The Ovaries Play a Crucial Role in Menopause After Hysterectomy

Although many women know it is common to experience a premature onset of menopause after hysterectomy, many are unaware that the relationship between the two is quite complex. Surgical removal of the uterus, cervix, and ovaries can each affect the speed and degree of symptoms of menopause after hysterectomy.

Oophorectomy and Estrogen Deficiency

In particular, the decision to conserve one or both ovaries during a hysterectomy should be given careful consideration and discussed in depth with the treating physician. An oophorectomy (removal of the ovaries) results in the rapid loss of estrogen normally produced by the ovaries. Symptoms commonly associated with menopause may set in within days of surgery due to estrogen deficiency.

Along with estrogen deficiency symptoms such as hot flashes and night sweats, after an oophorectomy women also face an increased risk of osteoporosis. For symptom relief and protection against bone loss, HRT is often commenced following surgery. HRT itself may be associated with specific health risks under certain circumstances, and for some patients other avenues for estrogen deficiency treatment will have to be pursued.

Estrogen Deficiency Without Oophorectomy

Conserving one or both ovaries at the time of surgery may be beneficial to women in more ways than one, particularly if they are well in advance of the average age of menopause onset (51 years). Ovaries left in tact continue to produce estrogen typical of the menstrual cycle even in the absence of monthly periods. This estrogen protects against osteoporosis, and the premature onset of uncomfortable menopause symptoms may be avoided.

It is also possible that ovaries left in tact will fail to function properly or will prematurely stop producing estrogen following a hysterectomy. In some cases, the ovaries fail immediately; alternatively, it may take 1 to 2 years before estrogen production stops. In either case, symptoms of estrogen deficiency may or may not be apparent. Testing when failure is not apparent should be done annually following a hysterectomy if the ovaries are left in tact. The risk of osteoporosis is present at the time of ovarian failure regardless of the presence of symptoms, and HRT can play a crucial role in protecting against bone loss.

Decisions about the type of hysterectomy to be performed are usually dictated by the condition precipitating it, family history, and the patient’s past medical history. But in many cases, a woman does have some choice about the extent of the removal of reproductive organs. An understanding of the relationship between the function of these organs and the onset of menopause can help guide the decision making process.