What Is Surgical Menopause
Menopause means the final menstrual period. The average age of menopause is around 51 years, but most women will start to notice menopausal symptoms from around 47 years. This may be noticed as the onset of hot flushes, night sweats or vaginal dryness or a change in menstrual periods to more infrequent and sometimes heavier menstrual bleeding . Removal of both ovaries before the normal menopause is called surgical menopause.
Indications For Surgical Menopause
Surgical menopause is commonly performed at the time of hysterectomy for benign disease, most commonly for heavy menstrual bleeding or fibroids . Another common reason to remove normal ovaries at the time of hysterectomy is to reduce the risk of ovarian cancer. This has been shown to be beneficial in women with an inherited increased chance of developing ovarian cancer , and for some women with very strong family histories of ovarian cancer, but is not recommended for other women as the disadvantages of removing normal ovaries at the time of hysterectomy are likely to be greater than their very small risk of ovarian cancer . Very little is known about the impact of removing normal ovaries from postmenopausal women.
Some premenopausal women will elect to have their ovaries removed for other indications, such as endometriosis or chronic pelvic pain. Depending on the circumstances, removal of the ovaries may improve pain, but it is not always effective. Some doctors may suggest a trial of a drug to bring on a short term chemical menopause before surgery to try and mimic the effects of surgical menopause. However, it is not currently possible to predict how surgical menopause will affect individual women.
Although surgical menopause is common, there have been remarkably few studies which have followed women before and after oophorectomy to try and understand how surgery affects their menopausal symptoms and short and long term health.
Can A Partial Hysterectomy Make Major Changes In Your Life
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The Cons: Reasons To Lean Against Hrt After Surgical Menopause
- Your menopausal symptoms arenât bothering you, or other treatments work fine. Some women donât have very severe symptoms after surgical menopause and donât want or need treatment. Even if you do have acute symptoms, HRT is not the only way to control them. Other drugs or lifestyle changes can help. Talk to your doctor.
- Youâre 50 or older. Many women who go into surgical menopause at 50 or older â the natural time of menopause â decide not to get HRT. Thatâs because their supply of estrogen would naturally drop during menopause anyway. There is some evidence that the older you are when you start HRT, the higher the cardiovascular risks â at least initially.
- You have liver disease. Estrogen pills can put a lot of stress on the liver. So if you have liver disease, your doctor may not want you to take oral HRT. Other ways of getting estrogen â like patches and gels â bypass the liver and are safer options.
- Youâre concerned about the side effects. HRT can also cause symptoms of its own. Many resemble the symptoms of premenstrual syndrome â swollen and painful breasts, headaches, and nausea.
- Youâre at a higher risk of health problems like:
o Strokes. Hormone therapy can increase the risk of stroke, although your odds are still very low.
o Blood clots. Oral estrogen, at least, may also raise the risk of blood clots. Estrogen patches and creams may pose a lower risk, but thatâs still unclear.
Removal Of The Ovaries
The National Institute for Health and Care Excellence recommends that a woman’s ovaries should only be removed if there’s a significant risk of associated disease, such as ovarian cancer.
If you have a family history of ovarian or breast cancer, removing your ovaries may be recommended to prevent you getting cancer in the future.
Your surgeon can discuss the pros and cons of removing your ovaries with you. If your ovaries are removed, your fallopian tubes will also be removed.
If you have already gone through the menopause or you’re close to it, removing your ovaries may be recommended regardless of the reason for having a hysterectomy.
This is to protect against the possibility of ovarian cancer developing.
Some surgeons feel it’s best to leave healthy ovaries in place if the risk of ovarian cancer is small for example, if there’s no family history of the condition.
This is because the ovaries produce several female hormones that can help protect against health problems such as weak bones . They also play a part in feelings of sexual desire and pleasure.
If you’d prefer to keep your ovaries, make sure you have made this clear to your surgeon before your operation.
You may still be asked to give consent to treatment for having your ovaries removed if an abnormality is found during the operation.
Think carefully about this and discuss any fears or concerns you have with your surgeon.
Sore Breasts After Hysterectomy
Breast pain is one of the unexpected side effects of hysterectomy that some women experience. When they leave the ovaries, you will continue to cycle after the hysterectomy. You wont have monthly menstrual bleeding because you have no uterus. But you will still have ovaries that are producing hormones. Thats why you still may have premenstrual symptoms such as tender, swollen and painful breasts, also known as cyclical mastalgia.
A woman who has her ovaries removed at the time of the hysterectomy may also experience breast soreness if she takes HRT.
There are many more reasons women can experience breast pain. They can be innocent, like off consuming too much caffeine, chocolate, or other things in her diet. Our first thought usually is that it may be a sign of breast cancer. So if it worries you or when you can feel a lump, a mass, or see any skin changes in your breast, you need to get it examined by a doctor.
Are You In Early Menopause
With so many variables to consider, it can be hard to determine if you are in early menopause or at risk of going into early menopause. If youre presenting menopausal symptoms and youre concerned that these symptoms could be a sign of early menopause, schedule an appointment with your healthcare provider to run a blood test to measure your hormone levels. If you are still menstruating, you are more likely experiencing perimenopause symptoms, which are completely normal. If you have missed a few periods and are not pregnant, or your periods have been very short and light, then you may want to do a blood test just in case. This could be a sign of early menopause or it may just be a case of fluctuating hormones and should be confirmed by a doctor.
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Why Would Someone Need A Hysterectomy
Hysterectomies are very common, especially in the United States. According to the Centers for Disease Control and Prevention , 1 in 3 women will have a hysterectomy by age 60. People have hysterectomies for different reasons.
Many people get a hysterectomy to help with symptoms and pain from other gynecological issues, such as endometriosis or fibroids. Others may get a hysterectomy to reduce their risk of some types of breast or ovarian cancer.
Typically, people have a hysterectomy after other non-invasive treatments fail. Some may try birth control or hormone therapy first. Others may need a hysterectomy right away because of a condition like pelvic prolapse .
A hysterectomy can be a big decision, so regardless of your situation, its best to talk to your doctor to see whats right for you.
Does A Hysterectomy Bring On Early Menopause
Hysterectomy increases risk for earlier menopause among younger women, study finds. Summary: In a finding that confirms what many obstetricians and gynecologists suspected, researchers report that younger women who undergo hysterectomies face a nearly two-fold increased risk for developing menopause early.
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Is There A Risk Of Reactivated Endometriosis Transforming Into Cancer
Reactivation of endometriosis by HRT is very rare and it is impossible to say how likely it is for endometriosis to turn into cancer. However, there have been a few reported cases of it occurring. This means that while on HRT, if you develop new symptoms or old symptoms start to recur, it is important to discuss this with your healthcare professional who can start any investigations that are needed. From all the evidence it seems that there is very little risk of reactivation of endometriosis or cancer for women on HRT who have had a removal of both of their ovaries and all of their endometriosis removed. For women with some endometriosis who are under 45 or who have significant menopause symptoms the evidence suggests that the benefit of taking HRT to manage the menopause symptoms outweighs the small risk of worsening of the endometriosis or risk of cancer.
Hysterectomy Increases Risk For Earlier Menopause Among Younger Women Study Finds
- Duke University Medical Center
- In a finding that confirms what many obstetricians and gynecologists suspected, researchers report that younger women who undergo hysterectomies face a nearly two-fold increased risk for developing menopause early.
In a finding that confirms what many obstetricians and gynecologists suspected, Duke University researchers report that younger women who undergo hysterectomies face a nearly two-fold increased risk for developing menopause early.
The study, published in the December issue of the journal Obstetrics & Gynecology, is the largest analysis to track over time the actual hormonal impact of woman who had hysterectomies and compare them to women whose uteruses remained intact.
“Hysterectomy is a common treatment for many conditions, including fibroids and excessive bleeding,” said Patricia G. Moorman, PhD, MSPH, an associate professor in the Department of Community and Family Medicine at Duke University and lead author of the study. “Most women are very satisfied with the results of a hysterectomy. But this is a potential risk of the surgery that should be considered along with the benefit.”
Up to 600,000 women in the United States undergo hysterectomy each year, but the long-term consequences of the procedure have not been well documented. Studies have been small or relied on the recollections of women about the onset of menopause.
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If My Cervix Was Removed In My Hysterectomy Do I Still Need To Have Pap Tests
If you have had a total hysterectomy in which the cervix was removed along with the uterus, you will not usually require Pap testing. An exception is if your hysterectomy was done because of cervical cancer or its precursors. Ask your health care provider if you need to have periodic Pap tests. It is important for all women who have had a hysterectomy to have regular gynecologic exams as part of their health care.
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How Long Does It Take To Recover From A Hysterectomy
The length of your hospital stay and recovery will depend on the type of hysterectomy you had abdominal, vaginal or laparoscopic. Most women stay in the hospital for one to two days, though some may stay up to four days. It takes longer to recover from an abdominal hysterectomy, with complete recovery usually taking four to eight weeks. Most women can return to normal activity in one to two weeks following a vaginal or laparoscopic hysterectomy.
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Will A Hysterectomy Cause Immediate Menopause
It is a misconception among many women considering a hysterectomy that the procedure will cause menopause to occur immediately. The truth is that most women seeking hysterectomies for heavy periods, uterine fibroids or pelvic pain are able to keep their ovaries intact following the surgery. Since the ovaries regulate the hormones that facilitate menopause, women who receive a partial hysterectomy or total hysterectomy will not experience menopause immediately.
The Ovaries and Their Role in Menopause
The ovaries are two small organs located on either side of your uterus. The ovaries produce estrogen and progesterone, two hormones essential to female ovulation and reproduction. As you near menopause, the ovaries slow down their production of these two hormones so that periods become more infrequent. Eventually your periods will cease altogether and after one year with no periods, you have officially entered the menopausal period. Many women experience hot flashes, sexual dysfunction and sleep disturbances as a result of menopause.
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What Is Likely To Happen During Induced Or Surgical Menopause
The menopause symptoms women experience are the same as with natural menopause but they usually develop suddenly in induced or surgical menopause and can feel a bit overwhelming if theyre not expected. Women tend to experience hot flushes and night sweats, low or changing moods and loss of sexual drive. Some women experience memory loss and develop anxiety. There can be joint pains and muscle aches and some women say they lose more hair than usual. Some women experience repeated urine infections or can feel that their vagina is dry, sore or itchy.
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What Is The Difference Between Early And Premature Menopause
Early or premature menopause happens when ovaries stop making hormones and periods stop at a younger age than usual . This can happen naturally or for a medical reason, such as when both ovaries are removed in a hysterectomy.
Early and premature menopause can have the same causes. The only difference is the age at which it happens. Menopause that happens before age 45 is called early menopause. Menopause that happens before age 40 is called premature menopause.
Women who have gone through early or premature menopause cannot get pregnant.
Reactions To Surgical Menopause
A surgical menopause can be a difficult time for many women. Menopausal symptoms are often severe, and depression and anxiety are more likely.
How you react can be influenced by the reason for the surgery. If your surgery is necessary because of a diagnosis of cancer, this creates challenges to cope with at the same time as coping with menopausal symptoms. On the other hand, if your surgery is the solution to ongoing chronic pain, then a surgical menopause may offer relief.
What’s happening in your life will affect your reactions to surgical menopause. This includes your age, whether you are in a relationship, whether you have children, whether you wanted to have children or more children, and whether you have support and help.
Some women say the impact of surgical menopause is that they no longer feel like a woman other women feel a sense of freedom from pain and fear. Some women feel they might not be as sexually attractive to their partner, and others feel they can be more sexual because they are not worried about pain or heavy bleeding.
No feeling should be dismissed as silly or small. It is important to talk to someone if you are upset and distressed about a surgical menopause. You can ask your doctor for help with symptom relief and with referral to a psychologist to discuss your feelings.
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Is There A Risk Of Worsening Endometriosis By Taking Hrt After Having An Oophorectomy Or Taking Medications To Cause Menopause
There is a theory that HRT contains just enough hormone to keep your bones healthy and to help with menopause symptoms and contains a low enough dose to not have an effect on endometriosis. This is called the estrogen threshold theory.
This means that it is rare for endometriosis to recur or get worse when on HRT but it is possible. It is more likely if there is a residual endometriosis and your HRT only contains estrogen.
Endometriosis And Menopausal Symptoms
Endometriosis is a common condition affecting women of reproductive age and can be painful and debilitating. Women with endometriosis may be treated with lifestyle changes, medications or surgery to help control the symptoms and severity of the disease. Some of the medical treatments offered can cause women to feel like they are going through the menopause. Some women choose to have surgery involving removing both ovaries. In both of these situations, women can experience a sudden onset of menopause symptoms which can range in severity. There is evidence to suggest that providing women with information of what to expect can help their mental and physical wellbeing .
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Induced Menopause Following Cancer Therapy
Ovarian damage from cancer therapy depends on the age at treatment and on the type of treatment. Women younger than age 40 years and children are at lower risk for ovarian failure than older women however, exposure to higher doses of alkylating agents and higher doses of radiation to the ovary are more likely to induce ovarian failure . Based on the Childhood Cancer Survivor Study , a cohort study of survivors of childhood cancer treated at 25 cancer centers throughout North America between 1970 and 1986, approximately 6% of childhood cancer survivors experienced acute ovarian failure during cancer treatment or shortly after completing cancer treatment . Another 8% retained ovarian function during treatment but later developed premature menopause . This is believed to be an underestimate of the true population incidence of premature menopause because the median age attained in this group at the time of analysis was only 29 years .
Follow-up of childhood cancer survivors has identified an increase in miscarriages, an increase in small for gestational age offspring, and a reduction in live births . Longer term health outcomes, beyond cancer free survival, are not yet available however, these subjects are expected to be at increased risk for osteoporosis, cardiovascular disease, psychosexual dysfunction, and decreased quality of life .