Life After A Hysterectomy: How Menopause Changes

For most women undergoing a hysterectomy, questions about early menopause often pop to mind.

However, the answer isn’t always simple.

This is because there are different types of hysterectomies, and depending on whether you've had your ovaries removed will impact the onset of menopausal symptoms.

Whether you've recently had a hysterectomy or are looking for more information about it, you'll find everything you need to know in this guide.

Understanding Menopause After A Hysterectomy

The onset of menopause following your hysterectomy will depend on whether or not your ovaries have been removed, as these organs are responsible for producing hormones like estrogen, progesterone and some testosterone.

The National Institute for Health and Care Excellence (NICE) recommends that women should only have their ovaries removed if there is a significant risk of disease involved, such as a family history of breast or ovarian cancer.

Let's explain the types of hysterectomies:

• Total hysterectomy - the uterus and cervix are removed, but not the ovaries.

• Total hysterectomy with bilateral oophorectomy - the uterus and ovaries are removed.

• Total hysterectomy with bilateral salpingo-oophorectomy - the uterus, cervix, ovaries and fallopian tubes removed.

• Radical hysterectomy - the uterus, cervix, ovaries, fallopian tubes, vaginal tissue and pelvic lymph nodes are removed.

• Supracervical hysterectomy (also known as a partial hysterectomy) - only the uterus is removed, leaving the cervix and ovaries intact.

Those who have had a radical hysterectomy or hysterectomy with oophorectomy will experience menopause symptoms almost immediately - a process known as "surgical menopause". This is because the ovaries have been completely removed, leading to a sudden drop in hormone levels which triggers the onset of menopausal symptoms, regardless of your age.

On the other hand, menopause won't necessarily start after a partial or total hysterectomy, as the ovaries are left behind. However, there's a chance that you'll experience menopause earlier than expected compared to if you did not have a hysterectomy, as your ovaries may release less estrogen following the operation.

Menopausal Symptoms And How To Manage Them

Knowing the symptoms of menopause can help you better understand why you're feeling the way you do or what to expect after having a hysterectomy. Armed with this knowledge, you can take proactive steps to manage your symptoms and improve your quality of life.

Of course, knowing your symptoms doesn't replace the need for medical intervention, and if you are concerned, it's best to book an appointment with your GP, menopause specialist or gynaecologist.

Symptoms of menopause

• Hot flushes and night sweats: These are common symptoms of menopause, and they can be more intense after a hysterectomy, especially if your ovaries are removed.

• Vaginal dryness: Lowered estrogen levels can cause vaginal dryness, making sexual intercourse uncomfortable.

• Mood swings and sleep disturbances: Hormonal changes can lead to mood swings, irritability, and difficulty sleeping.

• Bone loss: Estrogen plays an important role in bone health. After a hysterectomy, especially with ovary removal, the risk of osteoporosis increases.

• Hair thinning/hair loss: Estrogen helps our hair grow faster and stay on our heads for longer, so when these levels are low, it can lead to hair thinning or hair loss.

• Weight gain: Menopause slows our metabolism, which can lead to weight gain, especially around the middle.

• Weakened pelvic floor muscles: Reduced estrogen and progesterone can cause your pelvic floor muscles to weaken, leading to urge/stress incontinence and pelvic organ prolapse, among other health problems.

• Bladder problems: One in three women experience bladder issues due to menopause, with lower hormone levels are to blame. These problems can range from recurring urinary tract infections (UTIs) and low oestrogen bladder symptoms to anxiety-induced urination and more.

Other menopause symptoms include:

• Headaches or migraines

• Dry skin

• Depression and anxiety

• Fatigue

• Increase in facial hair

• Lower sex drive (libido)

• Joint stiffness, aches and pains

• Problems with memory, concentration and ‘brain fog’

How to manage menopausal symptoms

• Hormone replacement therapy (HRT): Your doctor may recommend hormone replacement therapy to help ease your menopause symptoms, such as night sweats, hot flushes or vaginal dryness. It's important to note that not every woman's prescribed menopausal hormone therapy will be the same, and you might need to try several different options/ dosages until you find one that suits you.

• Pelvic floor exercises: Strengthening your pelvic floor muscles is often recommended as it helps relieve stress incontinence, overactive bladders and other urinary problems.

• Lifestyle changes: Eating a balanced diet rich in calcium, vitamin D and high-quality protein helps support bone and muscle growth. Regular weight-training exercises, walking, pilates and yoga can also help with your mood, weight management and bone strength.

• Supplements: You might be advised to take bladder supplements and other vitamins alongside your HRT plan to help combat the symptoms of overactive bladder during menopause.

• Lubricants: Over-the-counter lubricants and creams can help relieve vaginal dryness.Some women are prescribed, low-dose vaginal estrogen to help alleviate this vaginal dryness.

• Other solutions: You could consider leak-proof incontinence pants if incontinence is a persistent problem.

Understanding A Hysterectomy

A hysterectomy is a surgical procedure that involves removing the uterus (womb) and, in some cases, removal of the:

1. Ovaries

2. Cervix

3. Fallopian tubes

4. Pelvic lymph nodes

5. Parts of the vagina

This procedure is often done to treat various gynaecological conditions, such as:

• Fibroids - noncancerous growths in the uterus that can cause heavy bleeding, pain, or pressure.

• Endometriosis - a condition where uterus-like tissue grows outside the uterus, causing pain and infertility.

• Pelvis floor disorders (PFDs) - urinary incontinence and pelvic organ prolapse. These conditions are generally more common in older women, but younger women can experience them, too.

• Heavy menstrual bleeding - that can't be controlled by other methods.

• Uterine prolapse - when the uterus slips down into the vagina.

• Cancer - of the uterus, cervix or ovaries; or as a preventative measure if you have a family history of ovarian or breast cancer.

FAQs

How long does surgical menopause last?

Surgical menopause is permanent as the ovaries have been removed. This means your body will naturally be in a state of menopause, regardless of age. However, your menopause symptoms may change over time.

What is the average age for menopause after a hysterectomy?

While natural menopause typically occurs between the ages of 45 and 55, menopause after a hysterectomy can vary. For instance, a 50-year-old woman may only experience symptoms a few years after a total hysterectomy, while a 38-year-old might go into menopause immediately following a radical hysterectomy.

What is a laparoscopic hysterectomy?

A laparoscopic hysterectomy is a less invasive surgical procedure to remove the uterus. Rather than making a large cut in your abdomen, the surgeon makes a few tiny incisions near the belly button. They then insert a tiny camera and specialised tools through these incisions to perform the surgery (called keyhole surgery).

However, this procedure may not be suitable for everyone. Your gynaecologist or gynecologic oncologist will assess your individual situation and recommend the best approach for you.

Final Thoughts

As you can see, the timing of menopause after a hysterectomy depends on whether your ovaries were removed during the procedure. If they were removed (following a radical, oophorectomy, or salpingo-oophorectomy hysterectomy), you would experience immediate menopause. However, if your ovaries remain (following a total or partial hysterectomy), menopause may occur naturally over time.

Understanding what you can expect following a hysterectomy is important for your health and well-being. While some symptoms, like urinary incontinence, may start gradually, others, like hot flashes and night sweats, might begin suddenly.

Working closely with your gynaecologist, you can discuss various treatment options to better manage your symptoms and improve your quality of life.