patient and should have been given all of the information by the ‘expert’ health professional. It wasn’t for you to sort out either, you were let down by your consultant. My mental symptoms have been horrific and terrifying. I thought I was losing my mind and not one g.p realised it was menopause. Please ask for HRT but make sure you get separate oestrogen and the progesterone called Utrogestan as they’re the gold standard in HRT and body identical. It’s worth checking out the NICE guidelines on HRT too as your g.p can’t refuse to prescribe you HRT. You don’t need blood tests as they have to go on menopausal symptoms and you’ve have had a hysterectomy anyway so definitely menopausal. Keep me posted and best wishes. You will feel better soon so hang on in there x
Thank you, Nikkky, that is so helpful. I will do that and let you know how I get on. I’m so pleased I joined this forum, I’d be desperate otherwise! X
Hi Nikkky, you weren't offered HRT after your op because you were left with one ovary. That is what the surgeon said to me that the one ovary would do the job for both! Not realising that my symptoms are menopausal and haven't been offered any HRT. But I must say I am still not understanding why I need to add more oestrogen to the mix when I am over producing it. I think that is why they keep telling me that I am not menopausal yet. I do know now that they should have given me progesterone at least, to counteract the excess oestrogen but also to slow down any regrowth of the endo. Now I have 2 new endometriomas and I am having problems with my bowels and bladder I think too. I know you have explained why I need oestrogen too but if I was oestrogen dominant before the hysterectomy (that is why I was growing an endometrioma and the endo to begin with) then how is not adding more oestrogen again not going to make the endo worse even if I take progesterone also? Because when I still had my womb, I was still producing too much oestrogen that led to the endo... I don't understand this. I don't want to make the wrong decision again with regards to HRT and re-flaming the endo. Should I not take progesterone only to balance the excess oestrogen? I know you say and the gyne/endo specialist has also said that it is the oestrogen that will improve my cognitive dysfunction but before the hysterectomy when my cognitive function was better and I had no menopausal symptoms like I do now, the oestrogen was high like it is now and I still had my natural progesterone from the womb. Doesn't it make sense to keep the oestrogen levels as they are (naturally high) but add the progesterone back in?? To level things out? Although perhaps my progesterone might have already been lower before the op due to the fibroid in the womb? That would explain why I was oestrogen dominant. I was offered cyclical progesterone (a few days around my cycle) rather than continuously. That is probably the first mistake my GP made when trying to address the ovarian endometrioma. This progesterone didn't make much difference to the growth of the cyst. I wish I had been offered a continuous oral dose instead of a vaginal capsule for a few days in the cycled 
That might have prevented the hysterectomy...
Hi. Yes, they don’t tell you that your ovary will fail within 5 years of a hysterectomy because it shares blood vessels with the uterus. Removing the uterus reduces the blood supply to the ovaries, so they can start shutting down within weeks of surgery in some women. You can have a gradual failure of the ovaries and gradual reduction in oestrogen or a sudden failure. We’ve only got the one ovary left to rely on so it's even worse for us. Menopause is an oestrogen deficiency (that’s what causes menopausal symptoms) so if you are menopausal (and you are definitely either peri-menopausal or post menopausal) you won’t be consistently over producing oestrogen. If you had a naturally high oestrogen level you wouldn’t have menopause symptoms, it’s as simple as that! Your oestrogen production will be low (or fluctuating between high and low if you’re peri-menopausal) but your progesterone will be even lower. Progesterone is the first of our hormones to slow down production long before menopause. You can have an oestrogen level that is low but still have oestrogen dominance as your oestrogen can be low and not balanced with your progesterone. You could take continuous progesterone alone but that won’t reduce or resolve your menopause symptoms. Oestrogen HRT is needed to treat menopause symptoms and continuous progesterone HRT will help prevent the oestrogen from stimulating any endo. If your blood results are showing a high oestrogen level then it’s because you’ve had a brief spike in oestrogen at the time of your blood test. That’s what happens in peri-menopause (leading up to menopause) as your ovary is gradually shutting down but erratically still trying to chuck out some oestrogen. Blood tests are unreliable during this time as oestrogen levels are constantly fluctuating. HRT is helpful to top up your oestrogen level so you avoid these big dips in oestrogen and the menopause symptoms that are caused by this. Have you had blood drawn and been told your actual oestrogen level? Not that it’s reliable if you’re peri-menopausal but many women get told based on blood tests that they’re not menopausal when they are. Most health professionals don’t have a clue what our oestrogen levels should be anyway!
Hi Laura, have you thought about taking glucosamine with chondroitin (the high strength one from Holland & Barret definitely works) to help with your joints. Also, I've just ordered some collagen. Also on an earlier discussion in this thread Vitamin D was recommended but please be aware if you decide to take Vitamin D you will also need to take Vitmain K2 as well.
Of course the glucosamine with chondroitin will not help with your hot flushes only with your joints.
Nikkky you are correct about the importance of HRT for bone, heart health. Ovaries removed due to ruptured cysts. Womb removed couple years later as I was still suffering heavy bleeding. Not given HRT straight away. I suffered terribly with hot flushes, insomnia & depression. Breast cancer in the family so I was reluctant. After having a bone density scan the results showed bone thinning due to lack of hormones.xx
I do hope you’re feeling well now. I am a bit worried about my bone density and debating whether to have a scan. I wasn’t sure about HRT either as I have breast cancer in my family but I didn’t know much about HRT. On researching it I was reassured that I was doing the right thing. I’ve had no quality of life for years due to endometriosis, adenomyosis and then debilitating menopause symptoms, so HRT has been the right choice for me. I just wish we were educated on all of this when we were younger as it would have been a big help and prepared us.
Aww so sorry to hear about your health issues & I do hope for better days ahead. My Gynae insisted I take it as I was in my mid 30s when my second ovary was removed & he was concerned. I can't have steroid injections to help with pain due to the bone thinning. After 7 abdominal surguries I am still in chronic pain. They won't go into operate anymore as every time it takes longer to get through the scar tissue. I am sick of justifying it to some. Who would want to be in pain! Stay safe Hun x
Oh dear, I do feel fo you. I don’t think anyone can understand what it’s like to be in pain all of the time. Some of my pain returned after hysterectomy and they say it’s more scar tissue. I think it is (as I’ve had scar tissue found it’s each op) but I had a return of bowel endo symptoms after being put on oestrogen only HRT. Are you on progesterone HRT too? It’s needed if you have a history of endo even if you don’t have a uterus.
Too be honest I'm not sure. It's Estradiol 1mg. At first it was the gel. Adhesions have been a problem since my first op in the 90s. I've been passed from pillar to post over the years & they have had me on everything. So much was stuck there is probably remnants. I had another bone density scan in Oct but no idea of results because can't get through to anyone. The person who asked for the scan now wants me to stop the HRT but again Im not sure when the follow up is with Covid & overworked staff. I thought the HRT was "feeding it" for won't if a better expression but as I say I had to take it. You will have pain with adhesions & I'm sorry you are experiencing that after your op. Thinking of you & thanks for the info on the HRT. Excellent x
It’s a nightmare as the medical professionals are not trained in menopause or HRT and as you’ll already know they’re not very knowledgeable on endo etc either. I really wouldn’t stop the HRT as you’ll end up with other problems. Estradiol and the gel is oestrogen only HRT and that will be helping with bone loss so you need it. You just need to ask your g.p for an oral, body identical progesterone called Utrogestan (to keep any endo from flaring up from the oestrogen) as this could be adding to your pain. It’s the only non-synthetic progesterone and you take 100mg every night. It’s very safe. As I mentioned earlier it is now recommended for women who have a history of endo but a lot of g.p’s and gynaecologists won’t be up-to-date. Take a look at Dr Louise Newson’s website called Balance. It has info & a podcast re: endo & HRT. It’s excellent for all info on menopause.
Nikkky thank you so much for this info. I was discharged from Gynae (said they couldn't do anything else). I have a video appointment with Chemical Pathology in a week's time. They requested lots of blood tests. She was the lady who was saying about stopping the HRT. I am going to discuss your suggestions with her if the link works this time. Thanks againg your help is greatly appreciated. Stay safe 🙂
Best of luck with your appointment. Use the Balance website and make some notes in preparation. It’ll give you the confidence to question things and not necessarily agree to whatever she suggests. If she’s approachable and you suggest staying on the oestrogen HRT (because of the huge long-term health benefits such as protecting from osteoporosis) and taking a progesterone called Utrogestan, she might be very receptive. Especially if you discuss that you’ve researched the latest guidance and explain the theory behind it. It’s actually better for your health to stay on the oestrogen and add in the progesterone rather than stop the oestrogen. I hope it goes well x
Brilliant advice. I can't thank you enough for taking the time to respond and your comprehensive explanations.x
Nikkky, do you know anything about the 3 types of Oestrogen? Apparently E1 is Estrone then E2 is the Estradiol which is high in endo and E3 is Estriol and it is the protective one which is the one we need prescribed. I produce all 3 in high doses. My nutritionist says not to add anymore estrogen but she also says the problem is not really that I am producing them in high doses but that my body is not disposing of them using the right detox route. We are working on aiding my liver to detoxify it using the safest route. My oestrogen in the blood are high because they keep recirculating... Have you ever come across this explanation for oestrogen dominance? she also says that body lotions, face creams, anything we put on our skin causes an excess of oestrogen and that we must avoid chemical lotions and detergents etc and try and increase phytoestrogens which are organic soy, flaxseeds and chai seeds, pulses like lentils etc...
Like I mentioned in my last reply. If you had high oestrogen levels you wouldn’t have any menopause symptoms. Has she actually drawn any blood and told you the number/level of your oestrogen? Unfortunately none of these practitioners are fully trained in regard to hormones. They are also very limited in the tests and treatments they can provide so they make everything fit within their scope of practice. For example, they can’t prescribe oestrogen but can sell non-regulated, bio identical progesterone so they tend to persuade women that this is what they need. They also up-sell by offering further non-medical and unreliable tests plus supplements. Our livers detox our blood perfectly well anyway! Sorry, but it’s all a con to make money out of desperate, menopausal women x
Hi Nikkky, I was prescribed by a functional doctor BHRT Bioidentical progesterone only because my levels of oestrogen are really high yet I have menopausal symptoms i.e. severe brain fog, memory and concentrations issues, anxiety. I had one ovary and womb removed (total hysterectomy) in 2019 and have not had hot flushes. Some night sweats. I've had palpitations and panic attacks and dizziness/vertigo. So GP says I am not menopausal (go figure) My Gyne/endo specialist is looking to putting me on HRT with progesterone but I am a bit concerned about the oestrogen part of it as I also have endo which was discovered during the hysterectomy and a new endometrioma in the healthy ovary they left behind plus adhesions etc I am not keen on going back to the functional doctor who prescribed the BHRT progesterone cream as it cost me £99 for a small bottle and I haven't noticed any improvements... Should I consider normal HRT with progesterone so that I can regain my cognitive function? I am so concerned as it feels like dementia
Hi there, sorry I haven’t replied sooner and sorry to hear you’re struggling. You are definitely menopausal and the symptoms you describe are typical of low oestrogen. I was similar in that I was told I wasn’t menopausal and just believed my gynae consultant. She did blood tests and said my oestrogen was high. You say your oestrogen levels are really high but they can’t be with your symptoms and the fact you’ve had your uterus and ovary removed. If you’ve had blood tests that show high oestrogen it will no doubt have been a very temporary spike in oestrogen and not a true picture of your oestrogen level. Oestrogen levels become very erratic and therefore blood tests are unreliable and a waste of time. They are supposed to go on symptoms alone. Nobody told me that if you have your uterus removed and keep both ovaries you go into menopause within 5 years because the blood supply to the ovaries is reduced. We only have one ovary left so that can quickly start to shut down after the surgery. Looking back I started with menopause symptoms a few weeks after my op but it just wasn’t on my radar. One thing I’ve learned from this is that we have to direct our own health care. It is so wrong and hard to do but it’s the only way to get anywhere with health professionals. You definitely need to start HRT as soon as possible. Please ask your g.p for HRT -separate oestrogen patches or gel plus an oral progesterone capsule called Utrogestan. These are body identical and regulated, unlike the bio identical progesterone you’ve already tried. Don’t let the g.p prescribe you a combined patch or tablet as these contain synthetic progesterone and that’s where the risks are. If you go for body identical HRT prescribed by your g.p you are on the best and safest HRT available. Remember you are just replacing the hormones that you would ordinarily be producing naturally. Prepare for your appointment: visit the Balance-menopause website and search for the symptom questionnaire so you can take it along to your appointment. Also, check out the podcast on there about HRT and endo. Print off some of their article so you can challenge the g.p with facts if needed. You will gradually start to feel better once you get some oestrogen into your system. The effect of low oestrogen on our brain function is awful and scary. Best of luck and sorry for my long post! x
Hi Nikkky, you didn't take long to post at all! I am so grateful for all that advice. You sound so well informed. Both the functional doctor and the nutritionist have said that all my symptoms can also be due to high oestrogen levels that is why I am so confused and concerned about adding more oestrogen to the mix as endo and endometriomas are fed by excess oestrogen. According to the Dutch test, my body recirculates oestrogen and doesn't get rid of it that is why the levels are high (apparently) The lab suggested I did a mould test as the only other time when they see high oestrogens in patients is when there is a mould infection so I am taking supplements to try and clean that up but they make my IBS worse so I don't know if it's working or if it's a gimmick... It's cost me so much money on supplements and testing and I think I've had enough of that. I'm not prepared to retest to see if it's gone as it's never ending... The thing is also is that before the hysterectomy I was already struggling a little with memory issues but nothing close to how bad it is now. I suppose I might have had pre menopausal brain fog if my ovary was already not working properly with the massive cyst in it and the endo... but there is such a thing as oestrogen dominance and the symptoms are very similar to the menopause so it could still be oestrogen dominance before surgery and now?? I could ask the menopause society if someone could still go through the menopause with high oestrogen levels from the endo?? These oestrogens could very well be masking the menopause, couldn't they? As otherwise, people with endo would never go through the menopause! Endometriosis produces high levels of oestrogens that is why people on HRT can experience a recurrence of it. What do you think??
Hi again, I understand how complicated and confusing it all is. There’s so much incorrect and conflicting information out there. Unfortunately lots of people are making money out of menopausal women who are really suffering and desperate to feel better. The practitioners who are not medically qualified and not qualified to prescribe regulated medications cannot provide blood tests or prescribe body-identical HRT. Instead they offer non-regulated, bio-identical progesterone cream, non-medical tests, herbal remedies etc, etc. As far as I understand the Dutch test is a urine test and not of any use. Blood tests to check the level of hormones actually circulating in the bloodstream are more helpful, apart from the issue of oestrogen fluctuating dramatically during peri-menopause. A g.p surgery can provide these, although you have to be able to interpret the results yourself as most g.p’s are useless when it comes to hormones!
There’s one thing for sure and that is that you will not be producing enough oestrogen. Oestrogen dominance gets mentioned a lot and I thought was oestrogen dominant for years with me having endo and adenomyosis. Although it was never fully explained, with knowing endo is stimulated by oestrogen and with my oestrogen production being switched off with medication, I was led to believe that oestrogen was my problem. I actually thought menopause would bring some much needed relief. I was wrong and I understand it much better. It’s all about hormonal balance and that is the key to good health and feeling well. You might have ‘oestrogen dominance’ but that doesn’t mean you are not menopausal or are producing too much oestrogen. In fact your oestrogen level might be really low, it’s just that your oestrogen is higher and out of balance with your progesterone and possibly testosterone. Oestrogen doesn’t cause endo it’s more that the other hormones are too low to counteract it’s affects. Progesterone and testosterone production naturally slows down years before our oestrogen does. So basically, you do need more oestrogen but you also need progesterone and possibly testosterone to bring everything to reasonable levels and balanced. Taking a daily progesterone capsule called Utrogestan will keep any endo from flaring up. It is controlling my bowel endo symptoms despite me being on oestrogen too. Surprisingly, oestrogen is actually anti-inflammatory.
Your symptoms are symptoms of low hormones and because you’ve had a hysterectomy and ovary removed you’ve got a hormone deficiency that you’ll have forever if you don’t replenish your levels with HRT. HRT reduces the risk of diseases such as dementia, heart disease, osteoporosis and diabetes. Please look at the balance-menopause website as it contains evidence-based information. Then contact your g.p for oestrogen patches or gel and tell them that with a history of endo it’s now recommended to take progesterone. Utrogestan is the only body-identical progesterone on the market. You don’t need blood tests as you’ve had a hysterectomy and got menopause symptoms. HRT is a journey and it can take some switching of brands and preparations, plus gradual increases in oestrogen dose. I definitely felt some subtle improvements on day 3 of starting HRT. Hopefully you’ll feel the benefits very soon and you’ll wonder why you didn’t start HRT sooner. I wish I had! x
Wow, you sound like an expert!! Thank you so much. I downloaded the app as soon as you told me and have the health report ready to show my GP on Monday at my appointment. I have written down Utrogestan to make sure she prescribes that one! Do I also need testosterone? Will I not start having issues with growing facial hair etc?? I'm scared! God bless you!!!
The Balance App is great but check out their website too as it has lots more articles and podcasts: balance-menopause.com
I hope your g.p is knowledgeable about menopause and HRT but if not just ask for either 50mcg oestrogen patches or oestrogen gel-starting on 2 pumps of gel a day. Have a think about whether you’d prefer to stick an oestrogen patch on twice a week or rub some oestrogen gel into your skin each day (it’s down to personal preference and whichever method works for you). Then say that despite not having a uterus you do need a progesterone to control your endometriosis and would like 100mg oral capsules called Utrogestan. You’ll take one Utrogestan capsule every evening.
It’s generally recommended to optimise your oestrogen levels before adding in Testosterone. You could ask your g.p if they would be able to prescribe it at a later date though. It’s worth having a blood test to check your testosterone level. Some g.p’s will not prescribe it (usually because they are not knowledgeable and see it as a male hormone) and it can also be a postcode lottery. On the NHS it’s not available for women in a lot of areas, it just depends on your local health authority. There isn’t actually a testosterone preparation for women (only for men!) although some g.p’s will agree to prescribe off license and you just use much less of the men’s preparation. They are gels and you usually rub a pea sized blob into your skin each day. Honestly, don’t worry about growing facial hair etc as women only use a tiny amount and once your oestrogen levels are sorted you’ll be fine. You’ll have blood tests to monitor your testosterone level anyway to make sure you stay within the normal female range.
Best of luck with your appointment x
I had my testesterone tested when I had the Dutch test earlier this year and it was within the normal female range... I am taking a note of all that you have said! Thank you so much for the private consultation! I feel like that also, that we have to be our own doctors. It's not right. You've been a huge blessing. Thank you Nikkky x
Not wishing to sound rude - but you are sounding like a spokeswoman for Newson Health to be honest! It's nice to try to help other women but every woman's situation is individual and should be discussed with her own health professionals - the very people who know her medical history.
Why say that you don’t wish to sound rude when that’s exactly how you mean to sound! It’s not a helpful comment.
Have you considered that women wouldn’t need to be on here desperately seeking help if their health professionals were providing them with a good level of care. You might be fortunate when it comes to healthcare but a lot of women aren’t. I’ve never seen a health professional yet who has spent time reading through my medical history prior to my appointment or carried out an in-depth consultation. Partly because they do not have sufficient time. I’ve also had incorrect advice, incorrect diagnoses and unnecessary tests and surgeries over the years, which has lead to further pain and suffering. I will try and help other women if I can as I don’t want them to suffer like I have.
When it comes to menopause and HRT our health professionals do not do mandatory training, therefore we are left to educate ourselves and that isn’t easy with all of the out-of-date and conflicting information online. I don’t actually recall mentioning Newson Health as such but I do recommend the balance-menopause website as it has a wealth of up-to-date, evidence-based information and is the best online resource I have found. It’s simply a free, informative resource.
You've described what's happened to me! So you are now back to normal? I have been suffering with all those symptoms plus the memory issues and severe brain fog, not being able to concentrate and focus or learn anything new, forgetting names and faces, feeling disoriented and confused. I have been to see my GP about these and she says it's just because I have so much on my mind with 4 kids and work etc but I can't even function at work and I am not with it at all. It's so concerning. I even asked for brain scan to see if it's early dementia but nothing showed up last year when I had one. Even my hearing loss got worse and severe episodes of loud tinnitus for no reason and I had my first episode of Meniere's 6 months post surgery. I wonder if that was hormonal also... So you have recovered completely from all the symptoms you described after beginning HRT?? You are giving me so much hope and I really can't wait to start. And your endo is behaving itself on HRT?? Did it come back without progesterone? Mine has. New endometrioma both in the ovary they left behind and on it. Is your ovary free from cysts? My surgery was nearly 4 years ago Hope all these issues are reversible once I start on HRT. Are they following you up with ultrasounds etc to make sure the HRT is not causing new issues?? I'm concerned about breast cancer and endometrial or ovarian cancer. If endo is fed by oestrogen. So are all these cancers that are hormone related. It is so complicated, isn't it??
You’re very welcome. I’ve been through hell and don’t want any other women to suffer. All of those symptoms you’ve mentioned including the tinnitus and dizziness are caused by low hormones. I’ve had both (still got tinnitus) and the forgetfulness, confusion, poor concentration. I had no idea Menopause affects our brain so badly. My op was 5 1/2 years ago and I struggled on for 4 years. Then one day last year I suddenly couldn’t function at all. It completely floored me physically and mentally, I thought I was having some sort of breakdown and felt like I was dying. It was terrifying. I’ve since learnt that we have oestrogen in every cell in our body and it’s needed for our organs to function properly. We even need oestrogen to make brain chemicals, such as dopamine and serotonin, which is why menopause can cause anxiety, depression and brain fog. Oestrogen doesn’t cause cancer. If a woman already has a female cancer that is oestrogen receptive then oestrogen can affect it but it doesn’t actually cause it. There’s a lot of incorrect scaremongering about risks with HRT. There was a flawed study 20 years ago that made claims of HRT causing cancer but they got it wrong and have since apologised. Unfortunately that misinformation is still believed today, even by some doctors. That study wasn’t even based on the body identical HRT we use today. Consider this- if oestrogen causes cancer why aren’t there lots of women in their teens and 20’s (when oestrogen levels are at their highest) with breast, ovarian or uterine cancers? The truth is that it’s mostly found in women who are 50 and over and their oestrogen is low due to menopause.
You will need blood tests to check your testosterone level. You need your total testosterone level and your Sex Hormone Binding Globulin (SHBG) level. With these 2 results you can work out your Free Androgen Index, which is the level of free testosterone that is actually available for your body to use. The Free Androgen Index is the important one and it ideally needs to be between 2 & 3.
I was put on oestrogen only HRT last year and my bowel endo quickly flared up. I found out that I needed progesterone too and it has been fine since starting that. I have pain where my ovary was removed but it could be adhesions. I haven’t had scans or anything to check but my pain has improved anyway since starting on HRT.
I haven’t got rid of all menopause symptoms yet as unfortunately I don’t absorb any HRT through my skin. I can only take oestrogen tablets and I don’t absorb them fully either as my oestrogen level is still too low. I’m definitely better than I was though and I know I wouldn’t be alive if it wasn’t for starting HRT. I’m waiting for oestrogen and testosterone implants as that’s my only option now but I have to go private. The NHS stopped providing them about 10 years ago. Menopause care is dreadful as none of them have had mandatory training in menopause or HRT x
So those blood tests for testosterone are private too?
No, my g.p agreed to do them but even though my testosterone was just about non-existent she couldn’t prescribe me testosterone on the NHS. It’s so wrong. Some g.p’s can prescribe it so it’s worth asking. I’d get your oestrogen and progesterone HRT sorted out first and then tackle the testosterone. Best of luck x
Should I try progesterone only first? Can't believe I wasn't prescribed it after surgery to prevent the growth of the new cysts and endo spreading... doctor said I shouldn't have any more endo with my womb taken out which is not accurate... I'm thinking that if it's about the imbalance between oestrogen and progesterone, then progesterone only at first might counteract the excess oestrogen before adding any more oestrogen?
Gynaecologist’s don’t even train in hormones or menopause- it’s terrible. You’ll need the oestrogen replacement too as it’s low oestrogen that is causing your symptoms. As long as you take the progesterone you’ll be fine with the oestrogen. Honestly, once you get some oestrogen into your system you’ll notice a difference in your brain function. It’s bizarre how low oestrogen makes you feel like you’re going crazy. It’s a horrible feeling and nobody understands unless they’ve experienced it. I feel much more stable mentally since starting the oestrogen. I just need a bit more oestrogen plus some testosterone. The testosterone can help with low mood and energy x
and all because of our surgeries and the surgical menopause... how frustrating... I feel the way you felt, like I'm having a nervous breakdown, l feel isolated and alone and no one understands how awful I feel although my faith keeps me afloat and full of hope. Don't know where I'd be without God holding my hand. Wishing you the best with the implants and getting your old self back 
How low is your Oestrogen now?? You say you are not absorbing it well orally or through the skin. How do you know this? My hormone levels last Feb were: FSH 9.32iU/L; LH 10.80IU/L; Oestradiol 707.00pmol/L. My progesterone was below minimum at 2.2ng/mL. Testosterone within normal range. Is the GP able to check progesterone levels with a blood test??
My oestradiol level didn’t increase at all when I was using oestradiol gel and patches. My testosterone level hasn’t increased on testosterone gel either. On high dose oestradiol tablets my level is still below 400 pmol/L. Apparently it needs to be between 400-600 for bone protection. Some women need consistent levels of 1000 or more to get rid of menopause symptoms, particularly the anxiety and depression menopause symptoms. It sounds like you might still be peri-menopausal rather than post-menopausal but a level of 700 isn’t extremely high and you won’t be at that level all of the time anyway. You will be going higher and lower than that. Health professionals are guided to go on symptoms alone, rather than blood tests with them being so unreliable. However, blood tests are helpful to check oestrogen levels whilst on transdermal HRT.
ah... I didn't know that.... do you think that the endometriomas that have been growing now could reverse when I go on HRT with progesterone?? That would be amazing because I really don't want a second surgery to remove the other ovary and endometriomas. Is your one ovary still healthy with no endometriomas? That would be a blessing!
Yes, it could certainly help with your existing endo. If you consider the affects of each hormone: Oestrogen thickens the uterine lining in preparation for a pregnancy and progesterone thins the lining again, keeping it healthy. Endo is tissue that is normally found in the uterus but is growing outside of the uterus (where it shouldn’t be). Basically progesterone counteracts the stimulating action of oestrogen on the endo tissue.
You need oestrogen HRT to control your menopause symptoms and protect you from future diseases such as osteoporosis and dementia but you also need the progesterone to stop the oestrogen stimulating the endo. You need to take the progesterone daily.
I haven’t had a scan or any further surgery since my hysterectomy but all I know is that I don’t have pain on the side where my remaining ovary is. Also, soon after my surgery I started with stabbing pain again on my left side (where my ovary had been removed). I was told by the gynae consultant that it would be adhesions and there was nothing they could do. The pain continued to get worse over the next few years and was going into my back, hip and leg. I wondered if they’d left some ovarian tissue behind when removing my ovary, as it was removed due to being stuck to my pelvic wall. My thinking was that the endo had not been fully removed and had flared up again. I couldn’t get it investigated as I was fobbed off and patronised by the gynae consultant. She just said “it can’t be your ovary causing the pain because it’s been removed” and insisted it was bowel pain. It wasn’t bowel pain.
All I can reassure you with is that the pain in my left side has improved a hell of a lot on the HRT. I no longer need to take any pain relief for it. It’s more of a milder, niggling, pulling pain but I think there could be adhesions causing that. I might get it investigated in future but right now the menopause symptoms are the bothersome symptoms, so I’m trying to get my oestrogen and testosterone levels up. I couldn’t function at all for 4 months before starting HRT so at least I’ve improved. Plus, I’ve had enough of seeing gynae consultants who aren’t knowledgeable on endo and are so patronising and dismissive.
You could have a 3 month trial of HRT (remember to have separate oestrogen and progesterone as they’re body identical) and see how you get on. If it does cause problems you can always stop it and it would soon be out of your system.
Sounds like you are on the right path Nikkky! Well done. It must have been an exhausting journey for you. I'll keep you in my prayers. I'll let you know how I get on! I am getting more and more skeptical about the functional nutrition treatments and diagnoses. I will try HRT. I haven't received any forms from the gyne whom I had a phone appointment with last week. I made an appointment with the GP and I thought it was going to be this Monday gone but it is next Monday so I have to keep waiting. Got my notes ready so I can ask her for the right progesterone and oestrogen. Is there an oestrogen that is body identical also? Or do I just take any oestrogen brand that is a 50mcg patch or gel? And have you ever tried GnRH agonists such as zoladex to shut down the remaining ovary? I wonder if I need that also to avoid a second surgery to remove it...
Correction there as I meant to say - If you have no ovaries but still have a uterus you’d still need progesterone to protect the uterus
Hi Nikkky
You are clearly very well informed on this subject. My comment above was in relation to women who have a risk of a hormone related cancer as it may be better to not take HRT. In your response above you say you’d advise every woman to take HRT if they can.
I have looked on Dr Louise Newson’s website but cannot see what she recommends for women who have hormone related cancers such as ovarian cancer and endometrial cancer (I have both cancers). The advice I have received from my consultant and the Macmillan nurses is to avoid HRT if I can unless my quality of life is awful and then it’s a case of weighing up the risk of taking the HRT. I of course wish to avoid recurrences of my cancers and this is my reasoning for choosing not to take HRT but I would be very grateful to hear your thoughts on this.
I can of course see the benefits of HRT however weighed up against the risk of my cancers returning I believed it best to not take HRT but I am always open to hearing the latest guidance and research on the topic.
Thank you for any guidance you could kindly offer.
Hi Sarah,Sorry to hear what you are going through and I do understand your concerns. I’m no expert, it’s just that I’ve had to do my own research after receiving incorrect advice from g.p’s and my gynaecologist, which resulted in me getting very ill. I only look at evidence-based information from reliable sources as there’s so much misinformation out there. One thing to bear in mind about health care professionals is that they are ‘experts’ in their particular field but lack knowledge and training in other areas. I wrongly assumed that gynaecologists would be experts in hormones but they actually only deal with our reproductive organs and not hormones.
On the Balance website there are some interesting podcasts and articles about hormone sensitive cancers and HRT. Have your biopsies confirmed that your cancer is oestrogen sensitive? Hopefully you can find the podcasts etc as it might help you to make an informed decision. It’s all about making the right choice for you to give you the best quality of life possible.
Hi Lauramw (sorry just realized I addressed Sarah in my reply instead of you)
I am sorry you are going through what you are going through. I am 40 years old and had a total hysterectomy and oophorectomy in July 2021. 6 months post surgery, I have never felt better in years!! I am not taking any HRTs. I cant as I am at high risk for breast cancer (family history). I started taking many supplements as prescribed by my Doc and currently taking a multivitamin, calcium, Vit D, collagen, joint support, omega 3, CoQ10 plus evening primrose, all once a day or atleast every other day. I was gradually hit with symptoms one by one. 1st hair fall and sleep issues, then eyesight, then knee pain. I try to watch what I eat, mostly natural organic, gluten free, dairy free stuff 80%-85% of the times with tons of veggies and good quality proteins. I started working out 3 months post-op, gradually increasing intensity, have added weights now as well as prescribed by my doc. I feel the symptoms I experience are a small price to pay for the relief I have gotten. And I am hoping that they will get better with the exercise and supplements. Feels like the best decision so far!! 🙏🏻🙏🏻
how do you feel so good? I did to for the first 6 months post surgery. They removed one ovary because it had a cyst in it and it turned out to be an endometrioma and discovered endometriosis which surgeon tried to scrape off. They removed the womb and cervix also. 8 months post surgery my IBS and some pain returned so I asked for a follow up ultrasound and they discovered a new cyst in the healthy ovary. It's an endometrioma also. I don't want another surgery because there are adhesions to the bowel now and another smaller cyst on the ovary as well as the bigger on in the ovary. I am also suffering from very distressing memory loss and I can't seem to learn or remember new information. I get confused at work and I don't remember names which is so frustrating. I think this might be menopausal symptoms but my oestrogen levels are sky high possibly because of the endo. I don't know how to address these memory problems. I take lots of vitamins and supplements and have a healthy vegetarian dairy free gluten free diet. Oh and I developed a pulmonary embolism 6 days post surgery also and I am sure it was because of the endo they scraped. Plus due to the fact that they discharged me without anticoagulants to take home. So I am not on Apixaban for life and I truly regret that hysterectomy. If they had given me the option of a hormonal treatment or scanned me to tell me the cyst was an endometrioma rather than a possible cancerous growth, I would have not agreed to that surgery... I am worst off for sure and I don't know where to go for advice or help. The gyne/endo expert doesn't sound very keen on HRT because of the endo and the risk for blood clots but these memory issues are really getting me down as I feel like my life is over and that I am 80 years old when I am only 48.
Total hysterectomy - resentful 
Hrt after hysterectomy 
HRT post hysterectomy
How long do you take hrt after total hysterectomy?
Hysterectomy done now the HRT decision
