Surgical Menopause: A Detailed Look

A major cause of early menopause, surgical menopause is believed to affect approximately 2 million women worldwide annually. Commonly it results from a what’s known as a bilateral oophorectomy (the removal of both ovaries), a surgical procedure that may be performed for many reasons — perhaps because of a cancer diagnosis; or to tackle a case of severe endometriosis.

You may also have undergone a hysterectomy (the removal of the uterus), after which your periods stopped.

In recent times the number of younger women undergoing this type of surgery has increased, and now around 50-55% of all hysterectomies are performed on women between the ages of 35 and 49 (i.e. before the average age of “natural” menopause).

We previously touched upon the topic of surgical menopause in our helpsheet: Causes of Early Menopause.

We’re now publishing this detailed guide to give you more information on the reasons why surgical menopause occurs, and to help you understand the implications in terms of symptoms and family planning.

The Surgeries That Lead to Menopause: Why are They Performed?

Surgery is one of the most common causes of early menopause — and the situation it puts you in is usually very challenging, since you are forced to cope with both sudden onset menopause and the recovery process from your surgery.

Bilateral Oophorectomy

This surgery involves the removal of both of the ovaries.  Because both of them are removed, your levels of both estrogen and progesterone plunge immediately and you enter menopause.

As a result of this sudden drop, you might suffer more intense symptoms than individuals who enter early menopause spontaneously or after a hysterectomy in which the ovaries are left intact.

Note that in cases where only one ovary is removed, you can  continue producing hormones and shouldn’t enter premature menopause.

In individuals with an elevated risk of ovarian cancer, the fallopian tubes are also commonly removed.

Reasons for surgery: Ovarian cancer, severe endometriosis, abscess, cysts (noncancerous).

The ovaries may also be removed after a cancer diagnosis to prevent hormones secreted by the ovaries from encouraging further cancer growth.

Hysterectomy

In general, a hysterectomy describes any operation in which a woman’s uterus is removed. While a hysterectomy alone won’t technically put you into surgical menopause if your ovaries are left intact, your periods will stop and you will no longer be able to get pregnant. However, because you’re still producing ovarian hormones, you should not experience menopausal symptoms like hot flashes and mood swings until you reach natural menopause.

Note that there are several variations on the procedure depending on exactly which parts of the reproductive system are removed:

• Total Hysterectomyis the removal of the entire uterus (this includes the cervix). The majority of hysterectomies in the USA are this type, with the procedure usually carried out via an incision in the abdomen. It may be performed following a diagnosis of ovarian or uterine cancer; due to endometriosis; or if you have uterine fibroids.
• Radical Hysterectomy is the removal of both the uterus and the upper vagina. It is significantly more rare but may be used in patients suffering from cervical cancer.
• Supracervical Hysterectomy refers to the removal of the uterus whilst leaving behind the cervix. On the plus side, it may come with a lower risk of vaginal prolapse. However, it is not recommended for women who are at a high risk of developing cervical cancer.
• Total Hysterectomy with Bilateral Salpingo-Oophorectomy: in some cases, both  fallopian tubes and both ovaries will be removed as part of the same procedure in which the uterus and cervix are removed. It may be performed in cases of ovarian cancer or to treat severe cases of endometriosis.

To perform a hysterectomy, your surgeon may make an incision in the abdomen through which the uterus will be removed. Alternatively, a vaginal hysterectomy involves the removal of the uterus directly through the vagina. On the plus side, the latter method is likely to eliminate scarring and offer faster recovery. However, it may also be linked to a greater number of complications — particularly with respect to sexual function.

Reasons for surgery: cancer, pain relief, correcting a prolapsed uterus (when your uterus has fallen out of place), fibroids, endometriosis.

Ovarian Damage Caused by Other Surgeries

In some cases, a hysterectomy will be performed in which the ovaries are left intact. Likewise, an oophorectomy might leave behind one functioning ovary. Subsequent to this, however, the ovary or ovaries might fail.

This might result from interference in blood flow related to surgery, or through the effects of procedures such as cyst removal. In rare cases, tubal ligation (getting your “tubes tied” as it’s commonly called) may interfere with blood flow to the ovaries, causing you to enter premature menopause.

Deciding Whether to Proceed: Are There Alternative Options?

The correct course of action for your situation is, of course, something you will discuss in depth with your doctor.

In certain cases, surgery that results in menopause is necessary — however, it’s important to remember that the procedure should generally only be carried out in younger women as a last resort. Where possible, less drastic interventions should be used.

For younger women, in particular, the sudden onset of early menopause can be a major blow, along with the classic physical and emotional symptoms that go along with the removal of your ovaries.

Possible alternatives to surgery do exist in certain cases. For example, medication may reduce symptoms including bleeding and pain. Uterine artery embolization may be employed to treat fibroids. And in some cases, less severe surgery may be suitable — such as a myomectomy in which the uterus is only partially removed.

The point worth illustrating here is that there are  often less invasive ways to proceed than hysterectomy/bilateral oophorectomy, but your suitability for these will depend on the nature of your case.

Where possible, always seek a second doctor’s opinion. This is a wise step to take before proceeding with surgery to ensure you’ve fully weighed up your options.

Surgical Menopause vs “Natural” Menopause

Surgical menopause (oophorectomy) brings with it a very sudden plunge in your hormone levels.

Unsurprisingly this can bring on very intense symptoms — not just classic physical symptoms like hot flashes, but also emotional changes including intense mood swings.

Other symptoms include vaginal dryness, depression and palpitations. These may stabilize once you begin taking hormone replacement therapy (HRT).

This is in contrast, however, with a natural menopause — wherein symptoms tend to be milder and you follow a course of much more gradual decline in the levels of your reproductive hormones. This typically begins with perimenopause several years prior to the total stop to your periods.

Not only can surgical menopause bring particularly intense menopausal symptoms, but it comes at a time when you’re also recovering from serious surgery. Naturally, then, it’s a time when the understanding and support of family and friends is crucial. You’re undergoing significant physical and emotional trauma and you deserve the compassion and help of those around you.

The Surgery Itself: Getting Prepared

A hysterectomy lasts around 1-2 hours and is performed in a hospital under general anesthesia. Your doctor will advise you on how to prepare in the days building up to your procedure. This might include:

• Consuming soft foods for several days prior to surgery and then fasting in the 12 hours immediately beforehand.
• You may be instructed to shower using soap provided by your doctor on the morning before surgery in order to reduce the risk of infection.
• You might benefit from making extra effort to maintain a nutritious diet in the weeks leading up to surgery.

Once your surgery is complete, the recovery process beings. Your stay in hospital will generally last from between a day up to a few days.

Recovering at Home

At this stage you’ll be advised to avoid any strenuous or even moderate physical activity for the first 4-6 weeks. Since you’ll be spending a significant amount of time in bed at first, you might benefit from purchasing a wedge pillow to improve your comfort whilst sitting.

Women have also reported benefit from using a hospital-style table. This allows you to write, read, or use a computer without having to rest the object on your abdominal area.

Initially, you might experience some discomfort in using the bathroom. To avoid constipation try to stay away from dairy products and other problematic foods. For using the toilet, consider hand-hold bars so you can use your upper body muscles to get up and down without exerting undue pressure on your abdomen and upper legs. It’s possible to buy temporary bars that fit to the toilet itself.

And, remember, don’t feel ashamed to call in help and assistance from family and friends. You deserve  all the support you can get while you recuperate from surgery.

Things to be Aware of

Your doctor will walk you through the steps to recovery in your appointments. Don’t be alarmed if you experience regular blood discharge from the vagina in the first few weeks after surgery. This is normal and once it subsides you should be able to restart your normal activities, such as working outside the home and sexual intercourse.

Driving is typically not recommended for the first 3-4 weeks after surgery. In addition, be aware that kidney and bladder infections are relatively common after surgery. If your doctor prescribes you a course of antibiotics to take before your procedure, be sure to follow his/her instructions carefully.

Looking Ahead: Family Planning

One of the hardest aspects of surgical menopause is the often drawn out process of reaching acceptance of your condition. For many it is the idea of not being able to carry a child that is most difficult to come to terms with.

Some women will opt to have their eggs frozen prior to surgery in the hope that their fertility clinic will help them have their biologically related child. In these cases your eggs can be fertilized with sperm in the lab to create embryos. These embryos can then be frozen then, when the time is right, transferred into your uterus with IVF.

Alternatively, if you’ve had your uterus removed, you may seek to find a surrogate.

Other options in family building include the use of an egg donor, or seeking to adopt a child. We covered adoption in our helpsheet: Adoption: The Ultimate Guide.

A Final Word

What you’re going through is tough! It takes a brave woman to come through surgical menopause, and to have your resolve tested to the limit. It’s important to remember that there is light at the end of the tunnel.

Surgical menopause has received an uptick in coverage in recent years following Angelina Jolie’s decision to undergo a bilateral salpingo-oophorectomy. Her case in particular highlighted the growing trend of opting for this type of surgery as a preventative measure. She had learned she was at an elevated risk of developing cancer and took surgery to offset this risk.

Regardless of your reason, there are many women out there experiencing the very same situation. For support from these like-minded peers you might consider joining our support group.