The truth about surgical menopause

Over 142 women had at least one ovary removed every single day between 2013 and 2014 in England and Wales. In Wales, the average age for women undergoing this procedure was 47. In England over 17,000 women had both ovaries removed and 15,000 had just one taken away before they were 55.

Why do these figures matter?

The reason is simple, removal of both ovaries will cause an immediate menopause; removal of a single ovary can trigger an early menopause; and even a hysterectomy that leaves both ovaries intact can trigger the same effect as removing just one ovary in a woman who is not menopausal.

The majority of women go through the menopause sometime between the age of 45 and 55. It starts with hormone disruption and some women have described it as being a little like going through puberty, but backwards – your skin can break out, you feel hot and bothered at odd times of the day and night and may be forgetful or distracted. In fact there are 33 signs that have been attributed to the menopause. Don’t worry though, the chances of experiencing all of them are minimal and you probably won’t see more than a handful through the entire experience.

For other women though, health problems may put them in a situation where they need surgery for conditions such as fibroids, endometriosis, pelvic inflammatory disease or even cancer. Whilst there are a lot of different treatments available these days, for some it inevitably ends up with surgery of some description, surgery that includes hysterectomy and oophorectomy (removal of the ovaries).

Strictly speaking, a surgical menopause is one caused when a woman has her ovaries removed, this can be as a standalone operation or as an addition to an operation like hysterectomy. However, having a surgery like hysterectomy that leaves the ovaries in place can also trigger an early menopause, and because this follows surgery it would be reasonable to call this a type of surgical menopause as well.

If you have your ovaries removed you will be plunged into menopause immediately, regardless of your age. If you’re of an age where the menopause ought to be behind you, you might be very surprised to find that you too start experiencing night sweats and hot flushes again. The reason this happens is because our ovaries don’t just turn off like a tap when we have our last period; instead they continue producing small amounts of oestrogen and progesterone for many years post menopause, and when they are removed this stops rather abruptly.

The reason having a hysterectomy might trigger an early menopause even if your ovaries are left intact has not yet been adequately explained. Theories suggest that it might be a shock reaction by the body to the trauma of surgery or that the operation causes a hormone disruption which stops the ovaries functioning. Regardless of the reason the reality is that 50% of women having a hysterectomy that only removed their womb will go through the menopause within five years – whatever their age. Studies have also shown that the remaining 50% will go through the menopause around two years earlier than they might have done if they are still young enough.

However it happens the menopause itself is no different; every women will experience a variety of symptoms that indicate a drop in their hormone levels. However, the intensity of those symptoms can vary significantly and the younger you are when you have surgery the more likely you are to feel like you’ve been hit by a train.

This is because with a natural menopause our body winds down slowly, hormone production drops away and the effects are barely noticeable for some time and symptoms kick in only in the last stages of the process.

When your ovaries are removed or stop working early there is often no time for the body to prepare and some women find they experience typical menopausal symptoms within just a few hours of surgery. This can come as quite a shock physically and emotionally; not only are you recovering from the trauma of surgery but you’re having to deal with everything that accompanies a major life stage as well.

In addition to the intensity and speed at which symptoms occur the younger a woman is the longer they are likely to be without essential hormones. Having your ovaries removed in your 20’s, 30’s and 40’s is a big deal because your production of oestrogen, progesterone and testosterone are all affected. What we do know is that all these hormones affect our physical appearance, heart health, bone strength, sexual pleasure and emotional integrity. A reduction in the hormones causes a variety of physical changes to take place and it can also be a contributory factor in heart disease and osteoporosis.

Of course, it goes without saying that the longer we are without these vital powerhouses the more we increase our risk of our health and wellbeing being adversely affected.

It’s really important for all women undergoing surgery to remove their womb or ovaries to be aware of these additional risks. If and when symptoms start they are easy to dismiss as other problems and may not be treated appropriately early enough, in fact some women have even been given anti-depressants when HRT would have sorted out their distressing symptoms.

As with everything medical there is often more than one reason you could be having particular symptoms and being aware that the menopause is possible means you are more likely to be tested for this as well. Once the menopause has been confirmed then a decision can be made with your GP about how to manage the transition. Remember though that HRT is just a stopgap – it manages the symptoms by fooling your body into thinking it’s still producing enough sex hormones; as soon as you stop taking it, the menopausal symptoms will come back and you will need to weather the storm, fortunately as you get older these symptoms may well be less forceful.

We’ve all heard the arguments for and against HRT and some women won’t be able to take it, especially if they had surgery for conditions like endometriosis or a gynaecological cancer; they will need to find another way of managing their symptoms. Others though will be wondering whether it’s ok in their particular circumstances. One approach is to accept that HRT is a replacement for some of the hormones you would have produced yourself anyway, at least up until the age you might have gone through the menopause naturally.

If you do decide to opt for HRT, the type you take will be very dependent on the circumstances surrounding your surgical menopause. For example, if you have your womb removed during a hysterectomy you probably won’t be offered HRT containing progesterone. If you only have the ovaries removed then you may be offered a combine HRT containing progesterone and oestrogen.

No form of HRT though contains testosterone though which is a shame as in women this vital hormone acts on libido and mood and is believed to be a significant factor in female sexuality. If, for some reason, you do believe you need some form of testosterone supplementation you will need to speak to your GP about whether they will prescribe it for you as it isn’t generally available on prescription.

If you don’t want to or can’t take HRT then your choices for managing symptoms revolve around diet, exercise and lifestyle changes and you can find more information about these in our HRT section.