- Surgical menopause occurs when both ovaries are surgically removed.
- This causes an immediate and abrupt drop in hormone levels.
- Symptoms are often more sudden and intense than in natural menopause.
- Starting HRT immediately is crucial for managing symptoms and long-term health.
- If you've had a hysterectomy, you will only need oestrogen-only HRT.
What is Surgical Menopause?
Surgical menopause is when menopause is induced by a medical procedure, rather than occurring naturally. Specifically, it happens after a bilateral oophorectomy – an operation to remove both of your ovaries. As the ovaries are the body's main source of oestrogen and progesterone, their removal causes an instant and permanent menopause.
This can happen at any age. Many women in the UK undergo this surgery to treat conditions like endometriosis, ovarian cancer, or as part of a total hysterectomy. The experience is very different from natural menopause, which unfolds over several years.
Hysterectomy: With and Without Ovary Removal
It's important to understand the different types of surgery. A hysterectomy is the removal of the uterus (womb). If your ovaries are left in place, you will not go into menopause immediately, though it may start slightly earlier than it would have otherwise. You will no longer have periods, but your ovaries will continue to produce hormones.
If a hysterectomy is combined with a bilateral oophorectomy (removal of both ovaries), you will enter surgical menopause. Your consultant will have discussed this with you before your operation, explaining the reasons and the consequences for your hormonal health.
Managing a Sudden and Intense Transition
Because the hormonal drop is so abrupt, the symptoms of surgical menopause can be sudden and severe. You may experience intense hot flushes, night sweats, mood changes, and vaginal dryness almost immediately after your surgery. It can be a significant shock to the system.
For this reason, starting HRT straight after the operation is strongly recommended for women who are not near the natural age of menopause. It is essential not only for symptom control but also for protecting your bone and cardiovascular health for the future, replacing the hormones your body would have naturally produced.
Frequently asked questions
If I keep my ovaries during a hysterectomy, will I still go through menopause?
Yes. Even if you keep your ovaries, a hysterectomy can sometimes disrupt their blood supply, causing them to fail earlier than they would have naturally. You will still experience menopause, but it may happen a few years sooner.
Why are symptoms of surgical menopause more severe?
In natural menopause, your ovaries gradually reduce oestrogen production over several years. In surgical menopause, this drop is sudden and total. Your body has no time to adapt, which is why the hot flushes, mood swings, and other symptoms can feel much more severe and appear overnight.
Do I need progesterone in my HRT if I've had a hysterectomy?
No. Progesterone's role is to protect the lining of the uterus (womb). As the uterus has been removed during a hysterectomy, there is no need to take progesterone. You can take "oestrogen-only" HRT, which is the simplest and safest regimen.
Can I have HRT immediately after my surgery?
In most cases, yes. It's generally recommended to start HRT very soon after the operation, sometimes even the next day. This helps to prevent the sudden onset of severe menopausal symptoms and provides long-term protection for your bones and heart.
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