The decision to use or not use menopausal hormone therapy in women without a uterus should involve an individualized risk/benefit analysis just as it should when the uterus is present. Thus, the need for a decision on the use of hormone therapy is accelerated. When a bilateral oophorectomy is performed before natural menopause, the onset of menopausal symptoms, primarily vasomotor symptoms, genital tract atrophy, and/or a decline in sexual function, is rapid, and the symptoms are more severe. Multiple lines of evidence suggest that regimens containing both estrogen and progestogen versus estrogen alone are associated with a greater relative risk of breast cancer without additional improvement in relief of hot flashes or vaginal symptoms. Reasons to add a progestogen to an estrogen-only therapy regimen after hysterectomy include the need to reduce the risk for unopposed estrogen-dependent conditions, chief among which are endometriosis or endometrial neoplasia. When the uterus is absent, estrogen treatment is all that is needed when hot flashes and/or genital atrophic symptoms are associated with surgical or natural menopause. We conducted a literature review, including a review of current guidelines. To review postmenopausal hormone therapy for women who have undergone hysterectomy with or without bilateral oophorectomy and to make clinical recommendations regarding changes in regimens compared with those for women with their uterus in place.
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