When we talk about menopause resulting from surgery, it is important to get a few things straight. You can have a hysterectomy (surgical removal of your uterus) and you won't have any more vaginal bleeding or menstrual periods. But your ovaries will continue to secrete the hormones estrogen and progesterone in a cyclical fashion, usually until close to the time of expected natural menopause. More and more frequently, clinicians are advising women who require a hysterectomy for benign conditions to keep their ovaries because of long-term health benefits.
It is only when your ovaries are surgically removed along with your uterus that you experience induced menopause and hormonal changes including a drop in estrogen, progesterone, and testosterone. Surgical menopause (with removal of the ovaries) is very different than natural menopause. The transition to natural menopause takes many years; surgical menopause occurs in a matter of minutes. Natural menopause results in a loss of estrogen and progesterone, but in most women, testosterone levels remain stable. With surgical menopause, testosterone levels also fall. Natural menopause occurs during midlife; surgical menopause can occur at any age, often years younger. Surgical menopause is usually recommended because of a health condition such as excessive bleeding and anemia, uterine cancer, or endometriosis, which can compromise your well-being before surgery. And surgical menopause abruptly ends your fertility, a significant loss for some women, but a relief for others.
If you have your ovaries removed, common symptoms of menopause, especially vasomotor symptoms or hot flashes, can occur while you are still in the recovery room. Depending upon the reason for the surgery and your personal risks and medical history, some clinicians recommend starting hormone therapy immediately after surgery. Estrogen alone seems to have fewer associated risks, such as less breast cancer, than combined therapy.
But if estrogen therapy is not advised for you, there are other options for relief of severe hot flashes. Beyond dietary and lifestyle changes, antidepressants, and prescription drugs such as gabapentin can help. If you have been prone to depression, you might experience symptoms after the surgery. Sexual function might improve, stay the same, or worsen. Vaginal dryness can be treated with hormonal or nonhormonal vaginal preparations.
The bottom line is that it is very important to understand before you go into surgery what the extent of the operation will be and what your options are for symptom relief. Will you have your uterus removed or both ovaries as well? Is estrogen safe for you, or should you explore other options? If you have already had your surgery, be assured that symptom relief is available. Don't be shy in asking your clinician about which options make sense for you!
Always check back with NAMS for more information about menopause and beyond.
I had a hysterectomy four weeks ago, my ovaries were removed as well. So far I have had very mild night sweats but no other problems. I am taking Prozac 20 my daily, and suspect that might be helping with hot flashes. I also take Vitamins, D, E, Magnesium, Calcium, and Flax. If I do not experience any unbearable symptoms, are there any reasons that I should even worry about HRT? My surgeon said many women are opting not to take them.
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