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Balancing Hormones during the Post Op Period:


Balancing your hormones immediately and for the first year after having your ovaries removed can be quite frustrating.  Some women leave the hospital with a prescription for Hormone Replacement Therapy (HRT) already in place in the form of a patch, injection or pill and never have the need for an adjustment.  However, this is not typical.  Most women are told to wait until the menopause symptoms kick in or for their 6-week post-op checkup to commence use of HRT.  Whatever the case may be, it’s important to understand some crucial facts about what is happening in your body during the first few months to a year post-op.


First and foremost, the body will be going through a withdrawal from the hormones your body was accustomed to producing from your ovaries.  The natural hormones that are stored and circulating in your body will drop; how fast or how slow this process will occur depends on your body’s metabolism.  How rapidly surgical menopause symptoms appear depends upon the individual, how much circulating hormones they had to begin with, along with how fast their hormone metabolism is. For some, this process can be only a couple of days, to a couple of weeks, whereas in other cases it could even take months.


Adding HRT during this period can alleviate many of the uncomfortable symptoms that come with surgical menopause, however, the HRT will initially be competing with the body’s own stored hormones.  As such, the dose you start on may not end up being the dose that you need for the long-term maintenance of your symptoms.  Most women are started on “starting doses” which usually tend to be in the middle range.  The reason doctors do this is so that doses may be adjusted up or down depending on symptom relief and how well that form of HRT is working.  As the body continues to deplete its own stores of hormones the need for HRT will increase.  Adding too much too soon can end up “overdosing” the body with hormones and usually leads to different symptoms.  It’s best to start “slow and low”, gradually tweaking in small increments as the body uses up its own stored hormones. 


This slow and methodical process, while producing symptoms that can be challenging, often leads women to switch methods too quickly and/or frequently. This, in turn, creates an even larger and more uncomfortable hormonal imbalance.  Being patient and understanding with your body during this time can be hard but ultimately will bring about better results from your HRT. 


The other thing that can greatly affect your HRT and hormonal balance during the first year post op is the body’s healing process from surgery.  The body has been through significant trauma. While externally you may look and feel healed,  complete total internal healing can take one year to eighteen months post-op.  During this period the body will be using and expending extra energy to heal.  While healing is a good thing, it is still a stressor on the body and any heightened stress can affect and deplete HRT. 


So, how do you hit on the perfect balance for your hormones during this “post-op” period?  You don’t really.  You adjust the medication to feel the best you can for the moment and realize that the dose you ’re starting with will most likely need adjustments as the body settles into its new normal.  We have put together a list of tips that can help you best navigate this period:


1.      Be determined to be as patient as possible and that this is a process.


2.      Realize your body is still healing internally even if on the outside it is looking fine.

            a.) Eat Healthy foods (i.e. lean proteins, healthy fats, fruits and vegetables)

            b.) Drink adequate amounts of water

            c.) Exercise as allowed by your doctor

            d.) Rest when needed


3.  Find a support group. Whether it be in person where you live, or online, peer support can offer invaluable support, advice, and camaraderie during this transition.  If you are in need of support, please feel free to join our Peer Support Group on Facebook.  You can find the link here:  Support Group


4.  Begin charting your HRT doses and symptoms.  Charting allows you and your doctors to see at a glance what might need to be changed.  It also helps you to notice patterns in hormones and recognize symptoms as “too low” or “too high” of a hormone dose.  We have created an easily printable chart that you can find here:  Monthly HRT Tracking Chart


5.  Start slow and low with HRT, meaning start with a lower dose and work your way upwards if needed and make small incremental changes (no more than 25% at a time).  Give each change 4-8 weeks to “settle” in and then re-evaluate. Jumping from dose to dose or form to form too quickly will lead to greater hormone imbalance as we mentioned above.


There are some common HRT guidelines for different demographics of women; however, remember these are suggestions only and one size does not fit all when it comes to HRT.  Be sure to run all medication ideas, doses and supplements by your doctor BEFORE making any changes.


               A.) Younger women tend to need higher HRT doses.  This is usually because                         their bodies have been used to using higher levels of hormones while in the

                        “fertility” stage.


             B.) Older women tend to need lower doses.  Usually, the ‘fertility stage” has                         passed and the body has adjusted to lower levels of hormones.


                        C.) Women who are skinny tend to need more HRT because their

                       body metabolizes it faster and they have less estrogen stored in their fat tissues.


                        D.) Women who are heavier or have more body fat tend to need Less HRT. 

                        Usually, this is because fat can make small amounts of estrogen.


                        E.) Typically smokers require higher doses of HRT as smoking can compete with                          and use up the hormones


                        F.) Women who exercise heavily will usually also need higher HRT doses as

                        exercise due to increased blood flow, heat, and stress on the body tissues will                         burn up hormones faster


                        G.) Women who are regular drinkers often need lower doses as alcohol can

                        increase estrogen temporarily


6.  Adjust one hormone at a time.  It is very common to see women with prescriptions for estrogen, progesterone and testosterone, however in the beginning as you are learning what your symptoms mean for each hormone and as your body is adjusting, it’s important to be able to evaluate how your body is reacting to each hormone individually.  It’s not uncommon to see hormone chaos escalate when all the hormones are being tweaked and adjusted all at the same time.  Exceptions to this would be estrogen with progesterone for women who need to use progesterone to protect their uterus (in the case of women who’ve only had an oophorectomy) or women who may have endometriosis.


7.  Hang in there.  Hormone balancing is never fun, but it’s not miserable for all.  Some fortunate women find their HRT on the first attempt, while some need more time for tweaking and adjusting.  Going into this with a positive attitude and an understanding there will be a lot of changes happening with your body will help.  If you feel it’s all getting to be too much, please reach out to your physician, a licensed mental professional or a crisis hotline for help.


The National Suicide Hotline Number for the USA is:

National Suicide Prevention Lifeline

Call 1-800-273-8255


Australian numbers are:


Lifeline: 13 11 14

Suicide Call Back Service: 1300 659 467


UK and Republic of Ireland Numbers for Samaritans is:


(UK): 116 123

(ROI) 116 123


There is no shame in needing help.  Hormones affect so much in your body and brain chemistry, it’s not uncommon to find yourself in moments of anxiety or depression, however, we never want you to feel alone or hopeless.  THERE IS ALWAYS HOPE!!!

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