September 6, 2022
How to Manage the Challenges of Surgical Menopause
Surgical menopause can be especially rough. Hormone therapy can smooth the transition. Here’s what you need to know.
By Selene Yeager
Menopause can cause more than three dozen symptoms over the course of several years. Surgical menopause can send you headlong into a host of them all at once, and many women are left to fend for themselves and just “ride it out.”
That’s gotta change, says menopause management specialist and 20-year cancer survivor Corinne Menn, MD, in episode 92 of Hit Play Not Pause, The Challenges of Surgical and Early Menopause. One in eight women will have their ovaries removed before the natural age of menopause and millions more will have them removed close to the natural age of menopause. That’s a lot of women who need care.
“When you wake up in the recovery room after having your ovaries removed, you’ve basically been castrated,” Menn says. “You’re completely devoid of your estrogen and progesterone and some androgens. Hot flashes, insomnia, mood changes, all of it can be very severe and drastic overnight.”
Yet many women are basically expected to “just deal with it,” Menn explains. “Do you think that if a man – because they have cancer or some disease, or for some reason, needed to have their testicles removed at 35 or 40, do you think anybody, anybody, any doctor, any human being out there would think it was acceptable to not talk to that man about replacing his testosterone? It would be a travesty. But for decades or generations since beyond time, women have just been expected, even if it [surgical menopause] is early, to just deal with it.”
What Causes Surgical Menopause
Women sometimes think a hysterectomy automatically means menopause, but not necessarily. There are different types of hysterectomy. In general, a hysterectomy refers only to the removal of your uterus. Doctors can take out the entire uterus or they can take out the uterus above the cervix (aka supracervical hysterectomy), which preserves some of the pelvic support to the vagina. An oophorectomy is when the ovaries are removed (with or without the uterus) and that induces surgical menopause.
Though having a hysterectomy doesn’t send you straight into surgical menopause, you may experience menopausal symptoms earlier and it can lead to an earlier menopause. That’s because surgical removal of the uterus compromises some of the blood flow to the ovaries, which may cause them to shut down sooner than they otherwise would.
Hormone Therapy for Surgical Menopause
Hormone therapy is the gold standard of care for women who have surgical and/or premature menopause, Menn says. What that hormone therapy looks like depends upon your age, as well as your health conditions.
- Younger women may need a higher dose. The term menopausal hormone therapy (MHT) is often used instead of hormone replacement therapy (HRT) because you’re not really “replacing” the hormones to bring a woman back to a premenopausal state; you’re managing symptoms with hormones. In the case of younger women going through surgical menopause the doses will be higher – maybe even double that of an older woman using MHT – because you’ve abruptly removed their hormones.
- Cancer does not automatically disqualify you from MHT. Menn has seen women who have suffered for 10 years with early menopausal symptoms, not having sex because of vaginal dryness and pain, not sleeping, and suffering for years because their doctors won’t prescribe hormone therapy because they’ve had cancer – and not even estrogen-receptor positive breast cancer. Now science is indicating that even women who have had early-stage estrogen receptor-positive breast cancer may be able to use some types of hormone therapy. You do not need to suffer.
- Hormone therapy needs evolve over time. If you were on higher doses of hormone therapy because of surgical menopause, as you approach the age of natural menopause, your doctor may adjust your dosages to transition you to a more traditional form of MHT. If you’ve been using oral contraception, your doctor may transition you from that to MHT. At some point after the age of natural menopause, your doctor may want to wean you off of hormones. But research continues to evolve, and many women are opting to stay on MHT longer and some choose to be on it indefinitely. Ultimately, the choice is between you and your doctor.
- Perform risk assessments after 60. The North American Menopause Society (NAMS) guidelines recommend hormone therapy before age 60. After that point, it’s not recommended, but again, scientific understanding of hormone therapy is constantly evolving. “All the available evidence tells us now that women who assess their health risks on an annual basis after age 60 can stay on it,” Menn says. “They may feel like their quality of life is improved, or they have risk factors like bone loss that they want to modify.”
- Therapies can help you wean off hormones. Women who are reluctant to wean off hormone therapy because their hot flashes will return can dial back their hormones and overlap their MHT with another therapy like a low-dose SSRI like Effexor. (Just know that it’s important to then wean off the Effexor appropriately as well.)
- Vaginal estrogen therapy is always an option. No matter who you are or how long you’ve been menopausal, you can almost always use local vaginal estrogen therapy for vaginal health and/or to treat symptoms like vaginal dryness and/or pain during sexual intercourse.
- Don’t delay potentially lifesaving surgery. There are women who carry BRCA genetic mutations that put them at risk for cancer who are reluctant to have their ovaries removed because they don’t want to immediately go through menopause, Menn explains. But evidence shows that women using hormone therapy in that situation are not at an increased risk for breast cancer. “And with breast cancer, we have screening we can do for early detection. We don’t have those tests for ovarian cancer,” she says.
Surgical and/or early menopause can be complex topics. Ask your doctor about hormone therapy (NAMS is a good resource and has recently issued a hormone therapy position statement). If your doctor is not willing to have these conversations with you, you can find a doctor to consult with through the NAMS practitioner finder tool or via a telehealth service like Gennev. You don’t need to just suffer through it.