Surgical Menopause (Fact Sheet)

Although most women go through their menopause naturally, many women have their menopause early as the result of an operation. The operation in which both of your ovaries are removed causes an immediate menopause. The onset of your menopause is very sudden and abrupt compared to the natural menopause. Recovering from an operation can take time and then experiencing these symptoms can be extremely difficult for many women without the correct treatment. I have written this article to therefore provide you with more information about how HRT can help you return to normal life as quickly as possible after having this type of surgery.

You may have only had your ovaries taken out. This is called an oophorectomy. Alternatively, you may have had an operation called a total hysterectomy and bilateral oophorectomy (TAH and BSO). This means that you have your womb removed at the same time. Note: If you have just had your womb (uterus) removed (an operation called a hysterectomy) before your menopause and not had your ovaries removed, you may still experience an early menopause. Although your ovaries will still make oestrogen and testosterone after your hysterectomy, it is common that your levels of hormones will fall at an earlier age than average. As you do not have periods after a hysterectomy, it may not be clear when you are in the menopause. It is therefore very important that you talk to your doctor if you are experiencing any menopausal symptoms following a hysterectomy.

Your ovaries are very important at producing the hormones oestrogen, progesterone and testosterone. Although some other areas of your body also produce small amounts of these hormones, the majority are produced in your ovaries.

This means that when your ovaries are removed you experience very sudden drops in your levels of these hormones. In addition to experiencing menopausal symptoms many women find that some of the worst symptoms they experience are the ones that affect the way that they think. This means that memory, concentration, mood and also energy levels can all be affected and this can make it really hard for you to function properly.

Taking HRT

Your doctor may have spoken to you about the need for hormone replacement therapy (HRT) after your operation and may have started you on HRT straight after your operation. However, many women are not so fortunate. I hear about many women who have not had this conversation with their surgeons and then needlessly suffer with menopausal symptoms. This can be very frightening if you are not expecting them.

If you are planning to have surgery in which your ovaries are going to be removed, then it is really important that you talk to your doctor (ideally the surgeon who will be performing your operation) to talk about your options for taking HRT. The NICE (National Institute of Health and Care Excellence) clearly state in their menopause guidelines that women who are likely to go through menopause as a result of medical or surgical treatment should be offered support. They should also be given information about menopause before they have their treatment and ideally should be referred to a healthcare professional with expertise in menopause.

What is HRT?

All types of HRT contain oestrogen. Oestrogen is a very important hormone in your body and has numerous important functions. Oestrogen has effects on many different systems in your body including your brain, bones, heart, skin, hair and vagina so low levels can affect all these areas of your body.

Taking HRT replaces the oestrogen that your ovaries were producing before your operation.

Without treatment in the form of hormones, there is a greater risk of conditions such as osteoporosis and heart disease in younger menopausal women. It is very important that if you have your ovaries removed when you are under 51 years of age, or if you experience an early menopause when you are under 51 years of age, that you receive hormones (HRT or the contraceptive pill) up to the natural age of menopause (51 years) to replace the hormones that your body would otherwise be producing.

HRT is the most effective treatment available to relieve symptoms caused by the menopause such as hot flushes, night sweats, mood swings and bladder symptoms.

If you still have a womb (uterus) it is important that a progestogen is combined with the oestrogen. When you take oestrogen the lining of your womb can build up which can increase your risk of cancer. However, taking progestogen completely reverses this risk.

Do I need different HRT compared to older women?

There are many different types and strengths of HRT so it is really important that you are given the type that is most suitable for you as an individual.

Most women are under the age of 51 (the average age of the natural menopause in the UK) when they have surgery to remove their ovaries. When you have your ovaries removed at a young age then your body’s requirements for hormones is greater compared to older women. This means that you typically require much higher doses of these hormones (typically oestrogen) than if you are older.

So if you are given HRT and are still experiencing menopausal symptoms after your operation then the most likely reason for this is that your HRT dose is too low. Many young women actually need two or even three times more HRT than the average dose given to older women.

Your doctor or menopause expert may recommend that you have blood tests to determine the levels of hormones in your body. This can be useful for some women who are still experiencing symptoms of the menopause. Some women do not absorb some types of HRT well, so if your levels of oestradiol (a type of oestrogen) are low in your body despite you receiving a high dose of HRT then it is likely that your doctor will recommend you changing the type of HRT. For example, your doctor may recommend you to change from a patch or tablet to using the gel.

Testosterone

Testosterone is also a very important hormone. Testosterone is one of the sex hormones that women produce. Many people think of it as the “male” hormone, which is correct, but women need to have testosterone too. In fact, women produce three times as much testosterone than oestrogen before their menopause.

Testosterone is made in your ovaries and also your adrenal glands, which are small glands near your kidneys. The vast majority of testosterone is produced in your ovaries. This means that after your operation you will experience a huge reduction in the amount of testosterone in your body.

As a result, you may find that your mood, energy, concentration and also sex drive (or libido) are negatively affected. Although taking oestrogen can help with these symptoms, it is often taking testosterone that really improves these symptoms. Many women notice that their mind is clearer and more focused when they take testosterone.

Testosterone is usually given as a gel which you rub into your skin. It can also be given as an implant. More information can be found in the testosterone leaflet. It can sometimes take a few months for the full effects of testosterone to work in your body.

Whichever type of HRT treatment you are given, it is so important that you are aware that the dose and kind of HRT is not fixed. So if you develop symptoms in the future, then you must talk about these to your doctor or menopause doctor.

 

Last updated: Feburary 2018

Print this article

Share this article