Surgical menopause is menopause that occurs in women who are not in menopause after the ovaries are removed. Menopause begins with removal of the ovaries, independent of whether the uterus is being removed or not. Just removing the uterus but leaving the ovaries in place will not bring on menopause.

Unlike natural menopause, surgical menopause stops estrogen, progesterone, and other reproductive hormones immediately. Most often, hormone replacement therapy will be administered in the hospital to prevent menopause symptoms from starting immediately after surgery. After recovery, women can choose to stop hormone replacement therapy or continue therapy under doctor’s care. Hormone replacement therapy is one of the most researched topics regarding surgical menopause.

What you need to know about hormone replacement therapy

Natural menopause causes a slow decline in female hormones, which allows a woman to gradually get used to the changes happening in the body. When a total hysterectomy is performed, the uterus, ovaries and fallopian tubes are removed. In most cases, the cervix is also removed and the vagina is sewn shut at its upper most end where the cervix was once located. Without ovaries, no reproductive hormones will be produced, and so the body is forced into full menopause immediately after surgery. If ovaries are left, menopause will occur naturally over time.

Hormone replacement therapy (HRT) is given in the hospital to stop the most severe menopausal symptoms from interfering with the healing process. If hormone replacement therapy were not given, patients could suffer from depression, mood swings, hot flashes, and migraines before being discharged or soon after surgery. Hormone replacement therapy also helps protect bone density, which is why many younger women going through surgical menopause choose to stay on low doses of HRT for many years.

Hormone replacement therapy comes in several varieties including patches, pills, and creams. Patches offer an advanced delivery system that increases absorption and bioavailability of hormones, so total dosage can be lower. For instance, an HRT patch may be 0.1 mg of estrogen while the equivalent pill may be 1.0 mg of estrogen.

Alternative therapies are also available to relieve surgical menopause symptoms. These may be better suited for use after the healing process is complete, and a patient has enough time to come to terms with the emotional side of surgical menopause.

Symptoms to expect after surgical menopause

After surgical menopause, symptoms may include changes in mood, vaginal dryness, decreased libido, and painful intercourse. Pain associated with intercourse typically fades over time as a couple gets used to the physical and emotional changes associated with early menopause.

Sex is not permitted until the enclosure at the upper end of the vagina is healed. This could take six to ten weeks or more, depending on how fast your body heals. A vaginal exam will be required before the doctor gives the go ahead for sexual intercourse. The first time, patients may wish to take it easy until both partners can feel out the process with a new body.