INTRODUCTION:

“How long does menopause last after the hysterectomy?” is the main query in the mind of every patient undergoing a hysterectomy. In this article, we will discuss the eye-opening facts between Hysterectomy and menopause, ways to manage its symptoms, and risks and complications. If you’re a woman considering or recovering from a hysterectomy, you might wonder what the future holds when it comes to menopause. You’re not alone in this curiosity. This article helps you…

MENOPAUSE AND HYSTERECTOMY; EXPLORING THE CONNECTION:

WHAT IS MENOPAUSE?

• Menopause, also known as climacteric, is when the complete stoppage of the menstrual cycle occurs.
• A woman who has had no menstruation for the last 12 months is said to be menopause.
• It is a natural physiological process with the age range usually varying from woman to woman; however, it begins in the late 40s.
• Years before menopause, a woman experiences irregularity in the cycle; either it becomes longer or shorter, also lighter or heavier, indicating the initiation of menopause.

WHAT IS HYSTERECTOMY?

• The Hysterectomy is the surgical removal of the uterus (the womb), the fetus development site during pregnancy.
• Depending upon the etiological factors for surgery, the Hysterectomy may involve the removal of near organs and tissues like ovaries, fallopian tubes, etc.
• Hysterectomy might be complete (body, fundus, cervix) removed, as well as partially in which the uterus body is removed while the cervix is intact.

TYPES OF HYSTERECTOMY:

Hysterectomy in itself means the entire removal of the uterus; however, other organs will be removed depending upon the type of surgery it is:

1. TOTAL HYSTERECTOMY:

It is the procedure in which the removal of the uterus along with the cervix occurs; however, the ovaries remain intact.

2. PARTIAL HYSTERECTOMY:

It is performed in cases when there is complete removal of the uterus while the cervix remains and is not removed.

3. TOTAL HYSTERECTOMY ALONG WITH BILATERAL SALPINGO-OOPHORECTOMY:

It is the complete removal of the uterus and cervix, along with the fallopian tubes and ovaries. If the patient does not undergo menopause after this procedure, she will experience menopausal symptoms due to the removal of ovaries.

4. RADICAL HYSTERECTOMY ALONG WITH BILATERAL SALPINGO-OOPHORECTOMY:

It is notably performed in cases of metastatic tumour formation. In these cases, removal of the uterus, cervix, fallopian tubes, ovaries along with the upper part of the vagina and in some cases surrounding tissues and associated lymph nodes are also removed.

WHY NEED OF HYSTERECTOMY?

Hysterectomy is the second most widely performed gynaecological performed surgical procedure. It is considered the last option when other treatment options fail or are unavailable. Some common medical conditions in which the Hysterectomy is the previous option are:

• Endometriosis
• Adenomyosis
• Menorrhagia
• Uterine fibroids
• Uterine prolapse
• Recurrent uterine polyps
• Unbearable pelvic pain (when other treatment fails)
• Pelvic associated cancers
• Postpartum issues (placenta percreta or placenta praevia).

WHY PATIENT EXPERIENCE MENOPAUSE AFTER A HYSTERECTOMY?

Hysterectomy is a surgical procedure, no matter in which age it is performed.

HYSTERECTOMY WITH OVARY REMOVAL:

• If a hysterectomy is performed along with an oophorectomy, it will cause a sudden decline in egg production; no eggs mean no estrogen and progesterone release, which will initiate the menopause-like symptoms.
• Here, it is essential to remember that in this condition, follicle-stimulating hormone (FSH) is still released from the pituitary gland. Still, in this condition, the pituitary-ovary axis is obstructed.

HYSTERECTOMY WITHOUT OVARY REMOVAL:

• If the patient has an intact ovary but no uterus, they experience no menstruation, but simultaneously, due to the ovary, remaining estrogen production resumes.
• These patients face premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) as the ovary continues to produce hormones, and the body undergoes a cycle monthly while the menstruation phase is missing.

WHO GO THROUGH MENOPAUSE AFTER HYSTERECTOMY?

• As I mentioned above, the various types of Hysterectomy will determine the occurrence of menopause after Hysterectomy.
• If the patient undergoes a Hysterectomy with an intact ovary, there is the release of estrogen from the ovary; however, there is no menstruation because no endometrium remains to shed.

HOW LONG DOES MENOPAUSE LAST AFTER THE HYSTERECTOMY?

• The series of symptoms related to menopause after Hysterectomy is sometimes called surgical menopause. The symptoms of surgical menopause are identical to natural menopause.
• If we are talking about the natural process of menopause, it is not a transient event that occurs immediately; instead, it is a transition from perimenopause, which lasts over years and then reaches the menopause stage.
• In the case of Hysterectomy with oophorectomy, the body experiences menopause immediately, just opposite to natural menopause. Because of the sudden drop of estrogen due to egg absence, the body faces a more rapid and intense series of symptoms as compared to natural menopause.
• How long menopause lasts after the Hysterectomy varies from person to person. However, these symptoms are temporary and gradually retrocede once the body adjusts to lower estrogen levels. Estrogen is synthesized in many non-gonad organs like the liver, heart, brain, etc.
• The associated symptoms remain for months to years. The treatment plan depends upon the patient’s age, overall health and severity of underlying symptoms.

WHAT ARE THE SYMPTOMS CONNECTING MENOPAUSE AND HYSTERECTOMY?

Many symptoms connect natural menopause and hysterectomy-associated menopause:

• Vagina dryness
• Night sweats
• Hot flushes
• Mood changes (depression, anxiety)
• Hair loss, hair thinning
• Dry skin
• Obesity
• Urinary tract infections
• Urinary incontinence

HOW TO TACKLE THE SYMPTOMS ASSOCIATED WITH HYSTERECTOMY-MENOPAUSE?

Depending upon the severity of the symptoms, the doctor suggests a combination of both self-counselling and medical help. The combination of both will help to cope with the situation more effectively.

• Hormone replacement therapy (HRT) is an alternative way to cope with estrogen deficiency and its associated health issues. It is helpful to minimize the irritating symptoms of hysterectomy-menopause and safeguard the CVS and bones. It is usually recommended until the age of natural menopause arrives. A few forms of HRT are vaginal rings, Creams, Pills, Patches, Sprays, and Gels.
• Dietary changes (avoid tobacco and caffeine)
• Exercise
• Psychotherapy (beneficial to cope with anxiety and depression)

RELATION BETWEEN ADVERSE CHILDHOOD EXPERIENCES (ACE) AND HYSTERECTOMY AND BILATERAL OOPHORECTOMY:

• It is proven that adverse childhood experiences (ACE) are associated with an increased risk of Hysterectomy and bilateral oophorectomy.
• A hysterectomy is usually performed to treat intense pelvic pain and heavy uterine bleeding, which arises as a consequence of endometriosis and leiomyomas.
• A bilateral oophorectomy is performed along with a hysterectomy in younger ages, and it causes deprivation of ovarian-induced sex steroid hormones and its impacts severe consequences on the body like CVS non-gynecological cancers like rectal or kidney.
• ACE includes all the mishappenings, abuse, trauma, negligence, and broken family-oriented circumstances from which a childhood passed. These mishappenings cause either too early or too late menarche, preterm delivery, and miscarriages.
• It is also thought that adverse childhood experiences are correlated with the occurrence of fibroids and endometriosis, which are simultaneously etiological factors for Hysterectomy.

CONCLUSION:

Understanding menopause after a hysterectomy is essential for women facing this procedure. While the experience varies from person to person, having the correct information and support can make the journey smoother. Remember, you’re not alone in this, and there are resources and professionals available to help you every step of the way.