Hormone Replacement Therapy
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CRS/HIPEC surgery may require removal of the ovaries and uterus, which can trigger surgical menopause by disrupting hormone production and fertility. Hormone replacement therapy (HRT) is often a safe and important option after surgery, and this resource helps patients understand menopause, HRT, and their associated benefits and risks.
Hormone Replacement Therapy
Once you decide with your surgeon that CRS/HIPEC is right for you, there is a potential that during the procedure they will have to remove your uterus/ovaries to achieve the best outcome. This part of the procedure will remove a major contributor to your hormone health, impacting your estrogen, testosterone and progesterone production in addition to fertility putting you into surgical menopause. Symptoms of surgical menopause may be immediate, or they may take awhile to emerge. Given the consequences of surgical menopause both short term and long term in terms of quality of life and chronic disease development, knowledge is important. We have created an evidence-based patient information page for Surgical menopause that includes links to important podcasts, websites and social media experts to support access to this important knowledge.
Replacing your hormones after Cytoreductive Surgery and/or Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) is an important decision after your surgery. This surgery is extensive, and most often includes removing your ovaries (the main factory for female hormones). Removing your ovaries causes surgical menopause. The good news is that your care team is knowledgeable about HRT and its safe use after CRS/HIPEC.
Depending on your age and health status, you may feel the effect of surgical menopause immediately, after you are discharged from the hospital and/or the acute effect may not be noticeable. Symptoms of surgical menopause vary between patients. This resource explains surgical menopause, HRT and the benefits/risks of receiving HRT.
Surgical Menopause
Surgical menopause occurs when both ovaries are removed (bilateral oophorectomy), often during a hysterectomy or as part of treatment for conditions such as endometriosis, ovarian cysts, or cancer. Because the ovaries produce estrogen, progesterone, and testosterone, their removal causes an immediate and significant drop in hormone level regardless of your age.
Unlike natural menopause, which happens gradually over several years, surgical menopause is abrupt. Symptoms can begin within days to weeks and may be more intense.
Symptoms of Surgical Menopause
Hormones are important regulators for 100s, maybe even 1000s of functions in the female body.
Common symptoms include but are not limited to:
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Hot flashes and night sweats
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Sleep disturbance
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Mood changes or anxiety
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Vaginal dryness and painful intercourse
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Decreased libido
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Brain fog
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Joint aches
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Fatigue
These symptoms can be confusing especially after surgery and may be dismissed as the result of chemotherapy and/or surgery. These symptoms can last a long time and contribute to poor quality of life long after recovery from surgery.
HRT: Explained
Every woman’s situation is unique. A comprehensive discussion about surgical menopause symptom management, bone and heart health, and long-term wellness is essential before and after surgery.
Hormone Replacement Therapy is a medical treatment that helps restore estrogen (and sometimes progesterone and/or testosterone) when levels decline after surgical menopause. When prescribed appropriately, it is one of the most effective treatments in midlife women’s health.
It typically includes estrogen (with progesterone if a woman has a uterus), and in some cases testosterone. These hormones can be provided in a variety of ways; pills, patches, gels, creams, injections, and/or pellets. Hormones are picked up at a pharmacy and you must have a prescription to obtain them.
Benefits of HRT
Relief of Vasomotor Symptoms
Hormone replacement therapy (HRT) is the most effective treatment for hot flashes and night sweats. Clinical evidence shows it can reduce symptom frequency by about 75% and severity by nearly 90%, often providing significant relief within weeks. [1,2]
Mood & Cognitive Support
Estrogen interacts with serotonin and dopamine pathways. For some women, HRT improves mood stability, reduces irritability, and may help with brain fog when started around the time of menopause.
Vaginal & Sexual Health
Systemic or local estrogen improves vaginal dryness, pain with intercourse, and urinary symptoms.
Testosterone therapy (when indicated) can improve sexual desire in women with diagnosed hypoactive sexual desire disorder (HSDD).
Improved Sleep
By reducing night sweats and stabilizing hormone fluctuations, many women report better sleep quality and fewer nighttime awakenings.
Bone Protection
Estrogen plays a key role in bone remodeling.
HRT significantly reduces bone loss and lowers the risk of osteoporotic fractures, especially when started near menopause.
Cardiovascular Support (Timing Matters)
When initiated in healthy women under age 60 or within 10 years of menopause onset, HRT may reduce coronary heart disease risk compared to starting later — this is known as the “timing hypothesis.”
Quality of Life
For many women, the greatest benefit is functional:
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More energy
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Clearer thinking
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Better intimacy
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Improved confidence
How to Access Hormone Replacement Therapy (HRT)
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Start with your healthcare provider
Schedule an appointment with your primary care doctor, OB/GYN, oncologist, or a menopause or hormone specialist to discuss your symptoms and goals.
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Review your medical history
Your provider will evaluate your health history, current medications, cancer history (if applicable), and any risk factors to determine whether HRT may be appropriate for you.
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Discuss risks and benefits
Have an open conversation about the potential benefits, risks, and alternatives so you can make an informed decision together.
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Complete any recommended testing
In some cases, your provider may order bloodwork, mammograms, or other evaluations before starting therapy.
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Receive a prescription (if appropriate)
If HRT is a good fit, your provider will prescribe the type, dose, and form (such as pills, patches, gels, or creams) that best meets your needs.
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Choose a pharmacy or delivery option
You can fill your prescription at a local pharmacy or through a mail-order or specialty pharmacy, depending on your provider’s recommendation.
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Monitor and follow up
Regular follow-up appointments are important to track how you’re feeling, adjust dosing if needed, and monitor for any side effects.
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Revisit your plan over time
Your needs may change, so ongoing conversations with your care team will help ensure your treatment continues to align with your health goals.
Risks of HRT
Like any medical treatment, hormone replacement therapy (HRT) comes with potential risks. Understanding these risks doesn’t mean HRT isn’t an option—it simply means patients and families should have the information they need to make thoughtful choices. Be sure to discuss the risks and benefits with your doctor so you can decide what feels right for your situation.
Breast Cancer
This is the risk most women worry about — and it requires nuance.
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Combined estrogen + synthetic progestin therapy (as studied in the WHI) showed a small increased risk of breast cancer after about 3–5 years of use.
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Estrogen-only therapy (for women without a uterus) did not show increased risk in the WHI and showed a slight reduction in breast cancer incidence in long-term follow-up.
Risk depends on:
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Type of progestogen
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Duration of use
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Personal and family history
The absolute increase in risk for most women is small.
Blood Clots (Venous Thromboembolism)
Oral estrogen slightly increases the risk of blood clots.
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The absolute risk is low in healthy women under 60.
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Transdermal (patch/gel) estrogen does not appear to increase
clot risk the way oral estrogen can.
Patients at the highest risk:
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History of clots
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Obesity
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Smoking
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Genetic clotting disorders
Stroke
Risk is influenced by age and route of administration.
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In women under 60 or within 10 years of menopause, the absolute increase in stroke risk is small.
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Risk increases with age, particularly after 60.
Again, transdermal estrogen may carry lower risk than oral.
Endometrial Cancer (If Estrogen Is Used Alone with a Uterus)
Unopposed estrogen stimulates the uterine lining. Women with a uterus must take progesterone (or equivalent protection) alongside estrogen to prevent endometrial hyperplasia and cancer. When properly prescribed, this risk is preventable.
Gallbladder Disease
Oral estrogen increases the risk of gallstones and gallbladder surgery.
Transdermal estrogen carries less risk.
Given the benefits and risks, it is best to have a discussion with your medical provider/surgeon prior to initiating any type of HRT. They will help you determine your benefit/risk ratio, type of HRT that you need, and appropriate follow-up.
Side Effects
Side effects are typically dose dependent, meaning when we adjust the dose these side effects get better:
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Breast tenderness
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Bloating
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Nausea
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Breakthrough bleeding
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Mood changes
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Acne (if testosterone is included)
If you start HRT and have side effects be sure to consult with your provider to discuss these and consider a change in dose and/or type.
Other Resources
Websites
• British Menopause Society: Surgical Menopause: a toolkit for healthcare professionals
https://thebms.org.uk/wp-content/uploads/2024/10/13-BMS-TfC-Surgical-Menopause-SEPT2024-D.pdf
• Surgical Menopause Questions and Answers with Dr Hannah Short.
https://menopausesupport.co.uk/?page_id=18181
• Surge Menopause
SURGE | Empower Your Surgical Menopause Journey
• The Menopause Society
Deciding About Hormone Therapy Use
Podcasts
• Dr. Corinne Menn, MD - The Challenges of Surgical and Early Menopause (Episode 92)
The Challenges of Surgical and… - Hit Play Not Pause - Apple Podcasts
• Dr. Louise Newson - Health risks and treatment of surgical menopause with Dr. Walter Rocca
Podcast Hormone and Menopause
• Dr. Louise Newson - Surgical Menopause with Dr. Rebecca Lewis & Dr. Louise Newson
Surgical Menopause
1. The North American Menopause Society. Hot flashes. Menopause.org. Accessed April 3, 2026. https://menopause.org/patient-education/menopause-topics/hot-flashes 2. Islam RM, Bell RJ, Billah B, Hossain MB, Davis SR. Vasomotor symptoms in menopause: a review of current evidence and management strategies. Front Endocrinol (Lausanne). 2021;12:564781. doi:10.3389/fendo.2021.564781 3. Lumsden MA, Davies M, Sarri G. Diagnosis and management of menopause: the NICE guideline. Best Pract Res Clin Obstet Gynaecol. 2022;81:3-14. doi:10.1016/j.bpobgyn.2021.11.002 4. Sarrel PM, et al. Hormone replacement therapy in young women with bilateral oophorectomy. PMC. 2016. Hormone replacement therapy in young women with surgical primary ovarian insufficiency 5. Mehta J, et al. Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy. Front Endocrinol. 2021. Frontiers | Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy: Current Concepts 6. Tomić Naglić D, et al. HRT in surgical menopause after gynecological malignancies. Biomol Biomed. 2025. Hormone replacement therapy in surgical menopause after gynecological malignancies - PubMed 7. Secoșan C, et al. Surgically Induced Menopause — A Practical Review. PMC. 2019. Surgically Induced Menopause—A Practical Review of Literature - PMC 8. Arnautu AM, et al. Menopausal hormone therapy — risks, benefits.... Int J Mol Sci. 2025. Menopausal Hormone Therapy—Risks, Benefits and Emerging Options: A Narrative Review
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