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Does Hysterectomy Cause Menopause


Does hysterectomy cause menopause

If you're considering a private hysterectomy in London (including a robotic hysterectomy), you might be worried about how it could affect your menopause.


At Rylon Clinic, our experienced gynaecologist Mr Naji performs hysterectomies and other gynaecological procedures every day. He understands the fears and questions you might have.


One common concern often seen is the worry about whether removing a uterus (also known as a hysterectomy) will cause menopause. That's why we want to explore the link between hysterectomy and menopause in this article, set the facts straight, and clear up some misconceptions about both.


So, what exactly is the link between hysterectomy and menopause? And how can you know what to expect after your surgery? Keep reading to find out.


If you’re interested in this article you may also want to read Can fibroids cause bleeding after menopause?


The link between hysterectomy and menopause


Firstly, it's very important to understand that menopause occurs naturally when your ovaries stop producing oestrogen and progesterone, the hormones that regulate your menstrual cycle. A hysterectomy, which removes the uterus, does not cause menopause as long as your ovaries remain intact and functional.


So, if your ovaries are preserved during a hysterectomy, your body will continue to produce the hormones needed to maintain your bone/heart health and overall wellbeing. And you will not experience sudden menopause in that case.


Is menopause caused by hysterectomy?


As mentioned, a hysterectomy will not cause menopause unless the ovaries are removed during the procedure. Here are some important points you should note:


Ovarian conservation and hysterectomy


Ovarian conservation is an option for women undergoing a hysterectomy, where the ovaries are left intact rather than being removed. This approach ensures that the woman does not experience immediate menopause since the ovaries continue to produce hormones. The decision to opt for ovarian conservation is based on several factors and must be tailored to each individual's health profile and preferences.


Eligibility for ovarian conservation typically includes women who are pre-menopausal and have no significant risk factors for ovarian cancer. This group generally includes women who do not have a family history of ovarian or breast cancer, do not carry BRCA1 or BRCA2 gene mutations, and do not have endometriosis or other conditions affecting the ovaries. The decision also takes into account the woman’s age, overall health, and personal and family medical history.


The process of ovarian conservation during a hysterectomy involves removing the uterus while carefully preserving the ovaries. The surgical approach can vary but commonly includes abdominal, vaginal, robotic or laparoscopic techniques, depending on the specific circumstances and the surgeon's expertise.


After a hysterectomy with ovarian conservation, women should be aware of several important considerations. Although the ovaries continue to function and produce hormones, the blood supply to the ovaries may be slightly reduced, which may rarely lead to an earlier onset of menopause than if the hysterectomy had not been performed. Regular follow-up with a healthcare provider therefore is essential to monitor the function of the ovaries and to manage any symptoms that may arise.


Women should also be aware that while preserving the ovaries reduces the risk of immediate menopause, it keeps the background risk of ovarian cancer. Thus, ongoing vigilance and routine medical check-ups are necessary. Additionally, some women may experience psychological effects from the hysterectomy itself, and support or counselling might be beneficial to help cope with these changes.


Bilateral salpingo-ophorectomy (BSO) during hysterectomy and the effects on menopause


A bilateral salpingo-oophorectomy (BSO) is a surgical procedure often performed in conjunction with a hysterectomy, where both ovaries and fallopian tubes are removed. This operation leads to what is known as "surgical menopause" if performed in the pre-menopausal state because the removal of the ovaries halts the production of hormones such as oestrogen and progesterone, resulting in the onset of menopause symptoms.


A hysterectomy with BSO is typically recommended for women who are nearing or have passed the age of menopause. In such cases, the natural decline in ovarian function and hormone production means that the removal of the ovaries does not have as profound an impact as it would on younger, premenopausal women. For women who are closer to or already in menopause, the risk of complications from BSO is reduced because their bodies have already begun to adjust to lower hormone levels.


The decision to perform a BSO in conjunction with a hysterectomy is heavily influenced by clinical indications. One of the primary reasons is the presence of ovarian cysts, endometriosis or adenomyosis. While many ovarian cysts are benign, some can be complex or exhibit characteristics that raise concern for malignancy, necessitating their removal along with the ovaries to ensure that all potentially cancerous tissue is excised.


Another significant clinical indication is the presence of ovarian malignancy. If cancer is detected in one or both ovaries, removing the ovaries and fallopian tubes helps to prevent the spread of the disease and is a critical component of the overall treatment strategy. In such cases, a BSO is often recommended irrespective of the woman’s age or menopausal status to safeguard her health.


Other indications for a BSO might include severe endometriosis, chronic pelvic pain, or a strong family history of ovarian or breast cancer. Women with BRCA1 or BRCA2 gene mutations, which significantly increase the risk of ovarian and breast cancer, may also be advised to undergo BSO as a preventive measure.


Undergoing a BSO means that women could experience surgical menopause, which could bring menopausal symptoms such as hot flushes, night sweats, vaginal dryness, and mood swings. The abrupt nature of hormone loss can make these symptoms more severe compared to natural menopause. Hormone replacement therapy (HRT) is often considered to alleviate these symptoms and manage the long-term health risks associated with low oestrogen levels, such as osteoporosis and cardiovascular disease.


In short, hysterectomy with bilateral salpingo-oophorectomy is a procedure that is generally reserved for women who are nearing or have already passed menopause, ensuring that the sudden onset of menopausal symptoms is less impactful. Ovarian conservation remains a viable and often preferred option for many women, especially those who are younger and not yet close to menopause. The decision to remove both ovaries is typically based on specific clinical indications such as the presence of ovarian cysts or malignancies, ensuring that the procedure is necessary and beneficial for the patient's health. For those who do undergo BSO, there are effective treatments available to manage menopausal symptoms and support long-term health, offering reassurance and support during the transition.


Hysterectomy and surgically induced menopause


Surgically induced menopause is a condition that occurs when a woman undergoes a hysterectomy along with the removal of both fallopian tubes and ovaries, known as a bilateral salpingo-oophorectomy (BSO). However, it’s essential to understand that the operation itself does not cause menopause. Instead, it is the removal of the ovaries, which produce essential hormones like oestrogen and progesterone, that leads to the sudden onset of menopausal symptoms.


Women who are concerned about the potential for menopause following a hysterectomy are primarily those who are younger and have not yet reached natural menopause. For these women, it is often possible and preferable to retain the ovaries, a practice known as ovarian conservation. By preserving the ovaries, the body continues to produce hormones naturally, preventing the immediate onset of menopause and its associated symptoms.


Ovarian conservation is a viable option for many women undergoing a hysterectomy, especially when there are no significant risk factors such as a family history of ovarian or breast cancer, genetic predispositions like BRCA1 or BRCA2 mutations, or existing ovarian conditions like cysts or malignancies. In such cases, the ovaries can continue to function normally, producing hormones and supporting overall health.


For women who do need to have their ovaries removed due to medical indications, such as ovarian cysts that are complex or suspicious for malignancy, or confirmed ovarian cancer, the removal is necessary for their health and well-being. These women will experience a drop in hormone levels, leading to symptoms associated with menopause, such as hot flushes, night sweats, vaginal dryness, and mood changes.


It's important to note that the majority of women who undergo a hysterectomy do not need to worry about immediate menopause if their ovaries are conserved. The surgery itself, removing the uterus, does not affect the hormonal balance significantly if the ovaries are left intact. This is reassuring for younger women who may be concerned about the hormonal impact of a hysterectomy.


For those who do undergo BSO and experience surgically induced menopause, there are effective treatments available to manage symptoms and support overall health. Hormone replacement therapy (HRT) can help alleviate symptoms like hot flushes and night sweats, improve mood, and prevent long-term health issues such as osteoporosis and cardiovascular disease. Each treatment plan is tailored to the individual, taking into account her specific health needs and risks.


The primary concern regarding hysterectomy and menopause lies with younger women who have not yet gone through natural menopause. Ovarian conservation is a highly effective approach to prevent surgically induced menopause, allowing the ovaries to continue their natural hormone production. For those who do require the removal of their ovaries, comprehensive treatment options are available to manage the transition and maintain health and quality of life.


Retained ovarian function after hysterectomy


Even after menopause, if the ovaries are normal and remain intact, there is evidence suggesting that they continue to secrete small amounts of oestrogen. This residual oestrogen production, though not as significant as during the reproductive years, can still play a role in managing menopausal symptoms and overall health.


Oestrogen, even in minimal amounts, contributes to various physiological processes that are crucial for a woman's well-being. For instance, it helps maintain bone density, thereby reducing the risk of osteoporosis and fractures. It also supports cardiovascular health by influencing cholesterol levels and maintaining the elasticity of blood vessels, which can help mitigate the increased risk of heart disease post-menopause.


Furthermore, oestrogen has a role in the health of the skin and mucous membranes, including the vaginal lining. The small amounts of oestrogen produced by the ovaries after menopause can help maintain vaginal health, reducing the severity of symptoms such as dryness, itching, and discomfort during intercourse. This can improve the quality of life and sexual health for postmenopausal women.


Additionally, there is some evidence to suggest that postmenopausal oestrogen production by the ovaries might contribute to cognitive function and mood regulation. Oestrogen interacts with neurotransmitters and receptors in the brain, potentially impacting mood, memory, and cognitive abilities. Therefore, even minimal ovarian oestrogen production could have beneficial effects on mental health and cognitive function during and after the menopausal transition.


However, it is important to note that while these benefits are suggested by current research, the evidence is not yet conclusive. More studies are needed to fully understand the extent and impact of ovarian oestrogen production after menopause. The variability in individual responses to menopause and hormone levels means that these benefits may not be uniform for all women.


In clinical practice, this understanding influences decisions around ovarian conservation during hysterectomy, particularly for women who are approaching or have reached menopause but do not have a high risk of ovarian cancer or other significant health issues. By preserving the ovaries, healthcare providers aim to retain any potential benefits from the continued production of small amounts of oestrogen, thus supporting overall health and well-being in the postmenopausal years.


So while the evidence is not definitive, the ongoing secretion of small amounts of oestrogen by normal ovaries after menopause can contribute to bone health, cardiovascular health, vaginal health, and possibly cognitive function and mood. This potential benefit underscores the importance of considering ovarian conservation during hysterectomy, especially for women who are near or have passed menopause but are not at high risk for ovarian-related health issues.


Benefits of hysterectomy


While the decision to have a hysterectomy is deeply personal, it's important to recognise the potential benefits this surgery can offer for various gynaecological conditions. Here are some of them:


Relief from painful symptoms


For many women, a hysterectomy provides much-needed relief from chronic pelvic pain, heavy menstrual bleeding, or other symptoms caused by conditions like uterine fibroids, endometriosis, or adenomyosis. By removing the uterus, a hysterectomy can significantly improve quality of life.


Reduced cancer risk


In some cases, a hysterectomy may be recommended to reduce the risk of certain gynaecological cancers, such as ovarian, uterine, or cervical cancer.


This is especially relevant for women with a strong family history of these cancers or those who carry genetic mutations that increase their risk.


No more periods


For women who have struggled with heavy, painful, or irregular periods, a hysterectomy can offer permanent relief.


Without a uterus, you will no longer have menstrual periods, which can be a significant benefit for those who have experienced severe menstrual-related symptoms.


Types of hysterectomy


There are several types of hysterectomy, each with different implications for menopause and overall health.


Total hysterectomy


A total hysterectomy involves removing the entire uterus, including the cervix. The ovaries and fallopian tubes may or may not be removed during this procedure, depending on your individual circumstances and the reason for the surgery.


Partial hysterectomy


Also known as a subtotal or supracervical hysterectomy, a partial hysterectomy removes the upper part of the uterus while leaving the cervix in place. As with a total hysterectomy, the ovaries and fallopian tubes may or may not be removed.


Radical hysterectomy


A radical hysterectomy is a more extensive procedure that removes the uterus, cervix, upper part of the vagina, and surrounding tissues. This type of hysterectomy is typically reserved for cases of cervical cancer or other gynaecological malignancies.


Instances when you are likely to need a hysterectomy


In certain situations, a hysterectomy may be the best or only treatment option available. Some common indications for the surgery include:


Uterine fibroids


Uterine fibroids are non-cancerous growths in the uterus. When they become large or numerous, they can cause severe symptoms. You may experience heavy bleeding, pelvic pain, or pressure on other organs. If these symptoms are very bad, a hysterectomy may be recommended.


Sometimes, fibroids can lead to complications. They can cause anaemia from heavy bleeding or problems with pregnancy. When less invasive treatments don’t work, removing the uterus might be the best solution.


Doctors may suggest trying medication or minor surgery first. But if those options fail, a hysterectomy can provide permanent relief. It stops the symptoms and prevents future fibroid growth.


Endometriosis or adenomyosis


Endometriosis and adenomyosis are painful conditions. They occur when the lining of the uterus grows outside it. This can cause severe pain and heavy periods.

For some women, medication and conservative treatments help. But when these methods don’t work, and the pain is unbearable, a hysterectomy can offer relief, as it removes the source of the pain.


Endometriosis and adenomyosis can also cause fertility problems. If having children is no longer a concern, a hysterectomy might be considered. It can end years of suffering and improve the quality of life.


Gynaecological cancers


Cancers of the uterus, cervix, or ovaries are serious conditions. A hysterectomy is often a standard treatment for these cancers. It may be done alone or with other therapies like chemotherapy or radiation.


Removing the uterus and possibly other reproductive organs can stop the spread of cancer. This surgery can be life-saving. Early detection and treatment are key. But sometimes, even with early detection, a hysterectomy is necessary.


Your doctor will discuss the best treatment plan. If a hysterectomy is needed, it’s to give you the best chance of beating cancer. This decision is made carefully with your health as the top priority.


Uterine prolapse


Uterine prolapse happens when the uterus slips into the vagina. This can cause discomfort and problems with bladder and bowel function. Severe prolapse can significantly impact daily life.


When the prolapse is serious, a hysterectomy may be necessary. It helps restore the normal pelvic structure and relieves symptoms. Less severe cases might be managed with physical therapy or a pessary, but severe cases often require surgery.


Living with severe prolapse can be very difficult. A hysterectomy can provide a long-term solution and improve quality of life. It’s a decision made to restore health and comfort.


Uncontrolled bleeding


Heavy menstrual bleeding is a common problem. But when it doesn’t respond to other treatments, it can cause anaemia and other issues. In such cases, a hysterectomy might be the best way to stop the bleeding.


Medication and minor procedures are often tried first. But if these don’t work, and the bleeding continues, surgery may be necessary. Removing the uterus stops the heavy bleeding permanently.


This option is usually considered when all other treatments have failed. It’s a major decision but can provide a lasting solution to a persistent problem. It’s about ensuring your overall health and preventing further complications.


Conclusion


There is no direct link between hysterectomy and menopause as long as the ovaries are left intact during surgery.


Ultimately, the decision to undergo a hysterectomy is a personal one that should be made in consultation with a trusted healthcare provider.


By understanding the potential benefits, risks, and impacts on menopause, women can make informed choices about their reproductive health and overall well-being.


If you're considering a hysterectomy or have questions about your reproductive health, get in touch with us at Rylon Clinic to schedule a consultation. Our team of experts is ready to provide you with the best possible care tailored to your needs.


FAQs


How long does it take to recover from a hysterectomy?

Recovery time varies, but most women can return to normal activities within 4-6 weeks after surgery.

Can I still have children after a hysterectomy?

Will a hysterectomy affect my sex life?

Will I need hormone therapy after a hysterectomy?



Mr Osama Naji

Author: Mr Osama Naji


Mr Naji offers a “one-stop” gynaecology clinic for instant detection of various gynaecological cancers as well as providing all the diagnostic and treatment services needed under one roof.



Mr Naji provides advanced gynaecology scanning which is essential when conducting any gynaecology consultation, he is bilingual in English and Arabic and has an NHS base at the highly reputable Guy's and St Thomas' Hospital in London.

He is passionate about raising awareness of various subtle signs and symptoms of gynaecological conditions that are often overlooked by patients.

You can read more about Mr Naji on his about page here.



DISCLAIMER: The information provided in this article is intended for general informational purposes only and should not be construed as medical advice, diagnosis, or treatment. The products and methods mentioned are not a substitute for professional medical advice from a trained healthcare specialist. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Use of the information and products discussed is at your own risk.

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