Unlike “natural” menopause, which refers to the slow but steady transition during which the body’s production of estrogen and progesterone begins to progressively decline until menstrual periods cease (average age of 51), surgically-induced menopause isn’t so gradual. The opposite, actually. The reason? With surgery, there’s a more abrupt cessation of ovarian function and, as a result, a more severe, sudden drop in hormone levels (50% reduction in serum testosterone and 80% reduction in the concentration of serum estradiol, a form of estrogen/oestrogen).
This is why surgically-induced menopause symptoms can feel far more intense and sudden, especially for younger women who weren’t yet in perimenopause prior to surgery. The triple whammy of navigating the physical and emotional effects of your condition (whether it be cancer, a BRCA-positive genetic test, or a benign condition such as severe endometriosis, ovarian cysts, or fibroids) PLUS recovering from surgery PLUS now…surprise!…dealing with hot flushes/night sweats, mood changes, insomnia, low libido, and more can feel hugely overwhelming — especially for those of us dealing with the added layer of potential loss of fertility. It’s not uncommon to hear women say that it feels like they’ve aged 10, 15, even 20 years overnight. And odds are you’ll have your fair share of questions, like “how long will these symptoms last?” We’re explaining it all below.
How long do surgically-induced menopause symptoms last?
In natural menopause, hormonal changes and symptoms can start 8-10 years prior to reaching menopause. Most of us will start in our mid-40s, but some may begin years earlier. It’s a wildly unpredictable time, and the way symptoms show up are anything but linear.
Unfortunately, the same goes for surgically-induced menopause symptoms.
When symptoms begin
If both ovaries are removed, then you’re considered postmenopausal when you wake up. However, if you only have a hysterectomy (without removal of ovaries), then you can’t know exactly when you’ll go through menopause since the surgery doesn’t directly cause it. However, some studies suggest that it can expedite the timing of menopause.
When symptoms end…or do they?
What we know is that symptoms can begin within a few days of surgery and continue for months afterwards. For some women, symptoms like hot flashes/night sweats resolve after a few years in postmenopause while others (vaginal dryness, decreased bone density, etc) don’t. But ultimately, there’s no simple answer because it’s highly variable depending on the woman: her health history, type of surgery, and more.
Types of surgery
- Hysterectomy: The surgical removal of the uterus, which may be needed to treat certain cancers (especially endometrial/uterine, ovarian, or advanced cervical cancer) as well as certain benign conditions like fibroids and endometriosis. Remember, there’s more than one type of hysterectomy: a total hysterectomy means that the cervix and uterus were both removed and a partial hysterectomy means that the uterus was removed but the cervix was left intact.
- Oophorectomy: The surgical removal of the ovary (a bilateral oophorectomy is the removal of both ovaries), which may be needed to treat uterine — especially endometrial, ovarian, or advanced cervical — cancer. Surgical removal of BOTH ovaries is what is defined as surgical menopause. Even women with one ovary can still ovulate and can still enter menopause naturally.
- Salpingectomy: The surgical removal of the fallopian tubes (one or both), the tubes that lead from the ovaries to the uterus.
Is there anything I can do to alleviate symptoms?
Women who have undergone bilateral salpingo-oophorectomy (BSO) before the “natural” menopausal age are advised to strongly consider hormone replacement therapy (HRT) or MHT (menopausal hormone therapy), which involves taking a supplemental form of either estrogen, or estrogen and progesterone together, to balance out and replace what the body is no longer producing. Additional hormones such as testosterone are sometimes used as well, but for the most part, HRT refers to estrogen only or estrogen and progesterone combos.
It can deliver short-term and long-term benefits but…and this is important…only for those of us who are candidates for it.
Eligibility depends on the type of cancer — specifically if it was estrogen-driven or not — so not every woman who has had surgery for cancer will meet the criteria for HRT. It’s necessary to consult with your healthcare provider to discuss benefits, risk factors, side effects, family history, and the proper course of action.
And remember, there are non-hormonal ways to manage symptoms, so if your cancer precludes you from taking HRT, rest assured there are still effective, evidence-backed treatment options available to you.
Additional educational material on the effects of surgical menopause
- What surgical menopause symptoms to expect, what conditions you’re at increased risk of (osteoporosis, cardiovascular disease/heart disease, etc), and what you can do about it (nutrition, supplements, exercise, stress management, etc.)
- Navigating life after surgical menopause: what to expect & how to prepare
- A personal story from our Founding Women’s Health Nurse Practitioner, Jackie Giannelli, about her experience with genetic testing for the BRCA mutation (BRCA1 or BRCA2)
- A hysterectomy healthcare professional weighs in on what to know about surgical menopause