Hysterectomy and oophorectomy for HRT progesterone intolerance

[LittleMissViper]

I'm considering whether to go ahead with a hysterectomy and oophorectomy, following my perimenopause/HRT woes, and would appreciate if anyone who has been in a similar situation could share their experience.

A bit of background first; I've suffered with PMDD and menorrhagia from the moment my periods started. I've been anaemic for much of my life. From my mid teens I've tried the pill, tranexamic acid, hormonal coils, etc, to try and control the worst of it. However, I've struggled with them all for various reasons.

So, around a decade ago, once my family was complete, I had an endo ablation and tubal ligation. This didn't stop my periods but reduced them to manageable levels, and I no longer needed any hormonal contraception which helped the PMDD, a bit.

However, I'm now in my early 40s and venturing into perimenopause. Aside from a bit of anxiety, weakness and cold flashes/hot flushes, my biggest struggle has been with insomnia. So I went to the GP, who started me on HRT. Since then, I've felt great on the oestrogen, but been struggling with every form of progesterone that's been offered. I have finally been diagnosed as progesterone intolerant.

There is discussion of the next option being a total hysterectomy and oophorectomy, after which I could drop the progesterone and just have the oestrogen. I'm in the fortunate position of being able to afford to have the operation privately, if I choose to. I'm hopeful it'd be vaginal with laparoscopy, and I'd be able to take oestrogen afterwards once I go into a surgical menopause.

Has anyone had the operation for these reasons? How did the operation go, and was recovery straightforward? Was the procedure a success, and did it solve any PMDD? Do you struggle any less with anaemia? Did it cause any new problems? I'm particularly nervous about introducing bowel/bladder problems.

Thanks!

Sorry I don't have experience but am considering the same. Hopefully someone will have some helpful words.

I had a a total hysterectomy and oophorectomy mid 40’s for Fibroids, Endo, heavy bleeding and constant anaemia.

It has been amazing.

No bladder or bowel problems, but I’ve been doing pelvic floor exercises religiously since my mid 20’s, recovery straight forward, I walked a little every day building my strength up so I was walking 30 mins a day by the 6th week and was more than ready to go back to work.

Moods & anxiety have improved massively with HRT patches, my peri symptoms were horrendous. No more anaemia, I had been on ferrous fumerate for nearly 20 years. I had tried pill, coil etc.

Having a hysterectomy has been life changing for me.

That's really helpful, thank you so much for sharing! I'm feeling a bit more confident now that I should just bite the bullet and get it done.

Do you mind me asking, did you have any significant weight loss or gain after the surgery? Both short and longer term.

I had crippling PMDD for my whole menstrual career and couldn't tolerate progesterone.
Aged 41 I had hysterectomy And asked them to take my ovaries as well because of the PMDD. I would totally do it again because instantly I no longer became suicidal every month.
Do, however, be aware of the risk of prolapse afterwards.

Weight wise I had already been calorie counting as I didn’t want to have surgery and feel embarrassed that they had to cut into my blubber! I think I had lost nearly two stone by the time I had my op.
Post surgery I just continued my calorie counting until I got to my target weight.
The amount of problems my reproductive system caused me I thought it would have been huge and would have weighed a lot, sadly not. My weight was all just down to wine, crisps and too much chocolate! I do think my HRT patches have helped though, weight isn’t just sitting on my belly as it was. I lost around 3&1/2 stone in total and have kept it off for 4 years by continuing being careful about what I eat.

Is that a vaginal prolapse, @FlopsiesAngrySandwich? Is it something you've experienced? If I do go ahead, I'll make sure to ask the surgeon for the risks and enquire about any mitigations for that. (Many pelvic floor exercises, I'm guessing!) Thank you for sharing your experience, it does sound like going for a surgical solution might be the best choice for me too.

That's a brilliant result with your weight, @MajorDanger, congratulations! I've got 1-2 stone to lose to be in the middle of my ideal BMI, and I've been nervously reading all the dire warnings about weight gain after a hysterectomy. However it sounds like weight gain isn't guaranteed.

My diet isn't too bad, so after recovery time I'd be hoping that by not being anaemic/depressed for 75% of the time I'll feel more energised and be able to get more regular exercise. I'm also hoping that if I have a date for surgery in the calendar, that might give me some drive prior to the operation too.

Any pelvic organ prolapse - I developed rectocele and vaginal vault prolapse afterwards. Pelvic floor is important but so are other things like avoiding constipation. Good luck!

I know this is an old thread but just wondering how you got on? I could have written much of your first post word for word @LittleMissViper . Really hoping it’s all turned out well for you.

I'm pleased to report that it did turn out well, @thehonscupboard. 😊

I had my surgery just under two years ago. Recovery was textbook, with no bowel/bladder/prolapse issues. In fact, things are much better than before, as my uterus isn't crushing various other organs now! Turns out I had adenomyosis, and my uterus was about double the size/weight it should have been.

It took a while to get HRT sorted afterwards, as it was eventually realised I was struggling to absorb through my skin. (Which, in hindsight, might be part of why I was struggling so much with the progesterone - as I wasn't getting anywhere near enough oestrogen!)

I didn't want to take oestrogen tablets (rather than gel/spray) due to the stroke risk, so I now have an oestrogen implant inserted every 5 months. I do have to pay privately for this, because the NHS won't cover it in my area at present. I'm hoping that might change at some point.

I did experience some weight gain after the operation, but after tipping into obese I decided to try Mounjaro. It worked incredibly well for me, and I steadily lost over 25% of my body weight over a year while staying on a low dose. I'm now maintaining at the middle of healthy BMI on the lowest possible dose.

With my uterus gone, my HRT sorted and my weight down, I'm in the best health (physical and mental) than I have ever been! I easily drift off to sleep every night, I've got bags of energy, I'm in control of my emotions all the time, and my iron levels seem fine. (Thinking about it, I should probably get them tested to see what they are now.)

I hope that was useful. Good luck with your journey!

I’m so pleased for you! Though a shame you’re having to get your oestrogen privately. 🤞that changes soon. It sounds like you’re in such a good place now which is well deserved after everything. Thank you for updating. Really helpful.