What is Surgical Menopause?
Surgical menopause happens when u had both your ovaries removed during a surgery, before you have gone through a natural menopause.
Why would a woman need to undergo Surgical Menopause?
The removal of both ovaries (bilateral oophorectomy) could be done for a number of reasons, such as alongside the removal of the uterus (during a hysterectomy), or for other causes such as ovarian cysts or as part of risk reduction surgery for women with an inherited increased chance of developing ovarian cancer.
Some women may also choose to have her ovaries removed due to endometriosis or chronic pelvic pain.
You should have a thorough discussion with your gynaecologist regarding your options to remove or keep your ovaries prior to undergoing the surgery.
I am scheduled for a hysterectomy. Should I remove or keep my ovaries?
The decision should be made after a thorough and mutual discussion with your doctor. Things that would be put into considerations are your diagnosis and the reason for hysterectomy, your medical history, your doctors risk and benefit assessments, and ultimately your personal preferences.
Most guidelines recommend that a woman’s ovaries should only be removed if there’s a significant risk of associated disease, such as ovarian cancer. Your surgeon will decide the pros and cons with you. If you prefer to not have your ovaries removed, you should inform your surgeon.
Your surgeon will inspect your ovaries during the surgery and if they appear to be normal, the ovaries may be left behind, as you have stated in the consent form prior to the surgery. However, you may still be asked to give consent to having your ovaries removed if an abnormality is found during your surgery.
Discuss all your fears and concerns with your surgeon.
What are the possible advantages of Surgical Menopause?
For women who carry genes with inherited increased chance of developing ovarian and/or breast cancer (BRCA 1, BRCA 2, HNPCC), surgical menopause may reduce their risks of developing the cancer, and reduce the anxiety surrounding this.
For women with severe endometriosis or pelvic pain, surgical menopause may to a certain extent reduce the pain, though it must always be borne in mind that it is not always effective.
What are the negative effects of Surgical Menopause?
The symptoms of Surgical Menopause may start abruptly, and the symptoms may be more severe compared to natural menopause. Symptoms like hot flushes, night sweats and vaginal dryness may be experienced immediately after the surgery, due to the sudden loss of estrogen. There are also long-term implications such as osteoporosis and increased risk of cardiovascular diseases.
Women may also experience reduced sex drive (libido) due to the loss of testosterone production, as well as impaired sexual function due to vaginal dryness.
How is Surgical Menopause managed and treated?
First and foremost, you should have a thorough discussion and assessment of risks and benefits with your gynaecologist prior to undergoing surgery that will put you in surgical menopause.
Younger women who undergo surgical menopause are advised to take estrogen only therapy till the age of 50 years to prevent immediate and long-term problems of the menopause.
Those with a personal history of breast cancer should avoid both MHT and tibolone, as they have been associated with an increased risk of breast cancer recurrence. For women with BRCA1 and BRCA2 gene mutations without a personal history of breast cancer, observational data suggest that MHT appears to be safe.
If you have undergone surgical menopause and are having symptoms, please seek advice from your doctor. It is also not uncommon to require psychological support due to this experience. You are not alone.