Why Your Doctor Tells You to Stop Hormones Before Surgery and Why You Should Not

April 15, 2022

If you are taking hormones and are due for an upcoming operation, you may have been told by your surgeon to stop taking your hormones a week to several weeks before the operation. This blog post will review why your doctor may tell you to stop your hormones and when and why you should not.

What are the concerns?

A risk of surgery is the development of blood clots which can typically be prevented safely and effectively. For hormone replacement therapy (HRT), the concern from some healthcare professionals is the hormones will predispose the patient to blood clots. Other concerns include the risk of negative cardiovascular outcomes such as heart attack and stroke. What is the basis for these concerns?

Disparities exist between synthetic and bioidentical hormones. Bioidentical hormones (BHRT) are identical to what your body produces whereas synthetic hormones (HRT) are not.

HRT and Surgery

The risk of blood clots has been associated with synthetic hormone formulations which is why your doctor will tell you to stop taking your hormones before surgery.  Synthetic progestins and estrogens may have a negative effect on vasculature and lipid metabolism, leading to clotting, stroke and heart attacks. Studies, including the Women’s Health Initiative, show the risk of having a venous thromboembolism (VTE) is almost two times as high (1.7) in woman taking oral synthetic estrogen and progesten hormones (HRT) than those who took no hormones. 14  Women who took oral synthetic estrogen only and no progestens had less than ½ times higher (1.31) incidence of VTE than those who took no hormones. 14  However, those who took topical bioidentical estrogen alone or with progestens had no increase in VTE, compared to controls. 14

BHRT and Surgery

Studies, however, have not found the same risk of blood clotting when using bioidentical hormone formulations compared to their nonbioidentical synthetic counterparts. In fact, several studies showed no increased risk with transdermal estrogen and progesterone as well as oral progesterone.   ”The lack of blood clots with transdermal estrogen and with vaginal estrogen is very reassuring for women who need to continue taking hormones as they age when risk of blood clots increases.” 14

Another study showed no increased risk of such outcomes with testosterone therapy.1,2,3,4 There is currently no evidence base to support stopping bioidentical hormones pre- and perioperatively at this time which is why there is NO REASON TO STOP your bioidentical hormones.

The Beneficial Role of Hormones in Surgery

Surgery almost always leads to some degree of stiffness, muscle weakness, atrophy and pain which then leads to longer recovery times and delayed healing. Stopping hormones before surgery may come at a cost to the patient for various reasons including decreased energy levels, stamina, mental health, and wound healing.  This is why you should NOT stop your bioidentical hormones before surgery.

Hormones are potent messengers, playing a crucial role in every organ system of the body with healing properties and numerous benefits. Without optimal levels of hormones, you may have muscle loss, bone loss, decreased motivation, decreased circulation, low energy and disturbed sleep all of which may hinder your ability to recover. Hormones also help protect against stress and inflammation which is essential for a fast recovery as surgery is a major stress on the body.

The benefits of hormone optimization before and after surgery include:

  • Enhanced wound healing
  • Decreased inflammation
  • Faster recovery time
  • Better sleep
  • Better memory
  • Prevention of muscle loss
  • Increased muscle mass
  • Prevention of bone loss
  • Increased bone formation
  • Improved mood
  • Improved energy
  • Cardiovascular protection
  • Improved circulation
  • Reduced blood pressure

Supporting Evidence

A 2013 study showed women are 30% more likely to require repeat hip replacement surgery within the first three years of operation compared to men due to failure of hardware, requiring revision surgery. This failure is hypothesized in large part to be due to bone loss.5

One year later, a retrospective study showed the comparison of outcomes from total hip and knee replacement surgery between women receiving HRT and those not receiving HRT. The women receiving HRT experienced a 40% reduction in the need for revision surgery in the year following compared to those not on HRT. For those on HRT for a year or longer, they had a further reduction in failure risk, increasing to about 50%. More adherence to HRT and longer duration of therapy appeared to be directly associated with hardware survival.6

Studies suggest the combination of estrogen and progesterone to play key roles in the maintenance of bone, improved blood flow and protection of the brain and nervous system. The combination of estrogen and progesterone is necessary for driving wound repair. A decrease in both estrogen and progesterone activates more inflammation, contributing to a lengthier recovery.7,8

A study dedicated to assessing testosterone levels in men and women with severe osteoarthritis who underwent total knee replacement showed higher total testosterone levels were associated with less pain in the operated knee of both men and women. Higher testosterone levels were associated with less disability in women following surgery and also appeared to demonstrate a protective effect, showing fewer arthritic changes on x-ray in obese women with higher testosterone levels.9

Decreased testosterone levels have been shown to impede wound healing, decrease muscle mass and contribute to bone loss. Studies have shown preoperative testosterone supplementation may counteract muscle weakness, loss of strength and improve outcomes. A study assessing outcomes among men undergoing ACL repair demonstrated supplementation with testosterone perioperatively increased lean muscle mass six weeks following ACL reconstruction.10,11

Low testosterone levels have been associated with increased morbidity and mortality from surgery. Low levels were associated with decreased survival.12 Similarly, estrogen and progesterone levels have been shown to be effective predictors of 30-day mortality in older women undergoing hip surgery. A study found higher progesterone levels were the “key protective factors for 30-day mortality” and that subjects with “lower estrogen and/or progesterone levels had a significantly higher percentage of death at 30 days post-surgery.”13

Conclusion

Optimizing hormone levels before and after any surgery has been demonstrated to be a key contributor to successful outcomes. Some surgeons are now recommending their elective patients to optimize their hormone levels prior to surgery as they have seen better outcomes and faster recovery times. Optimizing hormone levels makes people feel better, prevents bad outcomes, and promotes faster wound healing and recovery times. The potent healing powers of hormones have helped many recover faster from surgery while providing an abundance of other health benefits.

Have an awesome day!    Dr. D

  1. https://www.bmj.com/content/364/bmj.k4810
  2. 2.https://www.tandfonline.com/doi/abs/10.3109/13697137.2010.507111?journalCode=icmt20
  3. https://sci-hub.se/10.1016/j.mayocp.2015.05.012
  4. https://pubs.asahq.org/anesthesiology/article/127/3/457/17765/Association-of-Testosterone-Replacement-Therapy
  5. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1653996
  6. https://sci-hub.se/10.1136/annrheumdis-2013-204043
  7. https://sci-hub.se/10.1111/j.1524-475X.2008.00440.x
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5713294/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702066/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555502/
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1501119/
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743202/
  13. https://www.frontiersin.org/articles/10.3389/fmed.2020.00345/full
  14. https://www.sciencedaily.com/releases/2016/03/160330085613.htm
Posted in Hormonal, hormones