The Relationship Between Hysterectomy and Menopause

Sometimes a woman may need surgical intervention to treat a gynecological issue. In some cases, a surgeon removes the uterus (or womb) and cervix during a hysterectomy. In other cases, a woman may also have her ovaries (oophorectomy) and/or fallopian tubes (salpingectomy) removed. Gynecologists may recommend a hysterectomy to treat a woman who is experiencing any of the following:

• Abnormal or heavy vaginal bleeding

• Cervical or uterine cancers

• Chronic pelvic pain

• Endometriosis: A painful disorder where tissue grows outside the uterus that may develop into scar tissue and adhesions

• Uterine fibroids: noncancerous growths that can cause pain and bleeding

• Uterine prolapse: uterus that falls into the vagina

There are some treatment options to alleviate physical pain and bleeding, but in extreme cases, patients may opt for surgery. A hysterectomy is performed through the vagina, with no incision, laparoscopically, or through an abdominal incision. Over 600,000 hysterectomies are performed each year in the United States. 

There are two types of hysterectomy:

• Supracervical hysterectomy: uterus removal, with the cervix remaining intact

• Total hysterectomy: removal of the cervix and uterus

Sometimes the ovaries are also removed during a hysterectomy, this is called an oophorectomy. 

Post-hysterectomy, a woman will cease having periods, regardless of how young she may be at the time of the procedure.

Even when the ovaries are left in place, menopause symptoms often come sooner due to changes in blood flow to the ovaries  If the ovaries are removed at the time of surgery, menopause will begin abruptly, this is called surgical menopause and typically has significant symptoms.

Key Effects of a Hysterectomy: Before, During, & After Menopause

Before Menopause

If a woman has a hysterectomy before menopause, she will stop having periods. If the ovaries remain, a woman will not have menopausal symptoms immediately postoperatively, as the ovaries can still supply the necessary estrogen and progesterone. These reproductive hormones will help a woman ease into menopause.

With an oophorectomy, the symptoms of menopause will start to manifest, due to the immediate ceasing of estrogen production. Consulting with a knowledgeable provider on managing these sudden symptoms is vital. 

A physician may prescribe hormone replacement therapy (HRT) and other natural supplements after a woman undergoes “surgical menopause,” which will cause the classic symptoms of estrogen depletion. Early menopause can increase the rate at which a woman loses bone mass, increasing the risk of osteoporosis. Estrogen also protects women from cardiovascular disease and helps preserve cognitive function, so early menopause may increase the incidence of these health issues  HRT helps lower these risks. 

During or after menopause

A woman who undergoes a hysterectomy during or after menopause may have a smoother experience post-surgery. If the menopause transition has already begun, a patient may have already been dealing with hormone-induced symptoms like hot flashes, mood swings, and painful sex. However, a hysterectomy may intensify menopausal symptoms in this case. 

Because the body will have already gone through the gradual decrease and fluctuation of estrogen and progesterone, the sudden cessation of hormone production may not be as dramatic. Postoperatively, a woman may wish to begin or continue HRT to manage symptoms and protect from osteoporosis and other potential long-term health risks. 

Hormone Replacement Therapy After a Hysterectomy

HRT is a scientifically-based therapy used to reduce the symptoms of menopause and the long-term health risk that can result from the menopause transition. Depending on a woman’s health status, a provider may prescribe HRT after a hysterectomy to manage symptoms and decrease the risk of a cardiac event, cognitive decline, or bone fractures. The North American Menopause Society supports physician-guided HRT for women who undergo induced menopause to enhance their quality of life after a hysterectomy. Hormone replacement therapy after oophorectomy can also be helpful.

Women who experience gynecological cancer will need specialized treatment, depending on the type of cancer.

Other supplements may ease menopausal symptoms after a hysterectomy: 

• Vitamin E: reduces stress and mood changes during menopause and also reduces hot flashes

• Melatonin: aids sleep disturbances that are common with hormone changes

Is Your Condition Normal?

A hysterectomy may give a woman a sense of loss as the reproductive years have abruptly ended, which is a totally normal emotional response. With physician-guided recommendations, a woman can thrive after this life-changing procedure by replenishing the reproductive hormones with plant-based, bioidentical HRT. The board-certified physicians at Winona are here to help answer questions about natural hormone therapies backed by science. You can recover quickly from your hysterectomy and feel balanced and healthy again.