A total hysterectomy involves surgical removal of the uterus and cervix. This stops menstruation and a woman's ability to get pregnant. However, it typically does not directly cause menopause unless the ovaries are also removed.
After a total hysterectomy where the ovaries are left in place, perimenopause and menopause usually occur at the natural time they would have without the surgery. The average age of menopause is 51 years old.
There are a few key points about menopause timing after a hysterectomy:
- If the ovaries are removed during the hysterectomy (called an oophorectomy), this causes sudden surgical menopause no matter what the woman's age
- If the ovaries remain, natural perimenopause and menopause happen on schedule years later
- Even without ovaries, hormone therapy can help delay problems linked to sudden drops in estrogen
Reasons the Ovaries Might Be Removed
There are a few reasons why a woman may have her ovaries removed during a hysterectomy, including:
- Ovarian cancer risk: Removal may be recommended for genetic predisposition or family history
- Endometriosis: Severe cases unresponsive to other treatments
- Pelvic pain: Such as from recurrent ovarian cysts
- Age: If a woman is close to menopause, ovaries may be removed
- Patient preference: Some women considering hysterectomy want ovary removal
If the ovaries are preserved, they will usually continue functioning normally and secrete hormones until the natural age of menopause. This allows a more gradual transition into menopause over a period of years.
However, in about 10% of women with ovarian preservation, blood flow to the ovaries can get disrupted. This may speed up loss of ovarian function by 1-3 years. But it still occurs more slowly than if the ovaries are directly removed.
Impact of Ovary Removal
Removal of ovaries causes "surgical menopause" - an abrupt drop in estrogen and progesterone:
- This brings symptoms like hot flashes, vaginal dryness, irritability, trouble sleeping
- Bone loss and higher fracture risk also increase rapidly after ovary removal
- Heart disease and cognitive issues may develop earlier than natural menopause
To manage surgical menopause, women can take hormone therapy. Options include:
- Estrogen therapy: Replaces estrogen to prevent symptoms
- Combination therapy: Estrogen plus progestin
- Bioidentical hormones
Treatment is often continued at least until the natural age of menopause. This helps protect long-term health. Monitoring effects on the breasts and uterus is important.
Seeking Proper Treatment
All women have unique needs and health histories. Finding the right hormone therapy options takes an expert eye.
At Hormone Harmony Clinic, our doctors specialize in hormone balance from puberty through menopause. We help women determine if hormone therapy is advisable after hysterectomy and ovary removal. Routine follow-up helps ensure optimal treatment.
We also offer holistic therapies to manage menopause symptoms like acupuncture, diet changes, stress management and personalized fitness plans. Contact us today for a consultation.