I am 47 and recently had a hysterectomy and my ovaries removed.


Q: I am 47 and recently had a hysterectomy and my ovaries removed. I do not want to go on HRT but would like to take natural hormones. Are my needs for hormones different from a post-menopausal woman?

A: You basically had a surgical induced menopause. Whether you need hormone replacement depends on whether you have any symptoms or not. Don’t forget that while your ovaries are gone, your fat cells are still making some estrogen, so it is not as if you have zero estrogen in your body. Many people pass through menopause without any problem. Due to your young age, it will be good to establish certain baseline on your hormonal profile by saliva testing, including estradiol, progesterone, and testosterone to start. Don’t forget that you do put out testosterone as well from your ovaries, and male hormone such as testosterone are important as well to achieve overall hormonal balance. From the test and symptoms, you will be able to evaluate whether you need natural hormone replacement or not. Replacement comes in the form of estrogen (in a variety of forms), natural progesterone cream, and testosterone cream. You may need one or all of the above, depending on your needs. Take only as needed based on symptoms.
Generally speaking, start with Natural Progesterone Cream (not synthetic) delivering 15-20 mg a day for day 1-25 of each month. If your symptoms go away, then you do not need to consider estrogen replacement. If your symptoms persist (30% of the people), then your doctor can choose to add small dose (key is small dose) of estradiol (i.e. .25 mg) orally from day 1- 25 of each month. Some doctors choose to use Premarin, but do have it in low dose. You can also request your doctor for natural estrogen (tri-est.) or estriol only vaginal cream to use in combination with the progesterone. On the testosterone side, small amount of cream can be used effectively to increase libido or vaginal dryness as needed. There is no “standard” protocol when it comes to individualized treatment. Find a good doctor near you who is knowledge. I find many who are being “over treated”. Balance is the key – take what is needed, and preferably naturally. That is the safest route in my opinion.