What does ‘surgical menopause’ mean?
Every woman will experience menopause at some time in her life. But while the average age in the UK for women to reach menopause is 51, this can be significantly different if she’s undergone surgery which triggers her menopause. And this can have an impact on the type of symptoms she experiences, when she experiences them, and how they affect her quality of life.
Essentially, surgical menopause occurs when a woman has gynaecological surgery which involves the ovaries. This can be an operation where the ovaries alone are removed, called a bilateral salpingo-oophorectomy (BSO). In this operation, the woman retains her uterus and cervix.
Or the ovaries can be removed as part of a total hysterectomy, where the uterus, cervix, ovaries and fallopian tubes are also removed. The type of surgical menopause will be dictated by the disease or condition the surgery is helping to treat, or in some cases, prevent.
The ovaries produce our three key hormones, oestrogen, progesterone and testosterone. There are other organs in the body that produce these hormones but in much smaller amounts.
That’s the science. But for women experiencing a surgical menopause, the loss of these hormone-producing organs can lead to an intensely symptomatic menopause.
What is a medical menopause?
A medical menopause is not the same as a surgical menopause. This occurs when the ovaries’ ability to function, to produce hormones, is paused due to medical treatment such as chemotherapy, radiotherapy, or medication. Sometimes this is temporary, other times it’s permanent. In the latter case, women sometimes find menopause symptoms increase, building on those they may have already experienced during their initial treatment.
But while it’s good to arm ourselves with information about terminology, and understand some of the medical processes behind these terms, the reality is that for women experiencing a surgical menopause they can often feel overwhelmed, confused or alone.
Are the symptoms of surgical menopause different?
When a woman approaches menopause, her hormones fluctuate over a period of time. This is known as perimenopause. But those having surgery to remove their ovaries can begin to experience menopause symptoms more quickly and intensely, and at a much younger age. So the symptoms themselves aren’t different, but the how and the when are likely to be.
If the surgeon removes the uterus, fallopian tubes, or both but leaves one or both ovaries intact, menopause will probably start within five years of surgery. This is not classed as a surgical menopause. Some women may have their ovaries removed within this five-year period and they will menopause immediately.
If a post-menopausal woman has surgery to remove her ovaries then the effects are less dramatic. However, she may still experience post-menopause symptoms.
The symptoms of menopause can be physical and psychological, and can include:
- Hot flushes
- Night sweats
- Loss of sex drive (libido)
- Mood swings
- Vaginal dryness
- Painful sex
- Changes in skin and hair
- Joint pain
- Restless Leg Syndrome
- Loss of concentration
- Problems with memory recall
- Urinary tract infections (UTIs)
A surgical menopause is something of a double whammy. Women undergoing it have already had a period of very intrusive treatment and surgery. Being thrown straight into menopause with no advance notice and often very little understanding of just what is happening to her body can certainly be a strain.
NICE (The National Institute of Health Care Excellence) guidelines state that all women who are likely to experience menopause through surgery should be offered support by a healthcare professional, knowledgeable and experienced in this specific area of the menopause.
If you need to have a surgical menopause then your consultant should go through all the implications with you in detail. If you’re having your ovaries removed as part of an ongoing treatment plan for cancer than HRT won’t always be an option. But your doctor can talk to you about other options, such as lifestyle changes and alternative or complementary medicines.
If you can take HRT, the younger you are the higher the concentration of HRT you’ll need.
Not just a midlife experience
We generally associate menopause with midlife. So for younger women going through surgical menopause, being suddenly thrust into this life-changing state can be particularly traumatic. While the operation can be seen as a lifesaving procedure, it can still mark the end of a chapter in a young woman’s life, one which she will need to come to terms with.
Early surgical menopause is associated with lower bone density and increased risk of fracture, increased cardiovascular disease, reduced cognition and decreased life expectancy. This is why it’s important women understand the implications of a surgical menopause to prepare themselves, in particular regarding fertility.
Whatever your circumstances, if you struggle with menopause symptoms after surgery, it’s important to speak to your GP or a menopause specialist to find our what your options are.
You could also seek out support groups, to help cope with and manage not just the symptoms but also the emotional aspects of the procedure.
British Menopause Society Management of Menopause Sixth Edition
- The British Menopause Society: www.thebms.org.uk/find-a-menopause-specialist/
- The Daisy Network www.daisynetwork.org
- The Acupuncture Society: www.acupuncturesociety.org.uk
- British Acupuncture Society: www.acupuncture.org.uk
- Association of Naturopathic Practitioners: www.theanp.co.uk
- British Naturopathic Association: www.the-bna.co.uk
- Naturopathic Nutrition Association: www.nna-uk.com
- National Institute of Medical Herbalists: www.nimh.org.uk/find-a-herbalist/