Menopause is the permanent cessation of menstruation and a natural part of a woman’s life. However, for some women, menopause doesn’t happen naturally. Surgical menopause is the removal of a woman’s ovaries, which results in immediate menopause. Though symptoms of menopause are similar whether it occurs naturally or surgically, the experience is often more difficult following surgical menopause—but there are ways to make it more manageable.
Menopause typically happens gradually, with hormones fluctuating and symptoms waxing and waning. It’s a transition that can take anywhere from about four to ten years and begins with perimenopause. During this time, estrogen and progesterone, the primary reproductive hormones, are declining, which causes irregular periods, one of the first signs of perimenopause. Other common symptoms include hot flashes, trouble sleeping, mood swings, and brain fog.
Surgical menopause occurs when both of a woman’s ovaries are removed, a procedure known as an oophorectomy. “There are some very good reasons to remove both ovaries,” says Dr. Lisa Savage, board-certified OB/GYN, and Gennev clinician. The most common are a cancer diagnosis, a high risk for cancer, and endometriosis. Removing both ovaries is a bilateral oophorectomy and can be lifesaving for some women with cancer or a high risk of developing it, or in the case of endometriosis, it could significantly improve a woman’s quality of life. (The removal of only one ovary is a unilateral oophorectomy.)
The ovaries produce estrogen and progesterone, so when they are removed, these hormones are gone, too. “Surgical menopause is this abrupt cessation of those ovarian hormones, whereas naturally-occurring menopause is more of a transition,” says Dr. Savage. “The transition may not be a picnic, but an abrupt cessation can be more intense, especially in younger women.”
After the removal of your ovaries, you may experience more symptoms that appear immediately following surgery and are more severe, compared to perimenopause, where symptoms ebb and flow over a longer time period. So instead of your body being gradually weaned off of estrogen and progesterone, it’s like going cold turkey. The withdrawal can be tough. Suddenly, you could be hit with hot flashes, sleeplessness nights, mood swings, and low libido all at once or some combination on top of recovering from your surgery. And the intensity of these symptoms may be higher than if you gradually entered menopause. Like natural menopause, though, the types of symptoms and their severity vary from woman to woman.
Surgical menopause also has long-term effects that differ from natural menopause. When you go through menopause, you lose the protective effects of estrogen that particularly benefit your heart, bones, and brain. Heart disease risk increases. Bone loss may be accelerated. Cognitive function can be affected, and your risk of dementia and Alzheimer’s may rise. The average age of natural menopause is 51, and it’s after menopause that these problems tend to arise. If you have surgical menopause at an earlier age, things happen sooner.
“It’s double jeopardy if you lose your ovaries at a young age,” says Dr. Savage. “You have more years to live without estrogen and more time to develop those problems. More time of estrogen deficiency is worse than less time of estrogen deficiency.”
But there are ways to minimize the effects if it’s necessary to remove both ovaries. Sometimes you can have only one ovary removed (unilateral oophorectomy) or keep them both, based on your personal situation. That’s why it’s essential to talk to all of your doctors about your options and consider getting a second opinion whenever you’re having surgery.
“A hysterectomy does not directly induce menopause,” says Dr. Savage. A hysterectomy is the removal of the uterus. Just because you had a hysterectomy doesn’t mean your ovaries were removed.
In the past, a hysterectomy often included an oophorectomy for women nearing menopause, partly to prevent ovarian cancer. The latest research, however, shows that ovarian cancer more likely originates in the fallopian tubes, and there are benefits to keeping the ovaries. “Now, we may routinely remove the fallopian tubes at the time of a hysterectomy for benign indications but leave the ovaries because they may not be the primary source of ‘ovarian’ cancer,” says Dr. Savage.
If your uterus is removed, but you still have your ovaries, you’ll stop menstruating, but your ovaries will continue to produce hormones. That means you won’t experience perimenopause until ovarian function declines. For some women, who’ve had a hysterectomy, the decline will follow a similar timeline as women who still have their uterus. However, sometimes it occurs sooner.
“The blood supply to the ovaries can be compromised during a hysterectomy because some of the blood supply is common to the area,” says Dr. Savage. “That doesn’t mean anything was done wrong. It can be a natural consequence of a hysterectomy that ovaries cease functioning earlier than they might have otherwise.”
No matter what type of surgery you’re having, you should understand the procedure, your options, possible side effects, and the recovery process. It is even more critical if your doctor recommends removing your ovaries. “It’s very important that women talk to their surgeons in detail as to exactly why they want to remove the ovaries,” says Dr. Savage. “Make sure there's a good indication for removing them, and there may be. If not, advocate to keep your ovaries.” You might even want to get a second opinion. “I tell patients if they need a hysterectomy for a benign condition go to the mat to keep their ovaries,” Dr. Savage says. One ovary is usually sufficient to produce enough hormones to prevent you from going into menopause early.
If your ovaries have to go, the conversation with your doctor should shift to managing the impending menopause. “Have a plan in place preoperatively,” says Dr. Savage. “Don’t wait and be reactive. Knowing what to expect ahead of time is so empowering.”
Just like natural menopause, some women who have surgical menopause have an easier time than others. Even if your symptoms are mild, surgical menopause requires management, especially the younger you are. “It's not just about hot flashes,” says Dr. Savage.
Estrogen plays a role in nearly all your body systems, including your skin, hair, and vaginal tissue. More important is its effect on your heart, brain, and bones. Estrogen protects the heart, fuels brain activity, and strengthens bones.
When you no longer have estrogen, your risk of heart disease increases, cognition may decline, mental health issues like depression and anxiety are more common, and bone loss increases. It can also have a significant impact on your sex life. Vaginal dryness and a loss of libido can be more pronounced following surgical menopause. And the longer you are estrogen deficient, the more problems you can have. “With life expectancy into your 80s, you must take care of those body systems to carry you through,” says Dr. Savage. “You want them working well for the rest of your life.”
Here’s how to manage surgical menopause and stay healthy as you age.
Ask about hormone replacement therapy (HRT). Talk to your doctors to find out if you’re a candidate. The answer will depend upon your individual situation, including the reason for having your ovaries removed. There are some contraindications, for example, if you have estrogen-dependent breast cancer. Discuss your options with all of your doctors. “Any replacement that you take up to the age of 51 is just replacing what you should have had anyway,” says Dr. Savage.
Start HRT quickly. If you are a candidate for hormone therapy, you want to start as soon as is safe following your surgery. “You shouldn’t have to wait to feel terrible to be put on replacement therapy,” says Dr. Savage. “It’s like having your thyroid out and getting replaced quickly.” Dosages might need to be higher in younger patients to achieve physiologic levels of premenopausal estrogen. If you still have your uterus, you’ll also need progesterone to prevent an overgrow of the uterine lining which could become cancerous.
Explore other medications. If you’re not a candidate for hormone therapy, there are other options. Some SSRI (selective serotonin reuptake inhibitors) anti-depressants like Effexor and gabapentin, an anti-epileptic medication, have been shown to help with menopause symptoms, especially hot flashes and night sweats. A new, nonhormonal drug Veozah was recently approved to treat these symptoms. Other medications can reduce your disease risk.
Monitor risk factors. You’ll want to be proactive about disease prevention, so talk to your doctor about prevention strategies and screening tests. You may need cardiac evaluations or bone density tests at an earlier age. If your risk increases, for example, your cholesterol or blood pressure levels rise, or your bone density decreases, quickly addressing those issues will be critical.
Make lifestyle changes. All of the advice that can help with natural menopause, such as exercising, staying hydrated, eating more fiber, taking supplements, and reducing stress also apply to surgical menopause.
Take care of your mental health. Sudden menopause can be more intense psychologically, so seeking helpis essential. Mood swings, anger, and anxiety are common with any type of menopause. With surgical menopause, these symptoms can be more severe, and you may be dealing with other issues like a possible a cancer diagnosis that can add more stress.
Surgical menopause requires management by a trained menopause specialist. Speak with one of Gennev’s board-certified OB/GYNs to learn more about managing symptoms, and stay healthy as you age.