Surgical Menopause

What is Surgical Menopause ?

Surgical menopause is an abrupt, ‘artificial’ menopause which occurs after various operations, usually when a woman has both of her ovaries removed in a procedure called a bilateral oophorectomy. A woman’s hormones are controlled by her ovaries, and so removing them causes an immediate drop in hormone levels that plunges her directly into menopause with all its symptoms.

The most common reason for having a bilateral oophorectomy resulting in surgical menopause is to treat ovarian, cervical and endometrial cancers. There are other medical reasons for removing the ovaries however, such as uterine fibroids, endometriosis, or severe infections.

What to expect with surgical menopause

Because of the immediate nature of surgical menopause, many women find that their menopause symptoms are more severe than with the natural menopause. Hot flushes are often more severe, longer lasting, and more regular with surgical menopause.

The incidence of depression following surgical menopause is higher than with natural menopause, due both to psychological and physical factors. Women who have surgical menopause may be at a higher risk of developing osteoporosis or heart disease than women who go through the menopause naturally.

Types of surgery that involve removal of both ovaries

A bilateral oophorectomy, or removal of both ovaries, can form part of the following types of surgery:

Hysterectomy, or removal of the uterus, sometimes also requires removal of the ovaries. If a hysterectomy does not include removing the ovaries surgical menopause rarely occurs.

Abdominal Resection, which includes removal of the lower colon and rectum, sometimes requires removal of the uterus, ovaries and rear wall of the vagina. This operation is performed to treat colorectal cancer.

Total Pelvic Exenteration includes the removal of most pelvic organs including the uterus, ovaries, fallopian tubes, vagina, bladder, urethra and part of the rectum. This operation is only performed to treat repetitive cervical cancer that doesn’t respond to other types of surgery or radiation treatment.

Other causes of surgical menopause

There are other medical procedures that can sometimes induce surgical menopause without the removal of both ovaries. Medical treatments such as chemotherapy and pelvic radiation therapy can cause surgical menopause by damaging the ovaries. However, not all premenopausal women undergoing these procedures will experience surgical menopause. Even if the ovaries are damaged, leading to menopause symptoms, the damage is not always permanent.

When only one ovary is surgically removed, menopause usually occurs naturally. When the uterus is removed via hysterectomy but the ovaries remain, menstrual periods stop but other menopausal symptoms usually occur naturally. However, some women who have a hysterectomy, or who have just one ovary removed may experience menopausal symptoms at a younger age than other women.

Preparing yourself for surgical menopause

If you are having both ovaries removed, it is certain that you will experience surgical menopause directly after the operation. It is vital that you are prepared for this and that you discuss possible forms of treatment with your doctor before surgery. Being mentally prepared for surgical menopause can help to reduce the anxiety and depression that it can often bring.

The surgical menopause symptoms that you are likely to experience directly after your operation can include heart palpitations, hot flushes, uncontrollable sweating, insomnia, headaches, itchy skin and achy joints. Many doctors will start women on Hormone Replacement Therapy directly after surgery to avoid these problems, and then gradually reduce their dose to see what surgical menopause symptoms they are experiencing. .

If you are having an operation such as a hysterectomy that does not involve removal of both ovaries, you may still want to prepare yourself for the possibility of surgical menopause. Damage to the ovaries, or a diminished oxygen supply to that area during the operation, could potentially lead to surgical menopause although this is fairly rare.

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