Surgical Menopause

What is Surgical Menopause?

The word “menopause” refers to that point in time that a woman’s normal menstrual bleeding stops.   A “natural menopause" most often occurs between the ages of 48-52 and is recognized by cessation of the monthly menstrual cycle.   When a woman is born, her ovaries contain approximately one million follicles, or eggs.    By the time she reaches puberty, around 600,000 remain.   These follicles are responsible for the production of estrogen, the hormone that transforms her into an adult capable of reproduction.   After about 400 months of reproductive ability, at an average age of 48-52, the supply of available eggs is exhausted.  Without these estrogen producing follicles, estrogen levels become too low to trigger ovulation and menstrual bleeding no longer occurs.

The term “surgical menopause” refers to a menopause that is induced by a surgical removal of the uterus and ovaries.   This procedure is called a hysterectomy with bilateral oophorectomy.    After this surgery, a woman’s body produces much less of the female sex hormones, estrogen and progesterone; menstruation stops, and menopause occurs.    If the ovaries are not removed, they may continue to function and produce adequate levels of estrogen and progesterone up until the time that a natural menopause would have occurred.

The Procedure

As the second most common major surgery for women, over half a million hysterectomies are performed in the U.S. each year.  Approximately 35,000-40,000 of those hysterectomies include removal of the ovaries performed on women under the age of 45.  This procedure is often necessary to treat severe cases of endometriosis, fibroid tumors, cancers, or serious and recurring infections.

After the Ovaries are Removed

Because the menopause occurs within hours rather than over a period of several years, the symptoms can be severe.  The most common physical symptoms for women who undergo surgical menopause are hot flashes, night sweats and vaginal dryness.  Discuss with your doctor ways to handle menopausal symptoms.

Hot Flashes

Can occur at any time, day or night, and can leave you sweaty and red-faced.   Many times treatment is not necessary, but if they are particularly bothersome, treatment options are available.

When you're having a hot flash, you might experience:

• A feeling of mild warmth to intense heat spreading through your upper body and face
• A flushed appearance with red, blotchy skin on your face, neck and upper chest
• A rapid heartbeat
• Perspiration, mostly on the upper body
• A chilled feeling as the hot flash subsides

Hot flashes vary in frequency — you may have several a day or just a few a week – and can last from a few minutes to as much as 30 minutes.  Nighttime hot flashes — or night sweats — can wake you from a sound sleep.   Finding the best way to control your hot flashes can take time.  Start by asking yourself how hot flashes are disrupting your regular life. Then consider the benefits and drawbacks of the most common remedies, which range from lifestyle changes to prescription medications.

For mild hot flashes: Start with diet and lifestyle changes

If your hot flashes are mild — you have just a few a day, and they don't interfere with your normal activities — you may be able to manage them with lifestyle adjustments

• Keep cool. Slight increases in your body's core temperature can trigger hot flashes.
• Get active. Daily exercise is important during the menopausal years. If you aren't already exercising regularly, now is the time to increase your physical activity and add regular aerobic exercise.
• Watch what you eat and drink. Hot and spicy foods, caffeinated beverages and alcohol can trigger hot flashes. Learn to recognize your own triggers and avoid those foods or drinks that bring on hot flashes.
• Relax. Many women find relief from mild hot flashes through yoga, meditation, relaxation or other stress-reducing techniques.
• Don't smoke. Smoking is linked to increased hot flashes. By not smoking, you may reduce hot flashes as well as your risk of many serious health conditions, such as heart disease, stroke and cancer.
• For moderate to severe hot flashes:  Estrogen Therapy
• If you continue to have troublesome hot flashes despite making lifestyle changes, your doctor may recommend estrogen therapy to replace the estrogen hormone that your body is no longer producing. 
• Estrogen therapy is the most effective treatment for hot flashes, but is not without risks.  Estrogen therapies can increase your chances of blood clots, stroke and other serious medical conditions.  Your healthcare provider can help you decide if estrogen therapy is right for you, and if so, which course of treatment will be safest.

Vaginal Dryness

Vaginal dryness is another symptom frequently reported after surgical menopause.  The tissues of the vagina become thin and dry, and vaginal fluid production decreases. 
The result can be discomfort during sexual intercourse, itching and burning of the vaginal area, and even an increased risk or urinary tract infections.  
There are several types of treatment for vaginal dryness, ranging from over-the-counter lubricants to estrogen therapy.  Your physician or midwife will be able to advise you about your options.

Emotional aftereffects

Many women discover that a hysterectomy greatly improves their quality of life by providing relief from symptoms and an improved sense of well-being.
On the other hand, because the uterus is strongly associated with femininity and fertility, you may feel a sense of loss after hysterectomy.   Each woman’s reaction is unique to her situation and personality, and it is very important at this time to share your feelings with your partner, a close friend, or your physician or midwife.  

Remember

Menopause that occurs suddenly due to surgery can be more difficult to deal with than menopause that occurs naturally over several years.  Your healthcare provider is the best person to help you to manage your individual symptoms.