Hysterectomy and HRT after

[Endolemon]

Hi ladies,

Can you please ,share your experience about HRT after Hysterectomy with Endo excisions.

I had total Hysterectomy in March and now I have been prescribed by my Consultant:

Evorel patch 25 (twice a week) all month and Utrogestan 100 mg taking only for 2 weeks and after stop it for 2 weeks.

Are you taking Utrogestan with a break like this?

[city]

Hi, I had total hysterectomy in 2022 and was only prescribed Oestrogel, had to wait 10 days after surgery to start it. Am on the max dosage of 4 pumps per day as was getting joint pains . I feel amazing! No progesterone prescribed by my consultant but my GP that took over the prescribing questioned why not. Was told that progesterone was only if you had womb/ovaries remaining, so best to check this out.

[Lindle in reply to city]

For those with a history of endo the recommendation is continuous combined HRT as unopposed oestrogen is associated with endo recurrence and malignancy. What have your oestradiol levels been at your blood tests? I don't want to worry you but I had a huge mass grow under the effects of unopposed oestrogen HRT which was thought to be ovarian cancer on imaging. Fortunately it hadn't reached that point yet but was extremely aggressive post menopausal endo.

[Endolemon in reply to city]

I have been on Prostap after the operation and now my surgeon prescribed me HRT.

I feel very well now but have some menopause symptoms. So decided to try HRT.

Wish you health 💛

[Lindle in reply to Endolemon]

You have said you had your ovaries out so Prostap isn't appropriate as it only works by shutting down the ovaries.

[Lindle]

This is called sequential HRT and is not appropriate with endo. Endo is driven by unopposed oestrogen, meaning oestrogen not balanced by progesterone. The first half of the cycle (the follicular phase) is driven by unopposed oestrogen to enable the follicles to develop and to increase oestrogen levels so that ovulation can occur. Hormone meds that are given to those with endo such as the combined pill or progestins are aimed at balancing (opposing) the oestrogen in the follicular phase.

When it comes to HRT, only giving the progesterone in the latter half of the cycle means you are still on unopposed oestrogen during the first half. This is associated with recurrence or endo and sometimes malignancy. The recommendation is continuous combined HRT.

I have attached a screen shot the ESHRE 2022 guidance on this.

eshre.eu/Guideline/Endometr...

ESHRE HRT guidance

[Endolemon in reply to Lindle]

Thank you for reply. I can’t take combine HRT due to other health condition.

I had my ovaries removed as well.

Just was wondering if you should have Utrogestan for 30 days without breaking.

[Lindle in reply to Endolemon]

Yes utrogestan is recommended for all of the time without breaking as the progesterone component of combined HRT. I'm not sure what you are asking if you can't take it anyway.

[Endolemon in reply to Lindle]

I mean I can’t take combine pills.

I have patches + Utrogestan. Will try to ask his secretary about clarification .

Just wanted to find out what others use after hysterectomy with Endo 💛

[Lindle in reply to Endolemon]

OK if you feel a secretary will know more that the European endo guidance. Sorry I replied but it might be of use to others.

[city in reply to Lindle]

The doctors secretary will pass on the query Lindle, not answer it themselves!!

[Lindle in reply to city]

Pass on to who though? A gynaecologist who suggests sequential HRT for anyone with a history of endo and GnRH agonists for those without ovaries seems very ill informed. It would be very worrying if members on groups like these take such information as accurate and evidence based over the ESHRE guideline based on Cochrane evidence. Obviously individual members can ask questions and take responses how they wish, but there are many others who read these posts for guidance who can be harmed by such inaccurate information.

[Bakewey in reply to Lindle]

I felt compelled to reply to you even though this is an old post.

Long story short: after surgery my constant told me to go to GP for HRT advice. GP got out a book of medicines as he was not sure what to prescribe. Sent me away with Estraderm MX 50 patch and told me to give it a go for a month.

I called my local pharmacist today and he said I should be on combined HRT or Tibolone; adding I should to go to consultant and ask for histology report to ensure I get the right treatment. Consultant’s PA replied advising me to go to a GP and get a referral to a menopause clinic! I then remembered this thread and came back to check the details.

I’m going back to the GP tomorrow armed with screen shots of the guidance! Thank you 🙏

[Endolemon in reply to Bakewey]

Good luck ☘️

Strange that consultant not advised you. Menopause clinic hopefully knows what to do. Only they can tell that you don’t need Utrogestan cos there is no uterus.

I am using Evorel patch 25 and Utrogestan 100 (GP changed it to generic of course). Histology clear.

I feel OK so far 😊Started Pilates for pelvic floor strength 💛

[Bubblepoppy]

Hi I had a hysterectomy in 2022 I'm on tibolone HRT tablets I don't have anything else with it only this, works wonders for my hot flushes and psycho mood swings still get hot flushes only less frequent it helps to keep your bones stronger too I get a bone check every 4 years too with me been put into the menopause fast which is what everyone is supposed to have after a total hysterectomy so Im told.

[Endolemon in reply to Bubblepoppy]

Thank you 🌷my symptoms are hot flashes too and mood swings.

How are you checking your bones? Just a blood test?

I have booked a pelvic floor physio as well 💛

[Bubblepoppy]

Yes it's just a blood test, I also have a awful memory too with it all, I've seen a physio too, I've recently been diagnosed with fibromyalgia as well so can never remember which appointment is for what now haha ❤️ I know they have similar pains just extra with fibromyalgia in my case x