The good news, however, is that for women who choose to take estrogen when they have their uterus removed, there is no need to take progesterone as they no longer have a uterine lining at risk for cancer. Synthetic progesterone called progestins, such as Provera, often are prescribed to women with a uterus who are taking estrogen to balance out the estrogen and to prevent a buildup of the uterine lining. Without progesterone to balance out the effects on the lining, unchecked estrogen could eventually lead to uterine cancer.
I think all women need to be informed of their choices and apprised of the risks (there are many) and benefits (there are very few) of such a practice before they go under the knife. Expressing your concerns and wishes to your surgeon in advance will help your surgeon make the best decision for you -- and will more often than not mean you will wake up with your ovaries still intact.
I suggest four things you should ask your doctor before you have a hysterectomy.
1) Can I avoid a hysterectomy? Many women who undergo a hysterectomy could have their medical conditions, such as heavy bleeding and fibroids, treated without surgery. Don't be afraid to ask if you should have a second opinion.
2) Can I have minimally invasive laparoscopy or robotic hysterectomy? The recovery time after minimally invasive surgery is much quicker, and instead of a large incision you end up with a few tiny incisions.
3) Can I keep my ovaries? Always talk over the risks and benefits of keeping your ovaries. Only women with a strong family history of ovarian cancer or women who know they carry the BRCA1 or BRCA2 gene mutations that greatly increase their risk of ovarian and breast cancer should strongly consider having their ovaries removed.
4) Can I begin estrogen in the form of a patch during or immediately after surgery? Women, especially young women, who have their ovaries removed often experience disabling hot flashes soon after surgery. Taking estrogen will help considerably, although finding the right dose of estrogen can take some time. Ask about testosterone cream if estrogen does not completely relieve your symptoms, especially if you experience low libido after the surgery.
What has been your experience after a hysterectomy? What type of surgery did you have? Did you have your ovaries removed? Did you find the right balance of hormones?
As always, I welcome your comments and questions.
Marie Savard, M.D., is an ABC News medical contributor. Her new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions," will be available in August.