Thriving in Surgical Menopause

There can be some hurdles to overcome in surgical menopause - and we want you to thrive! Here we cover some of the aspects of surgical menopause that can cause concerns - and what you can do to help rectify or manage any issues.

‘Unlearning PMDD/PME’

Nutrition & Exercise

Looking after your pelvic floor

Sex, satisfaction and intimate health

Lifestyle

Don’t forget you can search for lots more answers to your frequently asked questions in our knowledgebase:


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‘Unlearning PMDD’

“How do I get back to ‘normal’ when my normal was living with PMDD?" I just don’t know where to start” - Patient

After living with PMDD, often for many years, when the hormones stabilize and you have a life without the cyclical interruptions - it can be hard to know where to start. Many people struggle with this ‘new normal’ and unlearning those mechanisms that were developed while living with PMDD means that sometimes people need some professional assistance.

  • CBT and/or DBT can be useful for recognizing unhealthy coping mechanisms and learning new ways to respond and cope with challenges.

  • Connect with others who are going through, recovering from, and on the other side of surgery in our support group here.

“I had learnt some pretty unhealthy responses to dealing with stress when I had PMDD. I found I really had to get professional help to ‘unpick’ lots of these habits and responses. I initially thought they were part of my personality but it turns out I had just developed skills to try and protect myself and just to get through the trauma of PMDD. I had to learn a new way of thinking to move forward” - Patient

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Do I need to take calcium tablets when in surgical menopause?

Many worry about bone thinning in surgical menopause, however calcium supplements are not needed if you have an adequate dietary intake but if they are taken, they should be taken alongside vitamin D, as calcium supplements alone are associated with increased cardiovascular risk. Adequate estrogen therapy can also help ensure bone protection.

Read this handy article for information on how to intake plenty of calcium via a varied diet.

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Which supplements do you need when you are in surgical menopause?

It is always advisable to gain nutrients through a varied dietary intake rather than use supplementation.

The general recommended nutritional supplements apply across the board, not just for those in surgical menopause specifically.

Magnesium - There is some suggestion that those who are are on HRT may need to increase their magnesium levels but no good evidence to suggest supplements should be recommended routinely. 

“Magnesium supplements, however, can be beneficial for sleep problems and/or anxiety. Many people do not consume enough magnesium dense foods. If you do choose to take a supplement then I tend to recommend magnesium citrate.” - Dr Hannah Short

Magnesium is an important mineral that your body needs in order to function. It produces energy and regulates blood sugar and chemical reactions in the body. Magnesium helps maintain the proper levels of other minerals such as calciumpotassium, and zinc. Your heart, muscles, and kidneys all need magnesium to work properly. The mineral also helps build teeth and bones.

Adult females should aim to consume 310mg (ages 19-30) or 320mg (ages 31+) through their diet on a daily basis.

Calcium - Calcium supplements are not needed if you ensure you are getting enough calcium through dietary intake. If you do take a calcium tablet it should be taken with vitamin D as calcium supplements alone are associated with increased cardiovascular risk.

In terms of other supplements, you can trial phytoestrogen/isoflavone supplements as there is some evidence of benefits.

Sea-buckthorn oil can be helpful for vaginal dryness (and dry eyes/skin)

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What’s the best way for me to exercise when in surgical menopause?

“Exercise is the big non-negotiable during the menopause as it improves all aspects of wellbeing; cardiovascular health (which is by far the biggest killer in those who are postmenopausal) as well as the most serious in terms impact on your life and levels of disability. It helps brain health, bone health, mental health, reducing blood pressure, cancer rates, risk of developing diabetes type 2 and managing weight… the list goes on!” - Dr Hannah Short.

Do ask for help and support of a fitness & health care professional.

 1. Weight-bearing exercise with 'impact'

It is important that people understand that you are weight bearing when you are standing - with the weight of your whole body pulling down on your skeleton. Weight bearing exercise with impact involves being on your feet and adding an additional force or jolt through your skeleton. This could be anything from walking to star jumps. Recommendations are 50 impacts moves most days. This could be jumping, skipping, jogging or 20 mins of lower impact exercise. Avoid prolonged periods of time sitting down. This is the recommendation for people with and without osteoporosis of any age. If you are not physically strong (or have a spinal fracture) start with avoiding prolonged sitting and adding in lower impact activities. 

2. Progressive Muscle strengthening

To strengthen your muscles, you need to move them against some resistance. Increasing muscle resistance can be done by adding a load for the muscles to work against, such as weights, resistance or body weights.

Research indicates that progressive resistance training is likely to be the best type of muscle strengthening exercise for bone strength.


How often do you need to exercise to help your bone and muscle strength?

Muscle strengthening exercises are recommended two to three days each week, on non-consecutive days and targeting all major muscle groups. Aim for 20 to 30 minutes per session. Work gradually with resistance bands and weights - use the most you can lift eight to 12 times, this is around 60-70% of your max lift. If you can lift it more often that that it is probably not heavy enough, and training will not be effective enough. Build up to three sets of each exercise.

“Being physically active and exercising helps you in so many ways and is very unlikely to cause a broken bone” - Royal Osteoporosis Society UK 

 The mantra is (unless there is a medical indication to be cautious): “You can’t go wrong getting strong”  

Either way, if you have the headspace of 'not wanting to build muscle' then it’s time to ditch that thought.  During the menopause, muscle is your friend!

  • Aim to move your body daily – this is important for mental & physical well-being.

  • If you don’t already have an exercise regimen, start slowly – even a ten-minute walk around the block has its benefits.

  • Consider a five minute morning online yoga session e.g. yogawithadriene.com/5-minute-morning-yoga

  • Weight-bearing exercise (e.g. hiking, running, dancing, weight-training, tennis) – at least twice weekly – is essential for bone health after menopause. Swimming and cycling are great forms of exercise for heart health and general well-being, but will not prevent osteoporosis.

  • Consider joining your local Park Run or similar - great not only for exercise, but also community-building, social inclusion and gets you out into nature (which has enormous benefits for our mental health). Do not be put off if you do not run (yet!); many people walk or walk-run around the courses. Children and dogs are welcome too!

  • Balance and core-strength are increasingly important as we age, and reduce the risk of falling in later life. Another reason to consider a regular yoga practice, or why not sign up to a local Pilates or tai chi class?

- Dr Hannah Short


Pelvic Floor

Looking after your pelvic floor

Pelvic Floor

We’ve all seen the adverts telling up that ‘oops’ moments are a part of life - but that is not quite the case. In many situations, with a little help, leaks and stress incontinence can be rectified.

Your pelvic floor muscles go from the front of your body, to behind your bottom - a bit like a sling! These muscles supports your bladder, bowels and helps to maintain continence (the ability to control movements of the bowels and bladder).

Good pelvic floor muscles function are important in all stages of life, but especially in menopause when your hormone levels are changing.


Issues with urine incontinence is common in menopause - but that does not mean that it is something you just have to learn to live with. There is level 1 (the highest level!) evidence that pelvic floor muscle training is the first line of treatment for urinary leakage. Leakage is very common but can nearly always be helped, the recommendation is to go and see a pelvic health physical therapist.

Can issues with incontinence/weak pelvic floor be caused by low estrogen?

What else can cause weakened pelvic floor muscles?

Are there any apps I can use to help with pelvic floor training?


Can issues with incontinence/weak pelvic floor be caused by low estrogen?

Yes. Estrogen supports muscles and collagen and so low levels of estrogen could lead to a weakened pelvic floor muscle. Pelvic floor muscles are rich in estrogen receptors. There is evidence that a combination of systemic HRT (that is estrogen delivered into your system via pill, patch, gel, spray, pellets etc) plus pelvic floor muscle training is effective in strengthening the pelvic floor muscle. Additional topical vaginal estrogen can also be prescribed and can be helpful. This estrogen treatment is delivered via a cream or a vaginal pessary straight to the vaginal area, boosting estrogen exactly where it is needed. See your doctor if this is something you feel would benefit you.

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What else can cause weakened pelvic floor muscles?

There are many reasons why someone may have (or be susceptible to!) pelvic floor issues. Risk factors include hormonal changes (such as going into surgical menopause and having a drastic drop in hormone levels), having had vaginal births when delivering a child/children, having recurring constipation, as well as there being a genetic factor. Whatever the reason - there are things you can do to help yourself and there is good evidence that working with a pelvic health physical therapist can be beneficial.

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Are there any apps I can use to help with pelvic floor training?

The pelvic floor is a muscle and it supports your pelvic floor to help to keep the pelvic organs  in an optimal position. It also helps to maintain continence. For most women/AFAB individuals, the easiest way to activate these muscles is attempting to squeeze your back passage like if you are controlling wind, followed by a full release. There are some apps which will guide you through repetitions and a combination of slow and fast contractions. Two apps recommended by our experts are Squeezy and Tät. These are not replacements for medical care - so do see your doctor if you are concerned. Evidence shows that directed pelvic floor muscle training works better than self directed.


Sex PMDD surgical menopause

Can being in surgical menopause change desire or enjoyment of sex? Is sex the same after surgery? 

This is a common concern for many people who are entering (or considering) surgical menopause. Being in surgical menopause can change the desire for and experience of sex. Below, we outline a few key considerations when considering sex in surgical menopause.

Reduction in Sex Hormones. The loss of the ovaries means that the main source of sex hormones (estrogen, testosterone) will be lost, and this has an impact on many areas of the body relevant to sexual function.

  • Low estrogen in the menopause often causes vaginal dryness or vaginal atrophy, which can make sex uncomfortable or even painful. Studies show that general estrogen HRT and/or vaginal estrogen cream can improve sexual function during surgical menopause. 

  • Lower testosterone in surgical menopause may cause a reduction in libido. There is some evidence that testosterone HRT can reduce this problem if it arises. 

Allow Time for the Normal Healing Process. It is normal and healthy to take an extended break from sexual activity following this major surgery. It is important to give yourself time to heal before masturbating or having sex again.

  • For partnered individuals, communication with your sexual partner is key; make sure that you tell them your medical limitations, boundaries, and preferences throughout the process.* 

  • Non-penetrative sexual activity can resume once your body feels ready; there are no guidelines around this, and it can be self-led. 

  • Penetrative sexual activity (or insertion of anything into the vagina) should be avoided for at least 6 weeks following surgery. 

  • When resuming sexual activity following surgery, go slow and listen to your body. You may find you need extra foreplay to get aroused initially and good lube is recommended to make intercourse/penetration more comfortable. If you’re uncomfortable or have concerns, talk to your doctor. 

  • Some individuals find that, even though (1) enough time has passed, (2) they want to have sex, and (3) they’re not having pain with sexual activity, they are STILL struggling to engaging in sex specifically because they are fearful that they may cause damage to their bodies. For some people, this can become a vicious cycle in which fear can cause vaginal tension and discomfort which then further increases fear. If this is the case for you, and your doctor has cleared you for sex, it may be useful to practice stress reduction techniques prior to sex. If this is not successful, a few visits with a sex therapist or a cognitive behavioral therapist specializing in anxiety may be useful for helping to reduce your fears around sex, reduce tension, and increase enjoyment. 

*If you feel unsafe in your relationship or fear that your partner will not respect your medical limitations or personal boundaries around sex, consider contacting a sexual abuse hotline or center for consultation and support, and try to find a way to mention the situation to your doctor so that they can support and protect you. Below are a few examples: 


I’m in surgical menopause. It hurts to have sex - why could this be?

If sex hurts, it is very important to seek help. Painful sex can usually be helped or treated, so do seek advice of a specialist health care professional. An internal vaginal assessment will help to diagnose the cause of the pain. The vagina is an elastic, muscular canal with a soft, flexible lining that provides lubrication and sensation connecting the uterus to our external genitalia. The vulva is the external part of the female genitalia protecting our sexual organs, urinary opening, vestibule ( vagina entrance) and vagina. It consists of the outer and inner 'lips', called the labia majora and labia minora, the clitoral hood and clitoris and is key to the sexual response in the majority of women and those with a vulva. Vaginal dryness is one menopausal symptom which often takes some by surprise and for many, is an embarrassing subject to talk about with their partner and their doctor.

“A survey by the British Menopause Society (2017) found that 51% of women said sex is off the menu due to vaginal dryness, vaginal atrophy, vaginal tightness, all of which can cause painful sex, decreased libido, decreased sexual sensation and body confidence. They found that 50% of women are too embarrassed to speak to their doctor” - Sam Evans, Owner of Jo Divine.

In surgical menopause the depleting and low levels of estrogen can lead to thinning of the walls of the vagina and the skin of the vulva, making it shrink, and feel sore, drier and less well lubricated. This can make sexual activity feel uncomfortable or painful and may lead to infections such as thrush, bacterial vaginosis and irritation. The walls of the urethra that lead from the bladder also thin, leading to cystitis and urinary tract infections, as they become irritated and inflamed during penetrative sex. 

Some people in surgical menopause experience vaginal atrophy which is much more than vagina dryness This atrophy can lead to splitting or tearing of the vulva/vagina, constant itching, burning, soreness, discomfort and recurrent urinary issues - which is why seeking medical advice to get the right diagnosis and treatment is important. To read more about sex and vaginal atrophy, click here.


Which kind of lube is recommended? Are there some types to avoid?

Sexual lubricants and vaginal moisturisers can transform your sex life and vaginal health but not all products are the same. Many, including well known brands, contain ingredients that can cause irritation, stinging, burning, and even infection such as thrush or bacterial vaginosis.

Toptip

“Before trying a product, do a skin test on your vulva. If you experience any stinging , burning, or it leaves you itching, wash it off straight away and do not use it again. Some lube manufacturers will send you a sample to try before you buy - so do your research!” - Sam Evans, Jo Divine

Do not be tempted to use something from your store cupboard or bathroom cabinet, just because you can eat it or it feel slippery does not mean it has been designed or is beneficial for your intimate health. This includes vaseline (petroleum jelly), olive oil, Bio Oil, hand cream, Baby Oil, butter, germolene, sudocrem, low fat spreads.

If your GP prescribes a lubricant or vaginal moisturiser, ask them what the ingredients are. If ingredients are not listed clearly on commercial lubes, then check out their website or contact them directly for full details.

Ingredients to avoid include: glycerin, propylene glycol, parabens, and tingling/colored/flavoured lubes:

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Glycerin is a common ingredient found in many commercial lubricants and even some that are available on prescription. Glycerin is a sugar, and so it creates a sugary environment that thrush loves to thrive in so it is advisable to choose a glycerin free product - especially if you know you are prone to vaginal infections or get recurrent thrush or bacterial vaginosis. If your GP prescribes a lubricant or vaginal moisturiser, ask them what the ingredients are.

Just because it is on prescription does not mean it is good for your vagina health and there are glycerin free products that your GP can prescribe instead.

Many flavoured lubricants contain glycerin but some only use natural flavourings that do not contain glycerin, so check the label. Flavoured lubricants are ideal for oral sex but if you know you are sensitive, it is advisable to wash it off before penetrative sex and use your glycerin free lubricant.


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Propylene Glycol - Another common ingredient in lube is glycol, a common preservative found in many sexual lubricants. It is a well known vaginal irritant, especially for those who experience vaginal infections or irritation. The sting, burning or itching sensation that many experience when they put the lubricant on their vulva or inside their vagina is often the propylene glycol causing irritation. This can be a particular problem with condoms as people think they have a latex allergy when it is, in fact, the lubricant on the condom causing irritation, not the latex. Again condom manufacturers do not put the lubricant ingredients on the packaging. Using a condom that has a silicone lubricant is advisable as there will be fewer issues with irritation.


Parabens in lube

Parabens - Some lubricants, even on prescription, can contain parabens. Parabens (methylparabens) are included as preservatives in many cosmetics, personal care and food products to prevent bacterial growth and have been potentially linked to breast cancer. Research by Dr Darbre at University of Reading (2012) looked at the concentration of five parabens in breast tumor tissue. One or more types were found in 99% of the tissue samples, and all five were measurable in 60% of the samples. They concluded that parabens are absorbed through the skin from skin care products. The delicate tissues of the vulva and vagina are highly absorbent, therefore avoid using sexual lubricants containing parabens.


Flavoured Lube  in surgical menopause

Tingling/Colored/Flavoured Lubes - Some people love them, others hate them. Lubricants designed to make you tingle or warm up your vagina contain menthol and chilli, substances that are not recommended for use on your genitals. The same goes for coloured lubricants which can cause vaginal irritation and allergic reactions. So, if you’re prone to sensitivity, avoid coloured and flavoured lubricants.

Some lubricants can be difficult to wash off and leave behind a sticky feeling, which is neither pleasant nor sexy. Others can stain your bed sheets and underwear.


Always try a small amount of any new lube first. If you experience burning, stinging or itching, wash it off immediately. Finding  a pH balanced sexual lubricant/moisturiser that works for you will enhance both your sexual health and pleasure, whatever your age and keep your vagina/vulva healthy and happy!

What other points are important to be aware of when selecting a lube?

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Choosing a pH balanced sexual lubricant is important to avoid upsetting the vagina flora and increasing your risk of developing thrush or bacterial vaginosis. Many lubricant brands do not tell you what the pH is on the tube or bottle so you have no idea if it is the same as the vagina which is between 3.8 and 4.5. Household substances are not suitable for use as a lubricant such as Vaseline, olive oil, Baby Oil, Bio Oil, hand cream or body lotion - as they are not designed for internal use or pH balanced to that of the vagina.


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Some popular water based brands including KY jelly and well known brands frequently prescribed and recommended by healthcare professionals and widely available on the high street and online can exacerbate vaginal dryness or vaginal atrophy. Many , including KY have a higher osmolality than the cells in the body, drawing moisture out of the walls of the vagina rather than hydrating them, exacerbating vaginal dryness, not helping it. This can leave the body vulnerable to infections such as thrush. 

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I’m in surgical menopause; My vagina is dry and stings - is this vaginal atrophy?

Vaginal atrophy (atrophic vaginitis) is the thinning, drying and inflammation of the vaginal walls due to your body having less estrogen. You may also hear vaginal atrophy and its accompanying symptoms called "genitourinary syndrome of menopause (GSM) as it is not just your vagina that is affected.

With moderate to severe genitourinary syndrome of menopause (GSM), you may experience the following vaginal and urinary signs and symptoms:

  • Vaginal dryness

  • Vaginal burning

  • Vaginal discharge

  • Genital itching

  • Burning with urination

  • Urgency with urination

  • More urinary tract infections

  • Urinary incontinence

  • Light bleeding after intercourse

  • Discomfort with intercourse

  • Decreased vaginal lubrication during sexual activity

  • Shortening and tightening of the vaginal canal

    Source

There is no need to be embarrassed if you are having any difficulties having sex or experiencing any soreness or irritation in your vagina - it is very common. There are a number of treatments to try, including moisturisers and lubricants, HRT, local estrogen and laser treatment. We recommend you speak to your doctor with any concerns you have.

This is useful guidance to take to your doctor to aid them in treating you:

GUIDANCE ON DIAGNOSIS AND MANAGEMENT OF Urogenital atrophy or Genitourinary Syndrome of the Menopause (GSM)

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What is vaginal atrophy?

Vaginal dryness or atrophy is also called atrophic vaginitis. In surgical menopause your estrogen levels are drastically reduced and so your vaginal walls can become less lubricated and stretchy. Some doctors refer to it a genitourinary syndrome of the menopause (GSM) . The low levels of oestrogen in your body can lead to thinning and weakening of the tissues around the neck of your bladder, or around the opening for urine to pass (the urethra). For example, urinary symptoms that may occur include an urgency to get to the toilet and recurring urinary infections or cystitis.

Estrogen is important at acting as a natural lubricant in your vagina and helps to keep this area healthy and moist. Estrogen also stimulates the cells that line your vagina to produce glycogen. Glycogen is a compound which encourages the presence of helpful germs (bacteria) which protect your vagina from infections. This lack of estrogen tends to cause the tissues around your vagina to become thinner, dryer and inflamed. These changes can take months or even years to develop and vary from person to person..

Your vagina may shrink a little and expand less easily during sex making sexual intercourse more painful or uncomfortable. Your vulva may become thin, dry and itchy. You may notice that your vulva or vagina has become red and sore. You may also find you have episodes of thrush more frequently. Many have symptoms of vaginal pain and discomfort throughout the day, so it is often not just a problem to those who are sexually active.

As the skin around your vagina becomes more sensitive it is then more likely to itch. This can make you prone to scratching, which then makes your skin more likely to itch, and so on.

Dr Louise Newson - ‘My Menopause Doctor’

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How is vaginal atrophy treated?

Moisturisers and lubricants -There are many different products available and it is important that you find one that suits you. These can be prescribed by your doctor, obtained from chemists or directly from the manufacturers. Moisturisers are used regularly whereas lubricants are usually used during sexual intercourse. YES has a range of certified organic products including a water based intimate moisturiser and lubricant (worldwide shipping). Sylk is a natural water based intimate moisturiser which can also be used as lubricant (UK only).

Local Estrogen - The usual treatment is replacing the estrogen in your vagina and the surrounding tissues. A cream, vaginal tablet or ring containing estrogen is often prescribed and they work really well.

A vaginal tablet is a very small tablet that you insert into your vagina with a small applicator. The vaginal tablets and creams are usually used every day for two weeks, and then used twice a week thereafter. The ring is a soft, flexible ring with a centre that contains the estrogen hormone. This ring releases a steady, low dose of estrogen each day and it lasts for three months. It can be inserted and replaced easily by yourself, or by your nurse or doctor.

Using topical estrogen in this way is not the same as taking HRT and therefore does not have the same risks associated with it. This is because these preparations work to restore oestrogen to your vagina and surrounding tissues without giving oestrogen to your whole body. These preparations can be safely used by most people and also can be used on a regular basis over a long period of time (usually indefinitely) as your symptoms will usually return if you stop this treatment. Vaginal lubricants and moisturisers can be used either with hormones or on their own and are usually also very effective. These are available either from your doctor or to buy from various chemists.

Laser treatment - Mona Lisa Touch is a safe, painless, hormone-free treatment that uses a laser specifically made for the vagina. It works to give light energy to the vaginal walls which stimulates a healing response. This creates new collagen, new blood vessels, moisture and also elasticity to the tissues. Speak to your doctor to see if this is an option for you.

HRT - Many people find that using the right type and dose of HRT can really improve their symptoms. It is quite safe to take HRT with the other treatments mentioned in this list. Your symptoms should improve after about three months of treatment. You should see your doctor if your symptoms do not improve, as sometimes these symptoms can be due to other conditions. It is also very important to see your doctor if you have any unusual bleeding from your vagina if you are receiving hormone treatment.

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Will drinking alcohol whilst in surgical menopause/on HRT affect my mood?

We are not aware of any scientific studies about whether hormone therapies change the effects of alcohol on mood. 

However, we do know from one experimental study that drinking alcohol while taking transdermal estradiol (estrogen patches) slows the metabolism of estradiol, which means that estradiol levels rise rapidly (a 3x increase within 50 minutes) because they are not being cleared from the body at their normal rate. In the same study, taking estrogen did not influence the rate of alcohol metabolism. 

Given these findings, it seems possible (though not proven) that estrogens could alter the impact of alcohol on mood and other important outcomes (e.g., cancer risk). 

We recommend that individuals in surgical menopause follow conservative guidelines for alcohol consumption, limiting alcohol intake to (at most) 1 unit of alcohol per day.

If you’re struggling with substance abuse or addiction that is upsetting you or interfering with your life, rest assured that you are not alone-- addiction risk increases in the menopause, and many people struggle more with substance abuse during this time.  We strongly encourage you to seek medical and/or psychological treatment for this complex problem. Consider telling a trusted doctor, therapist, or friend, and ask for practical support for finding a treatment that works for you. Addiction treatment requires long-term support, and usually benefits from a combination of biological and psychological therapies. 

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What are the chances of experiencing blood clots? Does smoking increase the risk?

Large studies of estrogen in surgical menopause completed in both America and Denmark have demonstrated that long-term estrogen therapy in surgical menopause (e.g., 5+ years) may actually reduce risk for cardiovascular disease and breast cancer, and does not appear to alter risk of blood clots or stroke. 

There are no studies on the role of smoking in the safety of hormone therapy specifically in surgical menopause; however, in natural menopause, smoking increases the risk that hormones will increase risk of blood clot. Use of transdermal estrogen (rather than oral) has been found to be more appropriate for those who smoke in surgical menopause, and this may be a safer option in surgical menopause, too. Talk to your doctor about what kinds of hormone therapy might be safe and effective for you; it is also a good idea to ask your doctor about medications and therapies that can help you quit smoking.

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Are there risks in using HRT if you are overweight/obese?

Large studies of estrogen in surgical menopause completed in both America and Denmark have demonstrated that long-term estrogen therapy in surgical menopause (e.g., 5+ years) may actually reduce risk for cardiovascular disease and breast cancer, and does not appear to alter risk of blood clots or stroke. 

There are no studies on the role of weight in the safety of hormone therapy specifically in surgical menopause; however, in natural menopause, elevated BMI increases the risk of blood clots when taking hormones. Use of transdermal estrogen (rather than oral) has been found to be more appropriate for those at higher risk of blood clot during natural menopause, and this may be a safer option in surgical menopause, too. Talk to your doctor about what kinds of hormone therapy might be safe and effective for you; if you’re interested in losing weight, you could also ask your doctor about medications and therapies that can help you in this area.

To read lots more about HRT visit:


Should I have my bone mineral density tested? If so, how often?

Assessment of bone mineral density (DEXA scan) should be considered at the time of surgical treatment (start of surgical menopause) to evaluate your individual risk level for osteoporosis. The frequency of repeated bone density assessment should be guided by your individualized risk (e.g., not taking HRT, family history, smoking) for developing osteoporosis. Talk to your doctor about whether and how frequently your bone mineral density should be monitored.

You can search for more answers to common questions in our FAQ knowledge base here:

 

 
 
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This project was financially assisted by The Patty Brisben Foundation for Women’s Sexual Health. The views expressed herein do not necessarily represent those of The Patty Brisben Foundation for Women's Sexual Health.