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[Heidi1]

Hi ladies- I recently had a total hysterectomy (everything removed - ovaries; uterus; cervix and excision of Endometriosis) I am 44. I had stage 4 Endo outside of uterus hence the surgery.  The surgeon left a tiny bit of Endo on my bowel to avoid me having to possibly have a bowel resection. I had terrible time after surgery with severe menopause symptoms. The surgeon gave me Evorel 75mcg patches. I have also asked for an Oestrogen vaginal pessary to help with the burning and any possible “dropping” in vagina. However, I am very worried about the Endo re-growing with the Oestrogen. I understand the vaginal pessaries are non-systemic so they should not affect the Endo (? Is this correct); but not sure if the patches will cause it to grow back. My surgeon seems very relaxed about it all (he is s BSGE Endo surgeon).  Anyone have any experience of this issue? Any advice most welcome x

[Hurdity]

Hi Heidi1

 

Sounds like your surgeon is an expert. However my understanding is that women who have had severe endometriosis might need a progestogen if taking HRT - even without a uterus - due to the possibility of it regrowing.

This is what it says on this website:

There is a small risk of reactivation of endometriosis with HRT use and any recurrence of symptoms should be reported. If a hysterectomy has been performed for endometriosis, the choice of HRT use thereafter should be influenced by the extent of endometriosis at the time of the operation. Since hysterectomy often causes a premature menopause, it is often advised to take HRT until the average age of the menopause; 51 years. HRT after hysterectomy usually consists of estrogen only. However, in the presence of endometriosis, estrogen may cause stimulation of residual deposits and consideration should be given to using continuous combined (estrogen plus daily progestogen) therapy, or tibolone, though little research has been done on the effect of different types and duration of therapy. Medical treatment of endometriosis often involves ovarian suppression which, along with ovarian removal, may increase the risk of osteoporosis.

https://www.menopausematters.co.uk/atoz.php

Presumably your surgeon has weighed it up and decided you don't need it - and I presume can monitor it somehow - at least this is a question you should ask him? However you will most likely feel better without the prog so if you can avoid it then that's great. You might also want to think about testosterone replacement in your circumstances.

https://www.menopausematters.co.uk/aftermeno.php  - scroll down to this:


Role of testosterone after hysterectomy

If the ovaries are removed at the time of hysterectomy, as well as the estrogen level falling, there is also a 50% decrease in testosterone production. Some doctors recommend testosterone replacement along with estrogen replacement; testosterone helping energy levels, mood and libido. However testosterone replacement does not seem to be required by all and the ideal route and dose of testosterone for women is still being researched. It is therefore not routinely recommended following removal of the ovaries but can be considered for some women who do not fully benefit from estrogen replacement alone.

That's right the vaginal oestrogen should not affect the endometriosis as the dose is so low.

Hope this helps and hope you are more comfortable soon

Hurdity x

[coldethyl]

Any endo left after surgery can regrow- even without added oestrogen in form of HRT- as the endo tissue itself can self-sustain- so it is up to you to balance that risk against how you felt post surgery off HRT- I had radical hysterectomy last year due to my endometriosis becoming cancerous and whether rightly or wrongly, my onc refused to countenance even pessaries for vaginal atrophy in case it reactivated any remaining but dormant cancer , so clearly she feels their is some systemic effect. Maybe contact one of the Endo societies to see if they have any thoughts.

[Heidi1]

Thank you ladies for your replies. So helpful. I've done so much research now and even read medical textbooks on hysterectomy and HRT. This thing really does educate you. :-)   Had to inform a few of my docs that after removal of ovaries you go into a sudden and often severe ‘surgical menopause'. HRT (and prayer!) has really helped me with these extreme symptoms. But it just means that if my HRT is suddenly stopped, then the surgical menopause immediately returns. I had a slight taste of that a month or two ago when my patches weren't absorbing (due to sweat/heat they came off). I went downhill quite rapidly a day later. It's taken about 4 weeks to start feeling normal again after that blip. It's scary. I'm going give the pill a try now. Hope you ladies are all good. x