WHAT IS A HYSTERECTOMY?
A hysterectomy is a surgical removal of the entire womb or uterus, which induces a "surgical menopause". Frequently, in addition to the uterus, one or both of the ovaries are removed during the same operative procedure.
IS THERE A DIFFERENCE IF THE OVARIES ARE REMOVED?
Although, we usually refer to premenopausal women who have had a hysterectomy as having experienced a "surgical menopause" they are not menopausal in a "hormonal" sense unless their ovaries have been removed.
HYSTERECTOMY WITH OVARIAN PRESERVATION
Women, in whom the ovaries are retained, although they no longer have monthly periods, will not experience menopausal symptoms or the effects of hormonal deprivation. That is, as long as the ovaries continue to function normally, or until the age an expected natural menopause would have occurred, or sooner if the ovaries have been compromised by the surgery.
Unfortunately, even if the ovaries are preserved, they become dysfunctional up to 50% of the time within 3 years following the surgery. Nevertheless, in women under the age of 45 preservation of the ovaries is an important consideration when reasonable.
HYSTERECTOMY WITH OVARIAN REMOVAL
If both of the ovaries are removed the source of estrogen and testosterone production is lost. The fall in hormone levels is sudden and severe. It is a very different circumstance, than a natural menopause where the decline in estrogen levels may be gradual in onset and ovarian testosterone production may continue for several years.
Women in this category, who are without the benefit of HRT, often have the most severe menopausal symptoms and long-term consequences of sex hormone deficiency. Health, quality of life and longevity are affected. There is a statistically shorter life expectancy, associated with a higher rate of death, mostly from heart attacks, strokes, and osteoporosis. Libido and sexual function deteriorate.
A hallmark study published 1983 in the Journal of the American Medical Association revealed a significantly increased death rate among women 40-50 years of age who had had a hysterectomy and who were without the benefit of estrogen replacement, as compared to those who were estrogen users. For those who had their uterus removed, the rate was 3 times higher. For those who also had both ovaries removed, the rate was 8 times higher. It is apparent that careful consideration should be given to HRT after a surgical menopause.
DOES HRT HELP?
Most of the routinely prescribed programs of HRT are usually effective in preventing the long-term consequences of hormone deficiency and maintaining quality of life.
DOES HRT WORK FOR ALL WOMEN WHO HAVE THEIR OVARIES REMOVED?
Unfortunately, following the surgery, there is a group of women who experience life-altering symptoms, which are unresponsive to the routinely prescribed regimens of HRT. This often presents a dilemma. We have a woman who has undergone a major surgical procedure. She has been told that if she takes HRT, her quality of life, including her libido and sexual function, will be the same, if not better.
If she is fatigued, having symptoms and has no libido in the immediate post-operative period, it may not seem unreasonable to her. After all, she just had a major surgery., didn’t she? A few months go by and she is still fatigued, having flushes, insomnia, problems with her memory and she has no sex drive.
She does the reasonable thing. She returns to her physician, who changes her HRT regimen several times. Months go by, and she feels no better. She returns to the doctor again and restates her concerns. The physician looks at her, shakes his or her head, almost, but not imperceptibly, and speaks.
"You weren’t psychologically ready for this surgery," or " Are you having trouble at home." And then, "This has nothing to do with the surgery … you need to see a therapist."
She looks at the physician in disbelief, just having suffered the indignity of having her legitimate concerns invalidated. She feels betrayed, and wonders what she has to do, after leaving this "jerk's" office to regain her life. So, she goes to several new physicians, and is placed on several additional HRT regimens, without success. Next, she purchases several vitamin and/or herbal preparations and rubs on progesterone cream with no improvement. She reads everything she can that seems to address her problem. Ultimately, if nothing helps, she begins to doubt that she will ever feel like herself again. And, sometimes she even begins to wonder if some of the problem is actually in her mind.
Well, it’s not in her mind. If she felt fine prior to her surgery, and now does not, it is probably related to the surgery. On the other hand, it could be an amazing coincidence, but I keep reading that great detectives don’t believe in coincidences, so why should we.
Does this sound like an unlikely scenario? Well, it’s not. There are many women who feel exactly this way and are desperately trying to regain their quality of life.
SO HOW CAN THEY FEEL BETTER?
They need to find a physician who is knowledgeable in the treatment of menopausal women and who has expertise in the wide range of HRT therapeutic options. Ultimately, if nothing else seems to work, "subcutaneous hormone implants" are almost always effective. The sections of the web site, MENOPAUSAL SYMPTOMS, ABOUT HRT, METHODS OF HRT and REGIMENS, will provide more information about this.
WHAT IF THEY CAN’T FIND A PHYSICIAN LIKE THAT?
It would be helpful to contact a compounding pharmacy, such as College Pharmacy for information about some of the HRT options that are available. They will provide information about their products to patients and their physicians regarding availability and appropriate use. There is a link to their web site on the links page. If necessary they can also provide the names of physicians to whom they provide specialized HRT products.
IF THERE ARE POTENTIAL PROBLEMS, WHY WOULD ANYONE HAVE A HYSTERECTOMY, OR THEIR OVARIES REMOVED?
No one should have a hysterectomy or any surgery if it’s not necessary. In the past far too many hysterectomies were performed. Even today patients need to remain vigilant and consider the benefits and potential consequences before making a decision.
But there are instances when surgery is reasonable. One indication for surgery is the presence a malignant or premalignant involvement of the uterus, cervix or ovaries. Another, is uncontrolled uterine bleeding, which is unresponsive to more conservative therapy. Vaginal bleeding can cause life-threatening anemia and often surgery is the only option. Endometriosis, and a condition called adenomyosis, can be painful and life altering and surgery is still the best option in many cases. Surgery is often the most reasonable option for women who have a ‘uterine prolapse,’ a condition where the uterus protrudes into the lower vagina. The surgery also performed for benign growths of the uterus, called "uterine fibroids," when they are thought to be the cause of bleeding unresponsive to non-surgical therapy, pain or impingement of other organs.
Sometimes, women who have surgery for these indications find that their quality of life is significantly improved. This is particularly true when the problem is endometriosis, vaginal hemorrhage and uterine prolapse.
Ovarian Failure Following Hysterectomy
Hypothetically, if you’re premenopausal and still have your ovaries following a hysterectomy, one would expect continued production of ovarian sex hormones. Unfortunately, it has been well documented that this is often not the case. A number of medical studies have documented that ovarian failure occurs frequently in retained ovaries following a hysterectomy ...
I Want To Know If I Should I Keep My Ovaries
There is no right, or wrong decision. The choice in keeping or taking the ovaries ultimately is a personal one...
Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years. His office is located in Bingham Farms, Michigan. Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM
IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.