Side Effects of Hysterectomy Before Menopause
After a C-section during childbirth, a hysterectomy is the most common surgery a woman can undergo. About 500,000 women have the procedure each year.
Despite the frequency of the surgery, many women have many questions about hysterectomies like:
- What will be removed during the hysterectomy?
- What changes will this have on my physical, mental, and sexual health?
- How long is the recovery period?
- What conditions to hysterectomies treat?
- Are there alternatives to avoid a hysterectomy?
Since the procedure is performed more often in older women, many wonder about the relationship between hysterectomies and menopause.
What Is a Hysterectomy?
A hysterectomy is a surgical procedure that commonly involves removing the woman’s uterus. Your doctor may recommend a hysterectomy for a variety of reasons including:
- Noncancerous growths in the uterus called uterine fibroids
- Heavy, lengthy, or otherwise unusual vaginal bleeding
- Abnormal slippage of the uterus into the vagina called uterine prolapse
- Severe pain and bleeding caused by endometriosis or adenomyosis
- Cancer of the uterus, ovary, or cervix
By removing the uterus, the medical professionals hope to limit or eliminate these conditions, which can dramatically improve your health and quality of life.
The Different Types of Hysterectomies
It is valuable to note that not all hysterectomies are equal. In fact, there are three distinct versions of the procedure:
- Total hysterectomy. This most frequently performed type of hysterectomy involves removing all of the uterus, including the cervix. Depending on the condition the procedure is meant to treat, the surgeon will remove the ovaries and fallopian tubes as well.
- Partial hysterectomy. Sometimes called a subtotal or supracervical hysterectomy, this variation only removes the upper segment of the uterus and leaves the cervix in intact and in place. The ovaries also may be removed here.
- Radical hysterectomy. As the name may suggest, the radical hysterectomy removes a larger portion than other hysterectomy variations including the entire uterus, the cervix, the tissue surrounding the cervix, and the upper part of the vagina. This type of hysterectomy is usually reserved as a treatment for cervical and other cancers.
What Is Menopause?
Menopause is not something that usually happens all at once. Instead, it is the process of a woman’s body transitioning from normal menstruation to no menstruation at all.
Menopause is actually separated into several stages:
- During this time, you will have normal menstrual cycles. This stage begins in adolescence.
- Perimenopause is marked by increasing changes to the frequency and consistency of your periods due to random changes in your hormone levels. Here, periods will be inconsistent, and the unwanted menopause symptoms will surge.
- This stage presents when your periods completely stop, and you have had no bleeding or spotting for a full year.
- Postmenopause encompasses everything following the time following your final period.
Menopause is controlled by the hormones estrogen and progesterone released from the ovaries. During postmenopause, the ovaries still release the hormones but at a much lower level than other stages.
Most women begin moving towards menopause in their mid to late 40s with perimenopause lasting for about four years on average. Of course, something like menopause has significant variation from person to person, but your experience may mirror that of other women in your family, like your grandmother, mother, aunts, and sisters, in terms of intensity, timing, and duration.
Hysterectomies and Menopause
The relationship between hysterectomies and menopause has everything to do with the ovaries. The way your ovaries are managed impacts your menopause.
As mentioned, the ovaries may remain or may be removed in any of the hysterectomy types: total, partial, or radical. Be sure to consult with your surgeon to understand what is being removed and why it is being removed to understand the risks and benefits.
Hysterectomies Without Ovary Removal
In general, having any type of hysterectomy which leaves the ovaries in place and intact will have a subtler impact on your menopause process. Ordinarily, the transition will occur naturally under the same timeframe as if you had no hysterectomy at all.
Without a uterus, you will not have your period, but the typical hormonal issues that present with menopause will be present. Some women report the process of menopause completing a few years earlier after a hysterectomy that leaves the ovaries in place.
Hysterectomies With Ovary Removal
So, if a hysterectomy removes the ovaries, will the hysterectomy carry a more profound influence on menopause?
Yes! The removal of the ovaries will have a major impact on the progression of menopause. Of course, if you are already postmenopausal than you will not likely notice any changes.
With your ovaries gone, you are more likely to begin perimenopause immediately. If you are already in perimenopause, your transition will accelerate and intensify without the usual hormones being released.
The heightened effects of perimenopause may result in visible symptoms like:
- Intense hot flashes
- Periods of insomnia
- Unexpected and dramatic mood changes
- Higher irritability
- Uncomfortable or painful sex
- Lower interest in sex
- Vaginal dryness
Other changes related to menopause will be less noticeable including:
- Decreasing bone density
- Higher cholesterol
- Greater risk for heart disease and stroke
Hysterectomies may seem problematic, but they are quite helpful in treating and preventing more serious conditions. And even if you had a hysterectomy before your menopausal years, it's best to find out all the information you can about the hysterectomy-menopause relationship.
If you are truly concerned, make an appointment with your doctor as your doctor may offer you recommendations and remedies to treat or limit the unwanted symptoms that accompany menopause. For example, your doctor may recommend hormone replacement therapy (HRT) in the form of estrogen, with or without progesterone. You may also opt for natural options, but it's best to discuss that with your doctor before you proceed.
Your healthcare team is there to help you and support you with all your questions, concerns and needs. Don't be afraid to reach out. They may have the answer your seeking and what next steps to take to help you cope with menopause after a hysterectomy.