After hysterectomy, (inc ovaries), what kind of hormone replacement would a 46 yr old have to go on? estrogen?

It would be a decision made between you and your doctor as to whether you had HRT or not. If the hysterectomy takes your ovaries, you would begin instant menopause- and what that did would depend on you and your body. HRT is primarily to replace the estrogen, and doctors don't like to give it for more than about six months because it puts you at a higher risk for a heart attack or stroke. How bad the symptoms will be is anyone's guess. A lot of how bad it feels is really your personal take on matters. As far as how old you feel, that's a matter between your ears, not a matter of the reproductive system. If you are looking at a complete hysterectomy, obviously things aren't functioning correctly now- things couldn't get any worse really. Once the body settles down to the postoperative changes, and the changes in hormones, you may well find menopause to be particularly attractive. You will like the freedom from the monthly inconvenience of a period, no more pregnancy fears, and no more problems. It can actually improve the life, being free of those concerns. And honestly, nobody can exactly tell you are post menopausal unless you tell them. It's their guess up to a certain point, really. Nothing else about you has to much change. You will need to up the calcium intake, but most of the changes are really sensible life changes anyway- things like a low fat diet, exercise and the rest. There are no "natural" alternatives to hormone therapy, as estrogen is a body product, not a plant product. The estrogen like compounds in soy are similar, but not the same. There was a theory that soy intake was why oriental women didn't have menopausal problems, but the explanation is likely more social conditioning. It's actually honorable to grow old in the orient, they don't see it as a bad thing. So menopause is not a thing to be dreaded, it's a rite of page into the status of honored elder woman, with wisdom and experience to be sought out by younger women. I won't say there aren't some physical discomforts, there may be some. But how bad it is, that's for you to decide. You can consider it freedom, or a sentence - that's up to you really. Speaking as an "honorable older woman", it's really not that bad. And I'm not so old that anyone else would suspect either.