Surgical menopause occurs immediately following removal of the ovaries and can occur earlier when one or both of the ovaries are left intact.
The majority of hysterectomies are performed between the ages of 40-50 although many take place before and after this age group. According to NHS statistics 60,000 hysterectomies are carried out each year in the U.K. and hysterectomy ranks as one of the most common surgical procedures among women.
Surgical menopause – hysterectomy is performed when non invasive or less invasive treatments have failed to provide relief from the following conditions.
- Uterine fibroids
- Uterine Prolapse
- Peristent pain and bleeding
- Malignant or non malignant changes to the uterus, cervix or ovaries
- Chronic Pelvic Pain
For more information on each of the above please see the reasons for hysterectomy article.
There are 3 Types of Hysterectomy
- Total Hysterectomy – surgical removal of the uterus and cervix.
- Total Hysterectomy with Salpingo-Oophorectomy – surgical removal of the uterus and cervix in addition to the ovaries and fallopian tubes.
- Sub-total or “partial” Hysterectomy – surgical removal of the uterus, leaving the cervix in place and the ovaries intact.
Radical Hysterectomy – surgical removal of the uterus and its supporting structures, as well as the cervix, ovaries and possibly the lymph nodes. This type of procedure is more common in those with cancer of the uterus, cervix or ovaries.
Surgical Menopause When One or Both Ovaries are Preserved
The female reproductive system
The removal of your uterus, but not your ovaries, doesn’t usually cause menopause. Although you no longer have periods, your ovaries continue to release eggs and produce estrogen and progesterone. However, such an operation may cause menopause to occur earlier than average. This early menopause is thought to be due to the disruption of the ovarian blood flow during surgery when the uterus (womb) is surgically removed. It is thought that this disruption causes early ovarian failure and as a consequence early menopause.
If one or both of your ovaries have been left intact, there are 3 possible outcomes:-
- Your ovaries may continue producing hormones normally until the usual age of menopause (average age 51 years). Because your hormones will be fluctuating normally this may cause symptoms of premenstrual syndrome (PMS) even though you will not have periods. This happens because PMS symptoms are due to changing hormone levels and not the presence of bleeding
- Sometimes following a hysterectomy the ovaries will stop producing hormones sooner than expected, this is sometimes referred to as apparent early ovarian failure. This can happen within one or two years after your hysterectomy and you may notice menopausal symptoms of estrogen deficiency. If this happens you should discuss this with your healthcare professional who may suggest the use of Hormone Replacement Therapy HRT
- Sometimes the intact ovary or ovaries may fail early but the decline in estrogen may not cause any normal signs of deficiency by the presence of menopausal symptoms. This is sometimes referred to as silent early ovarian failure. It is, therefore, recommended that following a hysterectomy when one or both ovaries are left intact before the age of 45, a blood test known as a Follicle Stimulating Hormone (FSH) test may be performed and together with your symptoms it will determine whether you are reaching menopause.
Surgical Menopause when your Ovaries are Removed
An operation that removes your ovaries as well as other organs (total hysterectomy and Salpingo bi-lateral oophorectomy) will cause immediate menopause after the operation regardless of your age. This surgical menopause is sometimes quite severe and without any natural transitional phase. Your periods stop immediately and you are likely to have hot flushes, night sweats and vaginal symptoms. For some women these symptoms can be more severe than those experienced through natural menopause. This is sometimes referred to as surgical menopause or induced menopause.
When the ovaries are removed at a young age (before the age of 45) it can result in premature osteoporosis and premature coronary heart disease. It is important to have estrogen replacement to prevent problems with bones and to keep the vaginal and pelvic tissues youthful at least until you have reached the usual age for menopause which is around 52 years.
Normally Hormone Replacement Therapy HRT will be discussed with you whilst you are in hospital. It will be considered for controlling menopause symptoms and for its protective effect on bone. The decision will also taken into account other factors such as your age, past medical history and family history. It is usual for HRT to be recommended if the operation has caused an early menopause in someone under 45 years of age because of the significant risk of osteoporosis.
Risks Associated with Abdominal Hysterectomy include:-
- Blood clots
- Adverse reaction to anaesthesia
- Damage to your urinary tract, bladder, rectum or other pelvic structures during surgery which may require further surgical repair.
- Onset of menopause if the ovaries are removed.
- Even if one or both of your ovaries are left intact, they could fail within five years of having your hysterctomy.
Risks Associated with Vaginal Hysterectomy include:-
- See above list.
- There is a risk of injury to other pelvic and abdominal organs including the bladder, ureter or bowel.
Useful link: You will find more information at the Hysterectomy Association.
Hysterectomy Considerations. Retrieved from http://www.nhs.uk/Conditions/Hysterectomy/Pages/Considerations.aspx
The menopause – surgical menopause. Retrieved from http://www.hysterectomy-association.org.uk/information/the-menopause/
Abdominal Hysterectomy. (Dec 2012) Retrieved from http://www.mayoclinic.org/tests-procedures/abdominal-hysterectomy/basics/risks/prc-20020767
Complications of a Hysterectomy. Retrieved from http://www.nhs.uk/Conditions/Hysterectomy/Pages/Complications.aspx
Vaginal Hysterectomy. (Dec 2012) Retrieved from http://www.mayoclinic.org/tests-procedures/vaginal-hysterectomy/basics/risks/prc-20020565