Should HRT be stopped before surgery?

I am going to have a face, neck and forehead lift as well as a bit of CO2 laser resurfacing in a few months. I am on the bio identical HRT estrodial patch and also progesterone and DHEA. Do I need to stop all of this before surgery - and how soon? Do I need to taper off or can I just stop?

Doctor Answers 9


In our opinion,and in our practice,we have our patients stop HRT 7to 10 days prior to their facelift.This is done to reduce the chances of a blood clot in the legs while under anaesthesia.We also place our patients on pneumatic compression devices and compression stockings during the surgery for the same reasons.Although vaginal breakthrough bleeding is a possibility with stopping the HRT abruptly ,it is extremely rare.I hope this helps.

Toronto Facial Plastic Surgeon
4.2 out of 5 stars 5 reviews

Should HRT be stopped before surgery

In our practice we ask all patient to get off of aspirin, ibuprofen products, vitamin E and herbal supplements. There probably won't be a consensus on this issue, but  to prevent bleeding during the facelifting procedure is probably best to stay off the bioidentical hormones and DHEA for 2 weeks before and 2 weeks after the surgery.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

HRT and facial rejuvenation surgery

Great questions for which there isn't a firm consensus opinion.  The theoretical problem with hormone replacement and a surgery, is the possibility of deep venous thrombosis (DVT) and/or pulmonary embolism (PE), both of which are undesirable complications, which can require additional treatments, including hospitalization.  Discuss all medications with your operating PS because the conventional wisdom is history which is not disclosed can eventually hurt both you and the physician.  Most PS will try to limit the operating time, position you comfortably, with your knees slightly flexed and the legs clad with either TED hose and/or sequential compression devices, which squeeze your calves and keep the venous circulation flowing.  Some colleagues require facial rejuvenation patients discontinue HRT, at least 2 weeks before and after surgery, however most discuss this with the patient's treating gynecologist.  Hope this helps.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 56 reviews

HRT and surgery

You need to discuss this with your operating surgeon.  There are several factors that come into play. 

Do you have other risk factors for blood clotting such as a personal or family history of blood clotting or obesity?  Will you be having a general anesthetic?  Does your doctor use compression devices on your legs (he/she should if you are having a general anesthetic).

And how do you feel off the HRT?  If you have a really hard time with hot flashes, you will probably want to continue your HRT.  Having a hot flash while recovering from extensive facial surgery sounds very, very unpleasant.

Make sure you discuss this with your doctor when he/she sees you for your preoperative appointment. 

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 67 reviews

HRT and Facial Rejuvenation

Dear misscre8iv, My practice is to stop HRT one week prior to surgery but no doubt your surgeon will have an opinion on this topic. Seasons greetings, James

James Southwell-Keely, MD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 16 reviews


Thank you for your question.

Normally for surgery the patient has to suspend any Medication that might lead to excesive bleeding during surgery, speak to your Doctor and Anesthisiologist to get their point of view on this issue.

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 241 reviews

When stopping hormone replacement therapy for surgery is needed

HRT is associated with an increased risk of blood clots in the legs which can cause serious complications. However, there are several other factors such as length of surgery, age of the patient, and body mass index. Your plastic surgeon will advise what is best in your specific case.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 45 reviews

Should HRT be stopped before surgery?

That is a good question, and you really need to check with your specific surgeon to get his recommendation. If you are a non-smoker and not dramatically overweight and no other serious health problems, we probably would not require you to stop the meds.            

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Should HRT be stopped before surgery?

Your surgeon will be the physician treating you and responsible for your care, so you really need to ask your particular surgeon your questions. He or she may have specific requirements in regards to HRT therapy and your surgeon's advice should be followed to obtain the best outcome from your procedures.

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.