The Relationship Between Hysterectomy and Menopause

Some gynecological health issues require surgical treatment. A hysterectomy, for example, is a procedure that involves the surgical removal of the uterus. In some cases, other female reproductive organs may also be removed.

Many women undergo a hysterectomy at some point during their lifetime. Data from the U.S. Centers for Disease Control and Prevention (CDC) showed that in 2021, over 22% of women between the ages of 45 and 64 had a hysterectomy. The percentage increased with age, reaching approximately 42% among women aged 75 and older.⁽¹⁾ The menopause transition typically starts between the ages of 45 and 55. Depending on a woman’s menopause status and the type of hysterectomy performed, menopausal side effects may vary after surgery. 

Signs That a Woman Needs Hysterectomy After Menopause

A hysterectomy may be recommended for postmenopausal women if they experience certain gynecological health issues. Although the treatment is not appropriate in all cases, a hysterectomy may be performed to address the following conditions:⁽²⁾

• Uterine Fibroids: Most hysterectomies are performed to treat uterine fibroids.⁽³⁾ These benign growths in the uterus can be painful but tend to decrease during menopause. Perimenopausal or menopausal women who develop uterine fibroids are more likely to develop symptomatic cases involving abnormal uterine bleeding.⁽⁴⁾ Postmenopausal women can also be affected. A study published by the North American Menopause Society found that uterine fibroids grew by an average of 13% every six months in postmenopausal women with the condition.⁽⁵⁾

• Uterine Prolapse: This is a condition in which the uterus falls into the vagina due to a weakened pelvic floor. Uterine prolapse is associated with increased vaginal births and obesity, but it can also develop after menopause.

• Endometriosis: Endometriosis is the abnormal growth of tissue on the outside of the uterus, which can lead to the development of scar tissue. This condition predominantly affects women in their 30s and 40s and can cause pain and spotting. Decreased estrogen production during menopause can reduce growths and associated symptoms. If not, treatment may be required.⁽⁶⁾

• Cancers: A hysterectomy may be used to treat uterine, ovarian, cervical, or endometrial cancer. Menopausal and postmenopausal women tend to be more susceptible to uterine cancer. Ovarian cancer is also more common among older women.⁽⁷⁾⁽⁸⁾

• Chronic Pelvic Pain: Once other health conditions have been ruled out, a hysterectomy may be recommended for persistent pelvic pain related to the uterus.⁽⁹⁾

• Abnormal Bleeding: Infection, hormone fluctuations, or certain health conditions can cause heavier-than-normal vaginal bleeding.

Comparing Different Methods of Hysterectomy

Hysterectomy procedures can be performed in different ways depending on the needs of the patient. Below are some of the benefits and risks of different surgical methods.⁽³⁾

• Abdominal Hysterectomy: Abdominal hysterectomy is performed in the lower abdomen and may be used for patients with larger uteruses or adhesions. However, more complications can occur with the procedure, and the surgery requires a longer recovery period of four to six weeks.

• Laparoscopic Hysterectomy: This procedure involves making small incisions in the abdomen through which a laparoscope is inserted to examine the reproductive organs. The uterus is then removed in parts through these incisions. Laparoscopic hysterectomy is typically less painful and involves a shorter recovery time. Infection is also less likely with this surgical method. However, the surgery itself takes more time and may pose a risk of pelvic organ injury. Some laparoscopic procedures are done with robotic assistance.

• Vaginal Hysterectomy: Vaginal hysterectomy does not involve surgical incisions and is often preferred over abdominal or laparoscopic procedures. Like laparoscopic hysterectomy, vaginal hysterectomy has a shorter recovery time of three to four weeks. This procedure may not be suitable for women with bigger uteruses or adhesions.

Types of Hysterectomy

Depending on the reason for a hysterectomy, the procedure may involve the removal of other reproductive organs, such as the ovaries (oophorectomy). A unilateral oophorectomy refers to the removal of one ovary, while a bilateral oophorectomy involves the removal of both ovaries. The following are different types of hysterectomy:⁽²⁾

• Total Hysterectomy: Most patients undergo a total hysterectomy, also called a complete hysterectomy, where the uterus and cervix are surgically removed. The ovaries and fallopian tubes may remain intact or be removed.

• Partial Hysterectomy: In this procedure, only a portion of the uterus is extracted, while the cervix remains intact. The ovaries may also be removed.

• Radical Hysterectomy: This procedure is typically performed on patients with gynecological cancers. During the surgery, the whole uterus, cervix, surrounding tissue, and part of the vagina are removed. The fallopian tubes and ovaries may also be taken out.

Pros and Cons of Hysterectomy 

A hysterectomy has many potential benefits. For people with more severe cases of uterine fibroids, for example, a hysterectomy may be the only effective treatment option. The surgery can also help increase recovery rates for women diagnosed with certain gynecological cancers.⁽¹⁰⁾ 

A hysterectomy can also enhance women’s health and quality of life. In a study published in the Journal of Minimally Invasive Gynecology involving over 800 women who had previously undergone hysterectomies, the findings showed that the procedure increased patient vitality and sexual activity as well as reduced physical symptoms and emotional distress.⁽¹¹⁾

However, one potential drawback of a hysterectomy is that symptoms may not always resolve after the procedure. Research shows that some women experience little to no improvement in chronic pelvic pain after a hysterectomy.^(9)(12) 

There are also pros and cons of hysterectomy as it relates to symptoms of menopause. Menstruation stops after a hysterectomy. Depending on the type of hysterectomy performed, some premenopausal women may experience additional menopausal symptoms if they also had a bilateral oophorectomy. This is known as surgically induced menopause or surgical menopause and occurs due to an abrupt decrease in hormones. These symptoms may be more severe than those of natural menopause. If the ovaries are left in place during a hysterectomy, women generally do not experience additional menopausal symptoms immediately post-surgery, although mild bleeding is not uncommon.^(2)(10)

Patients who have a hysterectomy during or after natural menopause may have already experienced hot flashes, mood swings, and other common symptoms, potentially making the effects of these sudden hormone changes less severe.

Menopause Symptoms After Hysterectomy

Women who had a hysterectomy with bilateral ovary removal may experience the following menopausal symptoms:^(2)(10)(13)

• Hot Flashes and Night Sweats: Vasomotor symptoms are caused by drops in estrogen levels. Women who undergo a hysterectomy with bilateral oophorectomy may experience sudden flushes of heat called hot flashes. If the ovaries remain intact, women may not experience immediate symptoms. However, hot flashes can still occur before the average age of natural menopause due to changes in blood flow to the ovaries.

• Mood Changes: Hormone fluctuations can affect mood. Women may feel sad or irritable and may be more prone to anxiety or depression, all of which are common psychological symptoms of menopause.

• Vaginal Dryness: Vaginal lubrication decreases during menopause. Women who have their uterus and ovaries removed may experience vaginal dryness, which can cause pain during sex and suppress sex drive.

• Brain Fog: Women may have difficulty concentrating or focusing due to changes in estrogen levels. 

Adverse Outcomes of Hysterectomy After 50

Women of any age may experience adverse outcomes after a hysterectomy. In the short term, temporary pain and urinary problems are not uncommon. There is also a risk of infection or adhesions.⁽¹⁰⁾ 

Hysterectomies can also increase the risk of other health conditions, depending on whether the ovaries were removed and the age at which the procedure was performed. While hysterectomies are generally considered safe for most older adults, including those over 65, some patients may require a longer recovery time in the hospital.⁽¹⁴⁾ The following are potential health conditions that may develop after a hysterectomy and how age may influence the risk:^(2)(13)

• Cardiovascular Disease: Women who have a hysterectomy with a bilateral oophorectomy may face an increased risk of heart disease if they do not receive supplementation through hormone replacement therapy (HRT). A study published in Menopause found that postmenopausal women who had a hysterectomy (with or without ovary removal) showed more arterial plaque buildup compared to those who experienced natural menopause. This risk was particularly pronounced in women who had the procedure (with ovary removal) after the age of 50.⁽¹⁵⁾

• Osteoporosis: Women who experience surgically induced menopause before the age of 45 are shown to be at a greater risk of developing osteoporosis, a condition characterized by loss of bone mineral density. Postmenopausal women who have their ovaries surgically removed are also more susceptible to osteoporosis compared to those who retain their ovaries.

• Urinary Incontinence: Involuntary bladder leakage becomes more common with age as the muscles of the pelvic floor weaken. Women can also develop urinary incontinence after a hysterectomy. A systematic review published in The Lancet found that women aged 60 and older were 60% more likely to develop urinary incontinence after a hysterectomy.⁽¹⁶⁾ 

Life Expectancy After Hysterectomy

Many studies have examined life expectancy after a hysterectomy. Research findings vary, with some studies indicating an increased risk of certain health conditions but no increased risk of death.⁽¹⁷⁾ Other studies suggest that all-cause mortality may be linked to the age at which the procedure was performed, whether a bilateral oophorectomy was also done, and whether patients subsequently received HRT.⁽¹⁸⁾

In a study published in Obstetrics and Gynecology, researchers analyzed data from more than 30,000 U.S. women over nearly three decades. The study found that women who had a hysterectomy in combination with a bilateral oophorectomy before the age of 50, and who never received HRT, were 41% more vulnerable to all-cause mortality.⁽¹⁹⁾ Similarly, researchers from another study published in the American Journal of Obstetrics and Gynecology observed a link between the underutilization of estrogen therapy in premenopausal women who had a hysterectomy with bilateral oophorectomy and an increased number of health conditions and deaths.⁽²⁰⁾ 

Along with reducing symptoms of menopause, bioidentical HRT treatment may lower the risk of certain health conditions associated with declining levels of female sex steroid hormones. Whether a woman experiences natural menopause or goes through surgically induced menopause, HRT can help restore hormonal balance, supporting women’s health and longevity.