Continuation of hormone replacement therapy after hysterectomy

To assess long-term hormone replacement therapy (HRT) usage in women after hysterectomy and to assess the relationship between age and long-term use of HRT in these women. Problems and comments of those women responding to a questionnaire were evaluated.

A postal semistructured questionnaire survey was performed in a single gynecological practice. A total of 545 consecutive women who had undergone a hysterectomy for benign conditions between January 1986 and September 1997 were studied, the main outcome measure being continuing use of HRT.

There was a response rate of 83.1% to the questionnaire; 83% of all responders were taking HRT at the time of the survey. A continuation rate of 95.7% was found among women who had had a hysterectomy after 1994, and of 84.7% among those operated on in 1989 or before. Implants were used by 68%, transdermal patches by 17%, oral preparations by 11% and estradiol gel by 4%. Ten per cent of those not taking HRT at present indicated that they were likely to start again in the near future. No correlation was found between age and likelihood of HRT continuation. Fifty per cent of women responding to the questionnaire made further comments: 17.6% of these made specific positive comments regarding HRT, 16.7% reported weight gain, 9.7% suffered breast symptoms and 13.2% admitted concerns regarding breast cancer.

A high HRT continuation rate of between 95.7% (women having had their hysterectomy less than 5 years ago) and 84.7% (women 10 or more years from their operation) can be achieved in the long term. Considering the high proportion having implant therapy, the use of testosterone as well as estradiol replacement may be a major factor in the greater adherence to HRT of this group.