Related Topics: Advice, Bioidentical Hormones, Hormones, Opinion, Treatments

What Treatment Is Needed After Hysterectomy?

The importance of using bio-identical hormones and whether or not to retain the ovaries.

Dr Jeffrey Dach

Forty Three year old Eva sought medical advice about irregular bleeding from massive uterine fibroids.  The continuous bleeding interfered with her lifestyle and caused severe fatigue from the iron deficiency anemia.

I had previously proposed uterine artery embolization, but the consulting interventional radiologist instead recommended hysterectomy because the fibroids were too large for his procedure.  Eva went home, and after thinking for a few days, finally accepted she would have to undergo surgery. The surgeon recommended a COMPLETE hysterectomy with removal of both ovaries.  Sitting in the surgeon’s office, Eva timidly protested. “Why remove my ovaries?” asked Eva.  The surgeon replied, “Removing the ovaries eliminates the chance of ovarian cancer, and you don’t need them anyway.”

So now Eva was again in my office asking for my opinion. Should she go against the surgeon’s advice and insist on preserving her ovaries, or should she follow the surgeon’s advice to have a COMPLETE hysterectomy with removal of the ovaries ?

The ovaries are important because they are the hormone factories that pump out women’s hormones on a daily basis.  Removing the ovaries removes the source of women’s hormones causing all hormone levels to decline to low levels, immediately sending the woman into Menopause.

Studies Show Removing Ovaries Increases Mortality

Luckily, the answer to Eva’s question can be found in the medical literature.  William Parker MD and Cathleen Rivera MD reported that removing the ovaries is detrimental to overall health and results in increased mortality.

Dr. Parker followed 30,000 women for 24 years after their hysterectomy.  Half had ovaries removed and half had ovaries preserved.  The group with ovaries removed did, in fact, have a lower rate of ovarian and breast cancer.  However, this was overshadowed by a marked increase in death from heart disease and other cancers. The group with the ovaries removed had a higher all cause mortality rate, and therefore Dr. Parker  recommended that women preserve the ovaries in the pre-Menopausal age group.  Dr Parker also found that postoperative hormone replacement is very beneficial at reducing heart disease risk.

In a second study, Dr Cathleen Rivera followed 1,000 Pre-Menopausal women (under age 45) after hysterectomy, and found that removal of the ovaries resulted in a disturbing 84% increase in death from heart disease.  However, if these women were given estrogen replacement after ovarian removal, they were protected with a 35% decrease in mortality from heart disease. I thought this was rather impressive.

Bioidentical Hormones After Hysterectomy

These two studies provide convincing evidence of the health benefits of hormone replacement after hysterectomy. Although the patients in these two studies were given Premarin which is a natural hormone (from a pregnant horse), we find that a cocktail of bioidentical hormones including estradiol, estriol, progesterone, DHEA and testosterone works as well or better than the horse hormones.  Since all women are humans, I consider it preferable to prescribe human hormones rather than hormones from pregnant horse urine (Premarin).

However, for women at high risk with familial breast and ovarian cancer, and positive BRCA genetic markers, Dr Parker says it makes sense to go ahead with removing the ovaries for these people in high risk groups.

The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician.  Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician — patient relationship.  Although identities will remain confidential as much as possible, as I cannot control the media, I cannot take responsibility for any breaches of confidentiality that may occur.


To read more on Dr Dach’s work please visit his website at

If you have any questions or comments on his articles you can contact him via his website.

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Comments 10
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AnnA Rushton | 10:32 am, November 16th, 2015

Mary after a hysterectomy you generally need a combination cream such as 20-1 to replace both hormones and you may find this updated article helpful, also by Dr Jeffrey Dach :

mary hoctor | 5:25 pm, November 15th, 2015

Am 53. Had a radical hysterectomy 6 months ago.. Feel absolutely terrible . So confused about treatment & hrt. But I know I need something to get my life back. Anxiety weight gain hot flushes & worrying. Thanks Mary

wellsprings | 4:00 pm, December 16th, 2011

Very sorry about that Sharon it seems to have vanished into the Internet ether!

What we said was that like you, many women do find they cannot tolerate HRT and after having a hysterectomy you certainly do need progesterone to balance your hormones and protect against osteoporosis and heart disease.

A hysterectomy is a surgical menopause and instead of a gradual, natural, process it all happens at once and your hormones become unbalanced. This means a number of issues can arise as your body tries to adjust. It is no longer producing the progesterone it needs to keep your hormones in balance and to protect you from the unopposed oestrogen in HRT.

There are several articles on the site that will help you, but you cannot continue to take the progestin part of your HRT alongside bioidentical natural progesterone and this article by Dr Tony Coope explains why:

If you have not already seen a list of symptoms of oestrogen dominance this article by Dr Shirley Bond will help:

Also if you would like to see the views of women who are using Serenity you can also see them on the Wellsprings Facebook page.

Sharon | 2:45 pm, December 16th, 2011

I have not received the email you spoke about in an earlier post only to tell me a comment had been left!
Please help

AnnA Rushton | 8:37 am, December 15th, 2011

Natural progesterone is know to be protective against heart disease and women after hysterectomy have no progesterone to balance their bodies continuing production of oestrogen – a situation which can lead to symptoms of oestrogen dominance – and fibroids are known to be cause by excess oestrogen. Supplementing with bioidentical natural progesterone will help protect against future health problems that occur after a surgical menopause – which is what a hysterectomy essentially is. You will find an article by Dr Shirley Bond on oestrogen dominance here:

Rajpal | 5:49 am, December 15th, 2011

My wife had undergone hysterectomy and both overies removed for benine fibroids of bigger size and excess bleedings. She is reaching 50. Is there any health risk after this opration like astroprosis etc., ? If so please suggest the treatments to be followed. (She has blood presure 90-140 for the last 5 years, on medicine. Her parents died due to cardiac problems during their sixtees.) Please offer your vauable suggestions.

AnnA Rushton | 12:39 pm, November 27th, 2011

Sharon – thank you for your enquiry which we have replied to on November 25th at the email address you gave us. Please let us know if you have not received this so we can resend it to you.

Sharon | 8:43 pm, November 26th, 2011

Hi there,
I am a 43 nearly 44 year old mum who had to have a complete hysterectomy when I was 39. They took everything, I have been on HRT ever since and hate it. I have put on loads of weight even though I dont over eat. I still have night sweats and have to take happy pills, my headaches have been terrible. I am looking to take something that is more natural and can help me? any advice would be great as my GP just keeps trying different HRT with me.
Many thanks

wellsprings | 11:19 am, November 16th, 2011

Leena – many women who have undergone hysterectomy need to have their hormones in balance and for that Serenity, bio-identical natural progesterone, supplies that. For a few women who need additional oestrogen there is 20-1 cream which has a small ratio of oestrogen with the progesterone for those needing additional support. You will find a full description of the kind of oestrogen dominance symptoms that can occur in women who have had a hysterectomy here: and generally which cream you need is related to the symptoms you are having.

Leena | 2:14 pm, November 9th, 2011

I have a hystorectomy made at the age of 40 (now 54) without removing of ovaries. I’m interested in a cocktail of bioidentical hormones – what is the best cocktail and how can I get it?
Thank you for your answer – Leena

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