Surgical menopause, or a hysterectomy, can be a difficult decision to make and a challenging journey to undergo. Dr Victoria Hobbs answers some of your most pressing questions around surgical menopause, and gives you the rundown on what you can expect from a surgical menopause.
What is a hysterectomy?
Menopause, medically defined as when it has been twelve consecutive months since your last period, and the ending of your menstrual cycle, on average occurs at the age of 51 years in the UK. However, it can be induced early through medical and surgical treatments.
A hysterectomy is a surgical procedure to remove the uterus, and often the ovaries, fallopian tubes and cervix as well. (The cervix is often removed to remove the risk of cervical cancer and to stop the need for smear tests.)
If your doctor recommends a hysterectomy, then depending on the reason for the hysterectomy you may be advised to have your ovaries removed as part of the procedure. The reasons for removal can include a family history of conditions such as ovarian cancer, or if you are post-menopausal and your ovaries no longer function.
The surgical menopause – what is it, and how is it different from a natural menopause?
During the time leading up to menopause, known as perimenopause, many women notice their periods beginning to change – often becoming erratic and irregular. Although these symptoms can be normal, they can also be caused by specific medical conditions, and so if your periods are severely impacting your quality of life, you should seek help from your GP. Depending on the cause, your GP may offer a range of medical treatment options to help you with heavy periods, but for some women, these options are not a good fit for their bodies and don’t ease their symptoms. If your periods aren’t getting easier, a specialist gynaecologist may suggest surgical intervention to remove the uterus and sometimes the ovaries.
Hysterectomy and ovary removal, known as oophorectomy, is often seen as drastic, but it is a safe procedure that helps many women – by stopping painful periods or preventing the possibility of pregnancy (if pregnancy is not right for them). It is true, however, that women who have undergone a surgical menopause can often experience a sudden onset of severe menopausal symptoms. And as such, it is essential to consider what effect removing the ovaries will have on your body, both to consider other beneficial treatment options like HRT, and to prepare yourself for surgery.
If a woman chooses to remove her ovaries, this removal, as well as the natural physical effects of surgery, will trigger a surgical menopause. Unfortunately, a surgical menopause can still be accompanied by menopause symptoms – including, but not limited to, sweats, hot flushes, joint pain, mood and sleep disturbances. Due to this, it is really important to discuss with both your gynaecologist and GP prior to surgery if you should be started on Hormone Replacement Therapy (HRT) after the operation. Many women find a surgical menopause much more severe than a natural menopause due to the sudden nature of oestrogen levels falling and the body having no time to gradually adjust as it does with a natural menopause. HRT can help ease the symptoms that accompany this sudden drop in oestrogen. The severity of menopause symptoms that can accompany a hysterectomy means that it is important to plan for these symptoms prior to surgery.
Symptoms after surgical menopause may include;
- hot sweats
- hot flushes
- panic attacks
- muscle pain
- memory loss
- brain fog
- eyesight issues
- weight gain
The benefits of HRT after surgical menopause
A common belief is that HRT is only used to help women going through a ‘natural’ or non-surgical menopause, when in fact there are reasons to take HRT post-surgical menopause. Receiving HRT after a hysterectomy is both safe and effective, especially for those under the age of 50. HRT can improve quality of life by reducing the difficult symptoms that can be triggered by a surgical menopause. HRT can also have the added benefit of preventing osteoporosis (bone disease) and heart disease by protecting the bones and the chest. HRT may not be a suitable option for all women, especially if the woman has a history of endometrial, ovarian or breast cancer, and again this should be discussed prior to surgery to plan what alternatives would be offered to alleviate menopausal symptoms.
Most women who are offered HRT after a hysterectomy will only require oestrogen. HRT provides a source of oestrogen to counteract the body’s loss of the hormone through either natural or surgical menopause. This will help alleviate the symptoms brought on by low or depleted oestrogen, such as hot flushes, night sweats, palpitations, headaches, insomnia, fatigue, bone loss and vaginal dryness. Women who still have a uterus or cervix will also require progesterone to protect the lining of the uterus from the build-up effects that oestrogen has on the endometrium. The main exception to this is if a woman has severe endometriosis. This condition can lead to deposits of endometrial lining outside of the uterus. As such, this should be discussed with a gynaecologist after the operation to determine if the woman also needs progesterone within the HRT to protect any deposits in the pelvis, and if so, for how long.
HRT can usually be started immediately after surgery. This is why it is so important to discuss your HRT before you undergo surgery and have it ready to start after the operation. Here’s more information about types of HRT and benefits of transdermal HRT article.
What should you do to prepare for a hysterectomy?
It is important to understand that any type of hysterectomy is a major operation. Undergoing such an operation can seem frightening, but there are steps you can take to prepare and make it easier on both you and your body. You could consider building up your fitness levels by doing regular exercise – such as walking, yoga, pilates, or other gym work. 150 minutes of cardio activity that results in getting out of breath spread over the week can help do a world of good in your recovery. Working on your pelvic floor can help build muscle, reducing your risk of vaginal prolapse and aiding bladder function.
If overweight (high BMI), trying to achieve a healthy weight before surgery will also be hugely beneficial. It will make both the surgery and the post-operative recovery easier. Weight loss can be very difficult, particularly around the time of the perimenopause, but can be achieved by avoiding processed foods which tend to be high in fats and processed sugars, looking at portion control and aiming for a diet rich in vegetables and fruit,
Recovering from a Hysterectomy
- It can take up to 12 weeks to recover from the physical effects of a hysterectomy.
- You are likely to stay in hospital for between 1-3 days after the procedure.
- It is possible you will have had a catheter (tube into the bladder) during the procedure to monitor how much urine you are producing; this needs to be removed and you will need to make sure you can pass urine.
- You will also have internal stitches which usually dissolve by 6-12 weeks post-surgery, so it is important you gradually build up activity levels so as not to damage this healing process. You must avoid heavy lifting and ensure you have enough fibre in your diet, so you do not get constipated.
- By 6 weeks you will be able to drive again.
This may seem overwhelming, and frightening – as all surgeries do. There are many facets to consider before getting a hysterectomy. It is a big operation, and as a result, does require recovery and preparation, and an awareness of the difficulties that go alongside it. It is important to remember, however, that for many women a surgical menopause has dramatically improved their quality of life; has brought them joy in their body again. What works for one woman will not necessarily work for another, and as such, while a hysterectomy isn’t right for one person, it could be right for someone else. Your quality of life, and your body, are of paramount importance, and if you think that a surgical menopause could be what you need, don’t be afraid to talk to your doctor and a specialist gynaecologist about it to learn more. It is important to remember that while it is a big choice to make, a hysterectomy is a safe surgical procedure, and though it isn’t a decision to be taken lightly or without awareness of the side effects, it isn’t something to fear.
Surgical Menopause Need-to-Knows
- Some women may need slightly higher doses of oestrogen to control their symptoms if going through a surgical menopause at a younger age as the body will have been used to having naturally higher levels prior to surgery.
- If your symptoms do not seem to be under control with the initial dose of HRT, please discuss this with your doctor in more detail because the dose maybe increased or changed.
- If you are going through a surgical menopause before the age of 50 years, the benefits of taking HRT are very likely to outweigh the small risks. HRT can help seriously improve menopausal symptoms, protecting your bones from osteoporosis and protecting your heart from heart disease
- Even with combined HRT (both oestrogen and progesterone) there is no increased risk of breast cancer when taken under the age of 50.
- Although there is no time limit to how long you can stay on HRT, this should be discussed on an annual basis with your doctor.
- Some women may also benefit from the addition of testosterone as part of their HRT plan if oestrogen alone is not fully resolving symptoms.
- Please do not suffer in silence and talk to your GP if you are having problems.