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[Dex139]

I was due to have orthopaedic surgery which was cancelled on the day due to my HRT - I am on Evorel patches and Utrogestan tablets.  I have been told to stop HRT 4-6 weeks prior to surgery and have no idea when I may restart again.  I am scared as it has taken AGES for me to become settled on HRT and I am worried what symptoms to expect when I stop.  I can't even take natural remedies as again I would have to stop prior to surgery.  I need the surgery, which will result in 3 weeks non-weight bearing and possibly 2 months in a cast.  I'm not sure which I'm more worried about - the op or stopping the HRT.  The internet is so contradictory in that some sites state there is no need to stop transdermal HRT whereas others don't agree.  I think at the end of the day it is down to what the opinions of the surgeon are and so again I am stuck.  Does anyone have any advice please?

[CLKD]

MayB send an e-mail to Dr Currie who runs MM?  there is a charge.  Asking the question. 

I can't understand why any1 has to stop HRT after all, if it were an emergency admission ..... also, with the amount of NHS strikes which are likely to continue until C.mas you will be on a knife edge as to how long you actually need to be off HRT.  Would any other medication be stopped 4-6 weeks prior to surgery and where you given any particular reason?

[Emma]

From Google: "If you normally take HRT your surgeon would like you to stop it at least four weeks before your operation. This is because of an increased risk of developing a blood clot."

[CLKD]

Tnx.  However, with all the strikes etc. and long waiting lists ........... I would want a positive confirmed date B4 stopping HRT!  Is there any Research to back these requests?

[Wrensong]

Hi Dex139, having been in your situation I sympathise.  I was asked to stop HRT prior to 2 episodes of major surgery in 2019-20.  I took in a then current BMJ article to show the surgeon that no increased risk of clotting had been found with transdermal HRT, & though he sympathised he said it was hospital policy that all forms of HRT should be stopped prior to surgery.  I could choose not to comply but he would have to note in my records that I'd been advised to stop & had declined to do so.  The surgeon had been very good to me & I didn't want to make a fuss so did as advised & stopped HRT on both occasions, continuing without it for the advised period post-op.

For more recent surgery at a different hospital, a more major procedure than the first 2 ops & with a longer recovery period, I was advised not to stop HRT & so continued with it.

Today I can't find the same BMJ article but you might find this link & extracts from the Balance website helpful:-

https://www.balance-menopause.com/menopause-library/do-i-need-to-stop-hrt-before-surgery-factsheet/

"Transdermal estrogen

If you take estrogen through the skin (transdermal) via a patch, gel or spray, there is no need to stop taking your HRT before or after surgery, regardless of the type of operation you have.

Studies have shown that there is no increased risk of clot with:

body-identical micronised progesterone, known under the brand name Utrogestan in the UK"

Please don't take this as a recommendation to go against medical advice, rather as info that may help you in discussion with your surgeon if you prefer not to stop HRT.

[purplebee]

I have definitely read an article recently that says you do not have to stop HRT when undergoing surgery. I think this an outdated policy and it is up to you whether you stop or not. I was told to stop  a few years ago when I had a polyp removed and it really upset my HRT..

[CLKD]

It will be up to the Anaesthetist ......... so mayB contact him/her and ask the question.  I would be reluctant to stop any of my medications in case the op was cancelled. 

[Wrensong]

Dex139, I feel for you. What are you going to do?

CLKD, if not raised with Dex139 by her surgeon, the hospital should have brought this up at pre-op assessment.  That they didn't seems a costly & frustrating oversight in terms of arrangements being cancelled at the last minute & is very unfortunate for Dex139.  I discussed it with my surgeon on each occasion, it was also discussed at pre-op assessment with the specialist nurse, at the subsequent anaesthetist appointments & detailed in the typed info sent out, so everyone was clear well in advance about policy at the 2 different hospitals.

I'm sorry Dex139, this must be a stressful situation for you.
Wx

[CLKD]

Tnx.