As part of our Lunch & Learn series we were joined by Dr Heather Currie MBE, founder of Menopause Matters.
In this session we talked about surgical menopause, how it affects the menopause transition and what support is available to those who experience it.
Henpicked: What exactly is surgical menopause?
Dr Heather Currie: The word menopause literally means our periods stopping. We tend to use it quite loosely though, to describe everything we experience at that time. But really, the important thing to know is that what it means is the ovaries have stopped working. The reasons that periods stop naturally is that the ovaries have run out of egg cells and they can no longer produce the hormones during the normal cycle, particularly oestrogen. When we become low on oestrogen, the lining of the womb isn’t stimulated or shed in a monthly pattern and hence periods stop.
If someone has a hysterectomy, their womb removed, their periods will stop. But that isn’t the same as menopause. If the womb is removed the ovaries are still there and will continue producing oestrogen. In this instance, we won’t know when the ovaries stop working, so what we have to go by is symptoms, such as flushes and sweats. However, if we have the ovaries removed, either on their own or along with a hysterectomy, that is surgical menopause. This is the same as the ovaries running out of eggs cells and stopping producing oestrogen.
Henpicked: So is there a difference between a hysterectomy and oophorectomy?
Dr Heather Currie: Yes. Hysterectomy is just removing the uterus. If that’s the only operation and we’re in our pre menopause years then the ovaries will continue producing hormones. We might still feel like we have PMS, as this is related to the changing levels of hormones. This can come as a surprise to people who have had a hysterectomy. Because they don’t bleed they don’t always realise they may still get symptoms.
If someone has a hysterectomy but still has their ovaries they tend to work less well or perhaps stop working at an earlier age by a few years than someone who hadn’t had their womb removed. This could be due to interference to the blood supply to the ovaries at the time of the surgery.
Oophorectomy means removal of the ovaries. It can be done at the same time or separately from a hysterectomy.
Henpicked: Can we have surgery at any age?
Dr Heather Currie: Yes, but fortunately we do far less surgery these days. Many women had hysterectomies in the past because of troublesome heavy periods. But we have more options now, such as hormone tablets, a coil, or other things that can control heavy bleeding. Hysterectomy is seen as a last resort.
Henpicked: What are the treatment options for menopause if you’ve had surgery?
Dr Heather Currie: If the ovaries have been removed or stop working at a younger age than normal, the options are the same for someone who has a natural menopause. If womb is still there, the HRT types are also the same as natural menopause, replacing oestrogen and adding in progestogen to prevent oestrogen stimulating womb lining.
If the surgery has included hysterectomy then it’s much simpler. In most situations, the HRT here can be just in the form of oestrogen and we don’t need progestogen to protect womb lining as it’s not there any more.
Surgical menopause can affect doses of HRT required. In natural menopause we usually start on a low dose. But a younger woman who’s had a sudden drop in oestrogen may need a medium dose and increases in dose may be needed to control symptoms due to the sudden drop.
Henpicked: Is it the case that a lot of women focus on the surgery and not what follows?
Dr Heather Currie: Very often, yes, and it’s understandable. Many women are just thinking of trying to sort the immediate problem. I always advise you to get as much information as you can before surgery, have a clear understanding of what to expect, what you might experience and what your options are. This will prepare you for the after effects of surgery.
Henpicked: Is treatment different depending on age?
Dr Heather Currie: Yes. Early menopause is classed as under the age of 45, premature menopause is under the age of 40. In these cases, the current recommendations are that they should be offered HRT and are advised to take it until the average age of menopause. Unless there’s a good reason not to take it, such as a hormone dependent cancer.
This applies whether or not the woman is having menopausal symptoms. This is because there can be later health consequences for women who lose their oestrogen at a younger age, particularly increased risk of osteoporosis and cardiovascular disease. It’s believed taking HRT at least until average age of menopause reduces those risks of later health consequences.
Henpicked: What about someone who has endometriosis?
Dr Heather Currie: Endometriosis is one of those situations where it might be appropriate not to give just oestrogen if the womb is removed. This condition is where you get bits of womb lining deposited outside the womb. These areas are stimulated in the monthly cycle and can cause inflammation and pain. If you just give oestrogen after surgery, there is a possibility these areas could be stimulated as well. So if there has been widespread endometriosis at the time of surgery then HRT can still be considered but it should be both oestrogen and progesterone.
Henpicked: Is there any advice for those who can’t or don’t want to take HRT?
Dr Heather Currie: There is a lot of diet and lifestyle advice for bone and heart health if you can’t take HRT. The biggest one is not smoking, as this is bad for our hearts and bones. I know it’s easy to say don’t smoke, I realise how difficult it can be to quit. But never give up on the idea of stopping. Also things like not being overweight or drinking too much alcohol or caffeine, taking plenty of exercise. There’s no specific advice, it’s the normal advice for a healthy lifestyle.
Cognitive Behavioural Therapy (CBT) can be helpful for mood changes, yoga can also be helpful, as can some alternative therapies. It’s about finding what suits you best and that you enjoy.
Henpicked: What are the benefits of HRT after surgery?
Dr Heather Currie: This depends on your age at the time of surgery. If your periods have already stopped then you’ll already be low on oestrogen. You may not need HRT if you’re not getting any symptoms. For younger women having their ovaries removed, they will get a sudden drop in oestrogen and are likely to get menopause symptoms. Replacing oestrogen is the most effective treatment here.
Henpicked: Is there a time to stop taking HRT?
Dr Heather Currie: For younger women the advice is to take it at least until the average age of menopause, so early 50s. At that point they’re in the same situation someone would be if they were going into natural menopause. Then it is reasonable to consider coming off, you can see if you’re having symptoms and you can always go back on it if need be. We recommend a three-month trial if you do come off it. We cannot predict how long symptoms will continue, and so we cannot predict how long treatment for menopausal symptoms is needed; there is no arbitrary limit.
Something to remember is that it’s not just about symptoms, it’s about the impact of symptoms. We could have other stresses going on in our lives. Sometimes at a different stage in life you’re in a better position to deal with symptoms. Life is changing, not just our hormone levels. It’s very individual and about finding what’s right for you.
Watch the video here:
Henpicked’s Deborah Garlick was joined by Dr Heather Currie is an Associate Specialist Gynaecologist at Dumfries & Galloway NHS, Trustee and past Chair of the British Menopause Society.
She is co-editor of Post Reproductive Health, the journal of the British Menopause Society, Founder and MD of Menopause Matters, and the Scottish National Clinical Lead for Modernising Gynaecology Outpatients.
There’s more information here:
*This is not a sponsored or paid for post and we have received no money for advertisement.
Check out the rest of Henpicked’s Lunch & Learn video series!
