Menopause After Hysterectomy

What is a hysterectomy?

A hysterectomy is a surgery to remove the uterus. In some cases, the surgeon may also remove the ovaries and fallopian tubes. Whether the ovaries are removed (a procedure called an oophorectomy) often depends on the reason for the surgery. There are more than 500,000 hysterectomies performed each year in the USA. The number of patients that receive both an oophorectomy and hysterectomy often depend on the patient’s age — 23% of hysterectomy patients ages 40-44 years also receive an oophorectomy, while the number is higher for patients ages 45-49 at 45%.

Hysterectomies are done for a variety of reasons, including uterine fibroids, endometriosis, and cancer. There are a few different general types of hysterectomies:

• Total hysterectomy. This is the most common type of hysterectomy. The uterus and cervix are removed. The fallopian tubes are often removed and the ovaries may or may not be removed.
• Supracervical (also known as subtotal or partial) hysterectomy. Just the upper part (the body) of the uterus is removed. The fallopian tubes are often removed and the ovaries may or may not be removed.
• Radical hysterectomy: The uterus, cervix, tissue on both sides of the cervix (parametrium), and the upper part of the vagina is removed. The fallopian tubes are often removed and the ovaries may or may not be removed.

A hysterectomy is a major surgery and there are alternative ways to treat many of these health problems. If you’re considering a hysterectomy, be sure to ask your healthcare team about all your treatment options.

Do you go through menopause after a hysterectomy?

After a hysterectomy, the impact on menopause can vary depending on whether the ovaries were also removed. Everyone who has a hysterectomy will stop getting their period. If the ovaries are left intact, you shouldn’t experience any other symptoms of menopause right away because the ovaries are still releasing hormones. Some premenopausal people may experience hot flashes after a hysterectomy due to decreased blood flow to the ovaries. It’s also possible that you will start natural menopause (and therefore have menopausal symptoms) a few years earlier than you would have if you had not had a hysterectomy.

However, if the ovaries are removed, you’ll no longer have a period and may start experiencing symptoms of menopause right away, regardless of your age. This type of menopause is also called surgical or induced menopause. Those symptoms may come on quickly and often intensely because your body had an abrupt end to receiving hormones from the ovaries, instead of the natural, gradual reduction of the hormone levels over years.

In addition to menopausal symptoms, you lose the protective elements of estrogen at an earlier age. Estrogen can help reduce the risk of conditions like heart disease and osteoporosis.

How can I manage my menopause symptoms after a hysterectomy?

There are several options available for those who have undergone a hysterectomy and are experiencing menopausal symptoms. Remember to always talk to your healthcare team if you have any questions or concerns.

Lifestyle changes

Certain lifestyle changes can help you manage menopausal symptoms. These include regular exercise and a healthy diet. A varied diet and regular exercise can also help lower the risk of heart disease and osteoporosis, which increases when your hormone levels decrease.

To help relieve some of the symptoms you can:

• Avoid hot flash triggers. Be mindful of when hot flashes happen and identify any possible triggers. Some common triggers are alcohol, caffeine, spicy foods, stress, cigarette smoking, and warm temperatures.
• Keep cooling items nearby. Have a fan and bottle of ice water nearby to help during a hot flash, especially overnight.
• Use a lubricant during sex. If you’re experiencing vaginal dryness, using a lubricant during sex can help you feel more comfortable.
• Help yourself get better sleep. Sleep can be a challenge, especially if you’re experiencing night sweats. But there are things you can do to help set up a better situation for sleep. Keep your bedroom cool and quiet. Avoid large meals and fluids before bed. Follow a similar bedtime routine every night.
• Stress management. Find the ways to relieve stress that work for you and try to fit them into your daily routine. Some good stress relievers can include getting enough sleep, exercising, walking and hiking, listening to music, mindfulness, and mind-body practices like yoga and breathing exercises.
• Seek medical care, when needed. If you’re struggling with any of your symptoms or have questions about what’s going on, don’t hesitate to reach out to a doctor, counselor, or other healthcare provider
• Join a support group. Find an online or in-person support group for people who have experienced surgical or induced menopause. Knowing you’re not alone can help you get through the harder moments. And it’s so helpful to have a group to bounce ideas off and learn from.

Medication

Menopausal hormone therapy (MHT) (also known as HRT (hormone replacement therapy)) is a common treatment for menopausal symptoms, including hot flashes and vaginal dryness and may help reduce the risk of osteoporosis. MHT involves taking medication to replace the estrogen (and progesterone for people with a uterus) that the body is no longer producing. After a hysterectomy, you may be prescribed an estrogen-only MHT. It can typically be started immediately after surgery.

MHT is not right for everyone, and some people may prefer not to take it. It’s important to discuss the risks and benefits of MHT with a healthcare provider before beginning treatment. If your hysterectomy was due to ovarian cancer, talk to your oncologist to find out if your specific type of cancer may prevent you from using MHT. You should also discuss if there are any alternatives to MHT that may work for you.

Emotional support

A hysterectomy can also come with some emotional challenges. It’s normal to grieve the loss of your fertility, especially if the hysterectomy happened much earlier in your life than you would have planned. You may also feel isolated in your experience — not only have you just been through a major surgery, but you’re also trying to figure out how to manage symptoms of menopause. But you’re definitely not alone. Thousands of hysterectomies are performed each year and there are many others going through the same thing you are right now.

Reach out to doctors, older friends, or family members for help in managing your symptoms. Call on trusted family and friends, and maybe even a mental health professional, to help you work through all the feelings you’re experiencing and get the support you need to recover, not only physically, but emotionally as well.