Q. I had a full hysterectomy at age 49. My health is excellent otherwise, with no smoking, regular exercise and alcohol in moderation.
My gynecologist put me on Estratest. I felt great on this but my skin became extremely oily with acne and my hair was also too oily. I chose to go off the hormones.
Since not being on hormone replacement therapy (HRT), I have terrible mood swings and depression. I have been searching the Web for information about HRT and am really confused. My gynecologist is very much in favor of hormones, but my friends keep sending me articles about blood clots, breast cancer and other frightening complications. How dangerous is HRT? Are bio-identical hormones better?

A. The male hormone in Estratest (a combination of estrogens and testosterone) was probably responsible for your oily skin and hair. Doctors continue to debate the pros and cons of HRT. A recent review from the U.S. Preventive Services Task Force concluded that hormones reduce the risk for fractures but increase the chance of gallbladder disease, urinary incontinence and blood clots leading to strokes and heart attacks (Annals of Internal Medicine, July 17, 2012).
We are sending you our Guide to Menopause with options for managing hot flashes, vaginal dryness and moodiness. In it, we also discuss bio-identical hormones. We have seen no well-conducted trials demonstrating that they are safer than conventional therapies.

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  1. SM

    Immediate relief for a hot flash: put cool water on your face, neck, arms–and especially your outer ears. Don’t wipe off the water; let it dry by evaporation. Such a relief!

  2. Tish

    Thanks Karen for your comment about sugar … for about six months (I’m 62) I noticed some leaks off and on. It was worse whenever I drank soda … I never would have thought about it being sugar. I will watch that more closely from now on. Thanks!

  3. JC

    I think Karen was referring to the photo of the young woman used, rather than the age.

  4. DiT

    I went through menopause at the age of 46, no hysterectomy. I did the HT for a few years to get me through after first trying to tough it out. However, with the hysterectomy, you could try what my friend does which is just estrogen. She did the flaxseed for years even before her surgery with no success in reducing the symptoms. She just took the lowest amount of estrogen that she could to alleviate the symptoms. Then she began to gradually taper off until she was taking the lowest amount, every other day. The latest research I read suggests that with a uterus, HT is safe for about 5 years if started fairly soon after menopause (within the first several years).
    Without a uterus (post surgery), estrogen is safe and even beneficial for many years after menopause. My own experience, after taking it for a few years (less than 5 though as I began to worry about the side effects), after a slight resurgence of symptoms after stopping, my symptoms settled down and tapered off on their own and I’m pretty much symptom free now. And they were severe when they started!!!! In hindsight, it didn’t take too long either.

  5. KC

    I had a partial hysterectomy when I was 31, and started menopause about age 48 (never had blood tests done so this is not exact). Went on HRT about two years later because of night sweats and hot flashes, among other symptoms. But, I had a TIA (mini-stroke) at age 51 while on a business trip. After a total diagnostic work-up as a hospital in-patient (CT, MRI, carotid Doppler, ECG, tons of blood work at all hours of the day and night) they could find no apparent reason for the TIA (a small clot showed up in my brain on the MRI), so they put me on Plavix. When I saw my gynecologist shortly after that, he had me stop the HRT IMMEDIATELY (no tapering off). I was on Plavix for a few years, but I now simply take a low dose aspirin once a day.
    I’ve had follow-up carotid Dopplers and ECG and had no recurring problems. All I can surmise is that the clot / TIA was caused by the HRT I was taking (it’s been 12 years, so I don’t remember exactly what it was). On the other hand, my mother-in-law has been on HRT for 30+ years (under her doctor’s supervision) with no apparent side effects, but when she tries to go off, she has horrific hot flashes again (she’s now in her mid 80s). Go figure.

  6. CG

    According to the NIH, the average age for menopause is 51, with some people experiencing it in their 40’s, and some not until later in their 50’s. Since menopause can go on for months or years before becoming final, it would seem that the age of 49 is spot on – more than “reasonably close to menopausal age.”

  7. Bea

    I had a hysterectomy at age 50. Several of the hormones were given to me and I seemed to have a reaction to them. My gynecologist then recommended that I use a compounded hormone which he prescribed for me. I was using the Women’s International Pharmacy in Wisconsin. I have been taking them for over 20 years and have had no problem with them. I now have a local pharmacy that does this for me.
    The compounded drug, however is not FDA approved. The amounts are smaller than the regular drugs on the market. Since they are not approved by the FDA, I must pay for them myself.

  8. AB

    At 48 I too was having problems until I started taking 2 Tablespoons of ground flaxseed per day (I took it all at once in my morning oat meal with a teaspoon of cinnamon). I notice improvement with my mood, night sweats, and dry skin within 10 days. After five weeks I cut down to taking 1 Tablespoon of ground flaxseed per day and no more hot flashes or mood swings. Also my depression improved and my cloudy thinking cleared up. My doctor was surprised. Flax seed can be sensitive to heat and can’t be taken with certain medications. So do your research.
    I bought the flaxseed whole and grounded as needed with a coffee grinder. I have been on this natural approach for the past six months and I am no longer taking any other medications for mood swings, or menopause.

  9. E D

    This was great for me to read. I am scheduled to have a hysterectomy in a few weeks and because it is all so confusing to me, I have yet to start looking into my options for HRT. Would like to go a more natural route. Thanks for printing this!

  10. Karen

    My friends send me the semi-recent (two or three years ago) article in the NYTimes about HRT that argues in favor of it. I use transdermal estrogen and love it.
    IMO, SUGAR increases the risk of urinary incontinence. I can always tell when I’ve been eating too many desserts…
    My doctor (and the entire practice) believes that women on HRT have better survival if they do get cancer.
    A huge variable in all the long-term effects studies is Vitamin D levels, which were not, ASAIK, mentioned in any of the WHI data.
    I wish the People’s Pharmacy had the decency to use an illustration of a woman reasonably close to menopausal age for this post.

  11. kaf

    This is such a confusing issue. I wish the science was a bit more figured out on this. Your article states that HRT is likely to increase urinary incontinence. I have been told by two doctors that estrogen is likely to help with urinary incontinence, and when I use a dab or so of Premarin, I have found it to be helpful.

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