Hysterectomy and the menopause

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Menopause Advisor
Ask Eileen

31 August 2015


There are two main kinds of hysterectomy, and depending on which one you have had, they will give you a very different menopause.

It can be confusing but let’s see if I can explain…

A total hysterectomy

This operation will remove both the womb and the ovaries and will plunge you straight into a full menopause regardless of what age you are, even if you are well below the usual menopause age.

Most women in this case will be offered HRT (unless the operation was due to any kind of hormone-triggered condition such as cancer), as the sudden drop in hormones will quickly cause menopause symptoms such as hot flushes, joint pain, low libido, dry vagina, etc., which HRT can reduce.

At some point in the future you will probably be advised to stop the HRT and this is when problems can arise. Most women find that they start to get menopause-like symptoms again. When you come off the HRT you are going from a high level of hormones (HRT) to your own natural levels, which will be low after the removal of your ovaries with the hysterectomy. Low hormone levels are the cause of menopause symptoms, so once HRT is withdrawn you are very likely to experience them. We advise that when the time comes to withdraw your HRT, lower the dose really slowly over at least 6-12 months to avoid these withdrawal symptoms. (See my blog on coming off HRT for more info).

If you have not been given HRT after your operation it can be really tough to cope afterwards, and natural remedies will usually not be strong enough to help much. The more you can do to support your body generally, the better in this situation. I will give some tips later on.

We do get a number of women who have had a complete hysterectomy early on in life and subsequently come off the HRT, but as they approach the usual age for starting the menopause (roughly 45-55), feel as if they are having another menopause, with various menopause-like symptoms manifesting.

This can happen because small quantities of hormones produced outside of the ovaries fall at this time. It can also be a side effect of low iron levels, low thyroid function and low vitamin D levels. Low iron is possible at any time, especially if you have a restricted diet; and disturbed thyroid function is common around the forties and fifties. It’s sensible to check for these with your doctor.

Partial Hysterectomy, leaving the ovaries in place

With this kind of operation most women will get the menopause at roughly the same time they would have done had they not had the operation, because their ovaries are still able to produce hormones and go through the normal menopausal process of producing fewer and fewer around the age of 50 or so. You can therefore treat all the symptoms naturally if you wish, as long as they are not too severe.

The confusing issue is that because you are not getting any periods, you can’t use changing/missing periods as a guideline to when things start to change. Instead you need to rely on spotting some of the other usual symptoms such as flushes, joint pain, low mood, etc.

In general the average age to start the menopause is 45-55, so if you are getting menopause-like symptoms at this point then it is more than likely you are on your way! Your doctor may be able to test your hormone levels (although it is not 100% accurate) and this will give you a better idea as to what is happening.

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Q: I am going to have a hysterectomy. Is there anything I can do to help myself beforehand?

We do know that the fitter and healthier you are the more likely you are to recover quickly, so preparing for the operation is a good idea. Start a few months beforehand if possible.

Make sure that you have a good varied diet with plenty of water, and work on your physical fitness – even a 15-30 min walk a day can make a big difference. I would also suggest a good female multivitamin supplement as well.

Make sure that you have discussed the operation fully with your doctor and that you understand what is going to happen afterwards, especially if you are having a total hysterectomy. Being faced with the operation and all that it entails, women often forget to ask basic questions of their doctor or consultant at the time, and not really knowing what is going on adds to the general stress. Being clued up and knowing what to expect can make it easier to adapt afterwards. A good idea is to make a list of all the questions you can think of before you go so that you are more likely to get everything covered! For example, discuss whether you are going to have HRT or not.

This operation is not only a physical one but has many emotional issues attached to it as well, so it is important to have someone to talk to about it. Ask your doctor if there are any local support groups or an experienced nurse that you can have a chat with.

Q: I am having a total hysterectomy but don’t want to go onto HRT/can’t have HRT what can I take?

This is really difficult as the operation will bring on a very sudden menopause if you don’t have HRT to counter the dramatic drop in hormone levels. Most natural remedies are unlikely to be strong enough to cope with the symptoms.

Being as fit and healthy as possible is important and can help up to a point. Acupuncture can often be supportive, so is worth looking into. Ask your doctor if there is an NHS registered acupuncturist in your area or attached to your local hospital and ask for a referral.

Phyto-oestrogenic herbs such as fermented soya (if appropriate) may help to ease things a little, but this is not guaranteed. You could seek the advice of a Medical Herbalist as they can prescribe herbs not available over the counter and they could formulate a personalised treatment plan for you. To find a local practitioner see www.NIMH.org.uk

If you can take HRT it is best to go for it to start with to help your body re-adjust. So many women do try to do without HRT and find that they are still struggling months, even years down the line. You could ask to go on a low dose and take it until you feel more balanced, then come off as advised above: really, really slowly. This can mimic a more natural menopause, making symptoms less dramatic.

Q: I had a hysterectomy operation a few months ago and still feel awful. What can I do?

Bless us all, but we women do sometimes push ourselves so hard. A hysterectomy is a major operation and can take an incredible amount out of you, and what do most women do?

Try to get back to their usual routine as quickly as possible, not realising that their body has been seriously stressed and needs time to rebalance. Rest and recuperation are vital at this point so please don’t skip them! Looking after yourself well can make a huge difference further down the line.

If you have any questions that I have not covered please do email me and I will be happy to help.

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Did you know?

You won’t get the menopause the minute you turn 50! The average starting age is actually between 45 and 55 and it can often depend on a number of factors including hereditary, weight and health, however every single woman will have an individual menopause.

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