A second injection containing both estrogen and a progestagen is given 10 to 14 days later, depending upon the patient's menstrual response. Menstrual cycle adjustment may be difficult. It may be several years after hysterectomy before HRT therapy becomes necessary. It depends upon the woman's age at the time of surgery and upon the health of her ovaries. In the absence of the uterus there is no need to provide cyclic hormone replacement since there will be no bleeding.
Transdermal estrogen continues unchanged, being replaced twice weekly.
Injections continue to be given at 2-week intervals but often can be spaced somewhat farther apart. Subcutaneous pellets are replaced as often as necessary, at up to 6-month intervals. Doctors disagree whether progestin is needed to be given in this situation. Many gynecologists feel that, with the uterus gone, there is no longer any risk of cancer from unopposed estrogen. Others feel that progestagens are still very important because there is growing evidence that progestagens protect the breasts against cancer, and also help with building new bones.