• Menopause
• Uniquely Female

Hysterectomies and Surgical Menopause: A Guide

Hysterectomy – the surgical removal of a woman’s uterus, or womb – has become less common over the past few decades. And that’s great news for most women.

“But sometimes a hysterectomy is the only viable solution for alleviating life-threatening or debilitating conditions, like cancer or unusually excessive bleeding,” says Amy Renshaw, MD, an OB/Gyn with the Center for Women’s Health & Wellness in Mason.

And like most major surgical procedures, hysterectomies come with downsides. This includes the sudden onset of menopause, if the hysterectomy includes removal of the ovaries.

If a hysterectomy is in your future, here are some things you need to understand about treating and coping with “surgical” menopause.

When Is a Hysterectomy Needed?

According to the Office of Women’s Health (OWH) at the U.S. Department of Health and Human Services (HHS), some of the most common reasons for a hysterectomy include:

• Uterine fibroids. These non-cancerous tumors grow on the wall of the uterus and can cause pain and heavy bleeding.
• Endometriosis. This is a condition in which endometrial cells (cells from uterine lining) grow outside of the uterus, attaching themselves to other pelvic organs. This can result in chronic pain and excessive bleeding.
• Endometrial hyperplasia and adenomyosis. These are two separate conditions affecting the lining of the uterus and resulting in abnormal bleeding.
• Cancer of the cervix, ovaries or endometrium (uterine lining).
• Uterine prolapse. This is when the uterus slips out of place, into the vagina.
• Chronic pelvic conditions, including pelvic pain or pelvic inflammatory disease.

What Is Surgical Menopause?

The type of hysterectomy a woman undergoes depends on her diagnosis and which of her pelvic organs are affected. A hysterectomy may only affect the uterus, or it may include the removal of her cervix (the tissue that connects the uterus to the vagina), her fallopian tubes, and/or one or both of her ovaries (which produce the hormones estrogen and progesterone).

Removal of the ovaries will cause a woman to rapidly undergo “surgical” menopause, because the body will no longer be able to produce these vital hormones. This is similar to “natural” menopause, but occurs almost immediately and with more intense symptoms. If the uterus alone is removed during a hysterectomy, a woman will experience menopause earlier than with natural menopause, but a bit more gradually.

“The loss of ovaries means the patient will experience a sudden onset of the symptoms of menopause, such as vaginal dryness, hot flashes and decreased sexual drive,” explains Dr. Renshaw. The patient is also at higher risk for osteoporosis.

How Do I Cope?

Pre-menopausal women who experience surgical menopause can have more intense symptoms, and therefore, a greater need for help with controlling them than women who undergo natural menopause.

“Hormone therapy can relieve the signs and symptoms of menopause and may help reduce the risk of osteoporosis,” Dr. Renshaw advises. “It can be started immediately after surgery. Other medications also can be given to prevent osteoporosis if you are at high risk.”

Sometimes a hysterectomy is the only viable solution for alleviating life-threatening or debilitating conditions

Hormone replacement therapy usually continues until the patient reaches the natural age of menopause. Your physician will work closely with you to determine the safest dosage, and provide ongoing monitoring to lower your risk of menopause-associated diseases, such as osteoporosis, later in life.

Advancements Continue

The good news is that science continues to make advancements in both the medical and surgical treatment of problems that used to lead to hysterectomy.

“Twenty to 50 years ago, it seemed as if most women had a hysterectomy before they hit menopause because it was an answer to solving issues such as heavy bleeding or pelvic pain,” says Dr. Renshaw. “It is becoming less and less routine for women to have a hysterectomy because we have so many good forms of medical management for these issues. It’s important to talk to your doctor about all of the alternatives available to you for treatment now, before undergoing major surgery.”

Source: Office of Women’s Health (U.S. Department of Health and Human Services); North American Menopause Society; Amy Renshaw, MD, Center for Women’s Health & Wellness in Mason; Hysterectomy