DEAR MAYO CLINIC: I have been using an estrogen hormone patch for two years since having a hysterectomy at 38. I had my ovaries removed as part of the procedure. How often should I have my estrogen levels tested, and how long will I need to continue hormone replacement?
ANSWER: For a woman in your situation, estrogen replacement therapy typically is recommended (assuming there is no medical reason not to use estrogen) until the average age of natural menopause — usually around 51. This is done mainly to reduce the risk of long-term health problems associated with removal of the ovaries. To ensure you’re receiving the right dose, it’s a good idea to have your estrogen level checked at least once a year, and eight to 12 weeks after any dose changes.
A hysterectomy is surgical removal of the uterus. As in your case, the procedure often is combined with removal of the ovaries — a surgery known as an oophorectomy. If the surgery involves removing both ovaries, it’s called a bilateral oophorectomy. When only one ovary is removed, it’s a unilateral oophorectomy. Because the ovaries make the main hormones responsible for a woman’s menstrual cycle, removing your ovaries results in menopause.
When both ovaries are removed before a woman goes through menopause naturally, there is an increase in the risk of a number of serious long-term health problems. They include heart disease, cognitive dysfunction and dementia, mood disorders, bone thinning, and early death. The younger a woman is when she has bilateral oophorectomy, the higher the risk.
Because of these risks, bilateral oophorectomy is less common now than it was in the past. In some cases, however, the procedure may not be avoidable, particularly for women who require the surgery due to gynecologic cancer or who are at high risk for developing ovarian cancer, such as women who have a BRCA gene mutation.
Estrogen replacement therapy can provide some protection against the health risks that result from bilateral oophorectomy. It also can ease menopause symptoms, such as hot flashes, night sweats and vaginal dryness. The current practice is to use estrogen-based hormone therapy at least until the natural age of menopause, unless there is a medical reason a woman shouldn’t receive it. For example, in women who have had breast cancer, estrogen replacement may not be appropriate.
In general, premenopausal women who have a bilateral oophorectomy are prescribed a dose of estrogen about two to three times higher than the dose that is used to control menopause symptoms in women going through natural menopause. This dose usually results in estrogen levels comparable to those found in a woman prior to menopause.
As in your case, a common way to receive estrogen replacement is through a patch that’s placed on the skin. This is called an estradiol patch. Estrogen replacement also can be taken in pill form. Using an estradiol patch that delivers 100 micrograms per day of the medication, or oral estradiol of 2 milligrams per day, typically results in an average estradiol level of 100 picograms per milliliter.
It is not standard practice to check estradiol levels in women on replacement therapy. Instead, the dose of estrogen replacement therapy typically is adjusted, as needed, to control menopausal symptoms effectively. That said, for young women like yourself, it is a good practice to have your estradiol levels checked annually and after dose changes to ensure that the level is around the desired goal of 100 picograms per milliliter. — Dr. Ekta Kapoor, Women’s Health Clinic, Mayo Clinic, Rochester, Minnesota