HRT for women with ovaries but no uterus

Although this site focuses mainly on women who have had both an oophorectomy (ovaries removed) and hysterectomy (uterus removed), some women choose to retain their ovaries and only remove a diseased uterus.

Technically speaking, these women will experience natural menopause. Of course, it's a little more difficult for them to tell when their last real cycle is because they won't have periods to mark them, but when they begin to experience the symptoms of perimenopause, they'll be the same classic ones most women see.

The only real difference that is likely to be obvious will be that a woman who has had a hysterectomy, even if she retained her ovaries, may go into menopause earlier than she might otherwise have done. When she does, especially if it comes particularly early, she may not find that her post-fertile ovaries provide the same level of hormonal support as they might have done had they never been subjected to the disruptions of surgery.

We're not saying this to worry you if you're not there yet. But it's a possibility—by no means a certainty—to be aware of. While the ideal of natural menopause is that our aging ovaries continue to obligingly pump out enough hormones to meet our post-fertile needs, women who have had a hyst should be prepared to revisit that image if it turns out that they arrive at menopause only to find they're not actually feeling so great about their coverage. Women who thought they might get away without having to deal with the whole concept of hrt may end up needing to revisit that plan.

In general, the same strategies the vast majority of women employ to ease themselves through the upheavals of perimenopause will pertain to this variety of natural menopause as well. Women with mild ovarian impairment may find that the over-the-counter nutraceuticals or soy estrogens in popular use may provide all the helpful boost they need to make up the gap between what their own ovaries make and what they need to maintain health and wellness. Other women will find, once perimenopause has settled down, that they still aren't meeting their needs well enough and they may want to go on to work with hrts to supplement themselves back up to a comfortable level of support.

Does not having a uterus change how I should use hrt?

Yes. For women without a uterus, a progestogen (progesterone or a synthetic version called, generically, a progestin) is not an obligatory part of their hrt. That doesn't mean that these women cannot use a progestogen as part of their hrt, but that it's not mandatory because that mandatory role is uterine protection from the estrogen...and without a uterus, no such protection is necessary.

Instead, for these women in natural menopause without a uterus, any progestogen needs only to be supplemented to a level that meets their actual, demonstrated needs for it. We don't need it just on spec—our ovaries and adrenals take good care of providing for most of our needs and if we're meeting our estrogen needs well, we should have plenty of progesterone available to meet our post-fertile needs for it. Additionally, more recent study data about the risks of progestogen exposure make frivolous use of progestogens much more questionable than it was even a decade ago. But if some needs remain after we have adjusted our estrogen as well as we can, then we have the information we require to go on to work on meeting our progestogen needs more fully with supplementation.

Are there any other special situations that will guide my choices of hrt?

Sure. The big decision factor has to do with personal risk factors and lifestyle preferences, of course, but in some cases we also have to deal with specific other disease treatments.

The obvious one is endometriosis, which often requires a progestogen-heavy hormone imbalance for best suppression of endo growth. Other health needs that might guide hrt use and choices would be cancer risk or blood clotting disorders.

And there may be others. The point is, we need to remember that we don't use hrt in a vaccuum: it does have to fit with the rest of our life and health. But aside from not needing a progestogen to protect a uterus, women in this flavor of natural menopause have all of the choices—and risks—of any other woman in natural meno.