Dr. Madhu Goyal

A hysterectomy is the removal of the uterus and is often accompanied by the removal of the ovaries. In such cases, women are said to experience surgical menopause. This is because the ovaries are the main producers of estrogen. Surgical menopause is usually more severe than natural menopause as there is a sudden drop in estrogen levels. Estrogen is responsible for a number of functions that affect the brain, bones, skin, heart and blood vessels.

Hormone therapy is often advised to counteract this loss of estrogen.

There are two main types of Hormonetherapy:

1. Hormone therapy with estrogen and progestin
2. Hormone therapy with only estrogen

The former is advisable for women suffering from surgical menopause. Like any other form of treatment, it has its pros and cons.

Pros

1. It protects young women from diseases associated with menopause: A hysterectomy is usually performed on women under the age of 50. In such cases, Hormone replacement therapy can protect the women from heart diseases. Removing ovaries before menopause can also increase the risk of Parkinson's disease and dementia.Hormone replacement therapy can help negate these risks.
2. Reverse menopausal symptoms: Menopause is associated with a number of symptoms such as vaginal dryness, hot flashes and insomnia. Hormone replacement therapy can help treat these symptoms and give you a better quality of life.
3. Other health benefits: Hormone replacement therapy can also help fight osteoporosis and strengthen bones. It is also known to reduce the risk of colorectal cancer.

Cons

1. Side effects: Hormone replacement therapy interferes with the natural Hormone production. Thus, it can cause a number of problems such as premenstrual syndrome, swollen breasts, headaches and nausea.
2. Increased risk of health issues: Though the odds are low, Hormone replacement therapy can increase your risk of having a stroke or heart attack. It has also been suggestively linked to breast cancer and ovarian cancer.

Thus, the choice of whether to have or not to have Hormone replacement therapy after surgical menopause is not easy to make. You must consider factors such as your age, lifestyle, family medical history and habits while making this decision. Do not rush into a decision and take your time. Talk to your doctor about the amount of medication needed and the delivery method most suited to you. Hormone replacement therapy can be taken in the form of pills, a patch, gel, vaginal cream or a slow releasing suppository. This should  also be accompanied by a healthy lifestyle that includes a healthy diet and plenty of exercise.

Folic acid is the synthetic form of the vitamin B9 and more commonly known as folate. For a pregnant woman, it is extremely important to consume folic acid in adequate quantities. It has the ability to prevent any birth defect, related to brain and spinal cord. It essentially protects the neural tube, which shapes into the spine and the brain. Since neural tube defects can occur in the first few weeks of pregnancy, it is essential that a woman starts consuming folic acid right before she endeavors to conceive.

What are the benefits?
Many researchers are of the view that folic acid is a key component for safeguarding the baby from certain diseases such as cleft palate, certain heart defects and cleft lip. Apart from this, folic acid mitigates the risk of pre-eclampsia in a pregnant lady. Pre-eclampsia is a disorder related to blood pressure and affects close to 5%of all pregnant women. Folic acid also helps a would-be mother from a type of anemia. It is responsible for giving birth to DNA and increasing cell growth of the baby.

Consumption amount of folic acid:
In order to save the baby from any neural defect, it is essential that a pregnant woman consumes at least 400 micrograms of folic acid on a daily basis. Since many women conceive without planning, it is therefore suggested by experts that all women entering the childbearing age should consume folic acid. Some groups such as the National Institute of Health, US suggest that folic acid consumption for a pregnant woman should be 600 micrograms per day. If you are taking any supplements, check the label to see the folic acid quantity present in it. If a woman is consuming prenatal vitamin as prescribed by a doctor, she should not consume any folic acid from outside, since it already has a folic acid content of around 800-1000 microgram. To abstain from any side effects, it is strongly advised not to consume more than 1000 micrograms of folic acid per day..

When is extra folic acid needed?

1. If you are carrying twins
2. If your previous pregnancy involves a neural tube defect
3. If you have a genetic condition called methylenetetrahydrofolate reductase
4. If you are suffering from diabetes or consuming any anti-seizure medications

What are the sources of folic acid?

1. Certain grain products such as pasta, cereals, rice and bread
2. Certain food supplements available in the market
3. Naturally occurring vegetables such as spinach, turnip greens, avocado, broccoli, and Brussels sprouts
4. Citrus food or the juice extracted from them without adding any sugar component to it
5. Certain nuts and peas 

   If you wish to discuss about any specific problem, you can consult a dietitian-nutritionist.

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Keep Your Bones Strong.

 Calcium and vitamin D can help you do that. Dairy products are the best sources of calcium, but other options are green, leafy vegetables like broccoli and kale. If you don't get enough calcium from food, ask your doctor about supplements.