After a hysterectomy, it's not uncommon for women to experience shifts in their hormone production that may result in symptoms like hot flashes, night sweats, and even insomnia. Hysterectomies that include the removal of both ovaries (oophorectomy) are more likely to cause hormonal symptoms, as this type of hysterectomy results in the woman immediately entering menopause. Still, even those with ovary-sparing hysterectomies may notice some shifts in their bodies. Understanding the impact of a hysterectomy on hormones can help women personalize a health and wellness plan to maintain hormone balance post-surgery.

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Understanding Hysterectomy and Its Impact 

A hysterectomy is the surgical removal of the uterus and can be categorized into a total, partial, or radical hysterectomy. A total hysterectomy is the most common type. It involves the removal of the entire uterus and cervix, whereas a partial hysterectomy removes just the uterus and leaves the cervix intact. A radical hysterectomy also includes removal of a portion of the vagina and is typically reserved for specific cancer treatments. Hysterectomies may or may not include removal of the ovaries and fallopian tubes.

Post-hysterectomy, hormonal changes can vary from woman to woman and depend on the type of hysterectomy. If the ovaries are removed as part of a hysterectomy, a woman will immediately enter menopause and can experience symptoms including hot flashes, night sweats, sleep issues, mood swings, and irritability. These symptoms are due to the sudden loss of estrogen and progesterone that comes with the removal of the ovaries. For ovary-sparing hysterectomies, these symptoms may not occur, though hysterectomy has been linked to an earlier occurrence of menopause, particularly in women over 40.

Hormonal Changes and Their Symptoms

After a hysterectomy, women may experience a variety of different hormonal changes and symptoms. If the ovaries are removed as part of a hysterectomy, menstruation stops, and the woman immediately enters menopause. The rapid plummet of estrogen and progesterone levels may lead to symptoms similar to that of women who have gone through menopause without a hysterectomy.  

The loss of estrogen may lead to symptoms including:

• Hot flashes
• Vaginal dryness
• Brain fog
• Depression
• Insomnia and other sleep changes
• Fatigue
• Night sweats
• Changes in skin elasticity

Low progesterone may also contribute to hot flashes and can present as mood swings, anxiety, irritability, or poor sleep.

While menopause will not occur immediately in those who have not had their ovaries removed during a hysterectomy, the procedure results in women being twice as likely to experience ovarian insufficiency post-op as those who have not had a hysterectomy. This also leads to a reduction in sex hormones like estrogen and progesterone, and women may still experience many of the aforementioned symptoms due to fluctuating and declining estrogen and progesterone levels; it just may occur over time rather than immediately after the procedure.

The Role of Diet in Hormonal Regulation

There are plenty of nutritional strategies that women can experiment with after a hysterectomy to help support hormone balance. An anti-inflammatory diet that’s high in protein and fiber can help keep inflammation at bay and support healthy hormone levels. With the drop in estrogen that can occur after a hysterectomy, women become more at risk of bone loss and lean muscle loss, so including adequate protein helps maintain lean mass in addition to improving hunger and satiety cues. Including fiber in the diet helps with weight regulation, which can become problematic for women entering perimenopause and menopause due to changing hormones. 

Additionally, a personalized approach that helps to keep blood sugar and insulin in check may also be helpful, as women tend to have an increased risk of insulin resistance and diabetes as estrogen levels fall. A great way to determine what diet is best is the use of a continuous glucose monitor (CGM) to gauge an individual’s responses to different diets and foods. 

Including foods that are sources of phytoestrogens - like flaxseed and soybeans - may help relieve some of the symptoms related to estrogen loss, such as hot flashes. Phytoestrogen also helps lower risk of cardiovascular disease, a risk that rises for women after menopause due to the loss of estrogen. 

Additionally, ensuring adequate intake of vitamins and minerals is essential to support hormone balance after having a hysterectomy.  Calcium and vitamin D become even more critical for immune and bone health, while adequate magnesium helps reduce anxiety and stress associated with hormonal fluctuations.  

Lifestyle Modifications

There are also several lifestyle changes that women can make after hysterectomy to help support healthier hormones, including paying attention to stress, optimizing sleep quality, and making sure they stay physically active.

Stress management is critical to help support healthy hormones. In women who’ve had a hysterectomy with an oophorectomy and immediately enter menopause, the adrenal glands have to start aiding in sex hormone production in addition to their regular role in cortisol production. High-stress levels can put a strain on the adrenal glands, and continually elevated cortisol from ongoing stress can amplify other symptoms of hormone imbalance. Practicing breathing, meditation, or mindfulness can help reduce stress, as can exercise and socialization.

Hormone changes after a hysterectomy can impact sleep, so prioritizing sleep hygiene and getting quality sleep is also essential. Having a consistent sleep schedule and ensuring one goes to sleep in a cool, dark room without technology is ideal for optimal sleep quality. There’s also been a rise in health tech, such as mattress coolers to help with thermoregulation; this may be an excellent option for women dealing with hot flashes or night sweats after a hysterectomy to improve sleep quality.  

When it comes to exercise, emphasizing strength training and weight-bearing exercise becomes more critical than ever to help support bone density and offset the increase in muscle loss that can come with the loss of estrogen. Regular walking and yoga also help keep the body mobile and help to reduce stress.

Hormone Replacement Therapy (HRT) Considerations 

Women may also consider the use of hormone therapies after a hysterectomy to better support hormone balance. HRT has benefits for many women dealing with hormonal symptoms, though it’s not for everyone. Functional medicine testing can help determine if one is a good candidate for hormone therapy, and it’s important to note that HRT is very bioindividual - meaning it may take some trial and error to figure out the right fit for each woman. 

There are two main categories of hormone therapies: 

• HRT typically involves synthetic estrogen and progestins derived from pregnant mares’ urine and other substances
• Bioidentical hormone replacement (BHRT) uses plant-based hormones (typically derived from wild yam or soy) to provide hormones more similar to those naturally produced by the body. 
  

Women experiencing early menopause (which is a risk even for ovary-sparing hysterectomies), significant vasomotor symptoms (such as hot flashes or night sweats), vaginal dryness, brain fog, and a trend towards osteoporosis all may have good reason to consider hormone therapies to improve their symptoms and quality of life.  

There are some risks for HRT, though these have primarily been studied in women who still have a uterus and are typically due to prescribing estrogen alone without progesterone. Risks may be minimized by always pairing the two hormones together. Hazards include blood clots, stroke, and breast cancer. When it comes to BHRT, side effects are not always reported because the FDA disapproves BHRT. Side effects are more likely to occur when starting BHRT as the body adjusts to the new hormones and may include fatigue, skin changes, bloating, mood swings, and weight gain, amongst others. 

Ultimately, having a conversation with your provider and taking your unique health history and functional medicine testing into account can help determine if HRT is a good fit for you post-hysterectomy. 

Integrative and Complementary Therapies

After a hysterectomy, integrative and complementary therapies can also be part of a personalized treatment plan to address any symptoms of hormone imbalance, especially in women who had a hysterectomy with removal of the ovaries. These therapies may include herbal remedies, acupuncture, or homeopathy.

Herbs such as black cohosh or dong quai have been used to help alleviate symptoms of low estrogen after a hysterectomy. Black cohosh is phytoestrogen and may mimic the body’s estrogen to help ease symptoms such as hot flashes or night sweats. Another herb, ashwagandha, has long been touted as a remedy to help address stress, as it is an adaptogenic herb. Studies have linked the herb to lower rates of anxiety and stress in perimenopausal women, making it another option to help with symptoms of hormone imbalance that often occur after a hysterectomy.  

Acupuncture has also been found to be helpful for certain side effects of hysterectomy, including bladder dysfunction and urinary incontinence. Additionally, randomized studies have found that acupuncture use is associated with reducing symptoms of hormone imbalance, such as hot flashes, excessive sweating, insomnia, mood swings, and even skin and hair issues in women dealing with menopausal symptoms.

Last, homeopathy is a natural approach to health that involves using diluted amounts of herbs, minerals, and other substances to help improve the body’s ability to heal naturally. While the literature is a bit scarce, some studies have found homeopathy to be effective for treating symptoms of hormone imbalance, such as hot flashes, making homeopathy another option for women dealing with hormonal symptoms after a hysterectomy. 

Functional Medicine Lab Testing

Functional medicine lab testing can be a helpful tool to assess hormone levels and overall health in order to design a personalized treatment plan in women post-hysterectomy. To evaluate hormone health, the Female Blood Profile II by ZRT Labs can look at hormone levels and identify any imbalances that may be contributing to symptoms. Additionally, the DUTCH Plus by Precision Analytical is an excellent fit to not only look at reproductive hormones like estrogen and progesterone but also to evaluate cortisol and the cortisol awakening response (CAR) to understand how stress hormones may be playing a role in a woman’s symptoms The DUTCH test is also a good test to help monitor bioidentical hormone therapies.

Additionally, a micronutrient panel such as the Micronutrient Test from Spectracell that looks at an array of vitamins and minerals would be helpful to ensure an individual has the building blocks needed for optimal hormone health and metabolism and can help guide supplementation of important micronutrients for women in perimenopause or menopause such as calcium, zinc, and vitamin D. 

Evaluating fasting insulin and blood glucose can also help monitor the risk of insulin resistance, as hysterectomy with oophorectomy may increase the risk for diabetes, mainly if hormone replacement therapy is not used.  

Emotional and Mental Health Support

‍Studies show that women who have had a hysterectomy are at a higher risk for depression compared to their counterparts who have not had the surgery, and including ovarian removal amplifies that risk. The sudden change in emotions and physical symptoms that can occur after the procedure can lead to mood swings, irritability, anxiety, and other mental health symptoms, and it can be an abrupt transition emotionally for some women. It’s essential to have a support network in place before and after the procedure, including both family and a professional support team. In fact, studies have found that women need a post-procedure support system to help with adaptation to life after a hysterectomy, particularly from their partners and healthcare providers. 

The rapid change in hormones that occur after hysterectomy with ovary removal also impacts brain neurochemistry, as neurotransmitters such as serotonin and dopamine are directly related to estrogen levels in the female brain. Changes in neurotransmitters influence mood, emotional regulation, and even sleep, meaning that women may need to prioritize emotional and mental health support during the post-procedure transitional period. 

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Hormones After Hysterectomy: Key Takeaways

There are many options for supporting hormone health after a hysterectomy, with the type of hysterectomy being a primary factor in determining how hormones may change after the procedure. Looking at diet, exercise, and lifestyle can help support better hormonal harmony and set each woman up for long-term success. Functional medicine lab testing can be used to determine a personalized treatment plan to ensure hormonal balance after a hysterectomy.