What is a Medical or Surgical Menopause?
Ovaries produce the majority of our sex hormones; oestrogen, progesterone and testosterone. During the normal course of the menopause there are fluctuations and then the gradual decline in the levels of these hormones. It is these changes that lead that to the many different symptoms women experience.
A medical or surgical menopause is very different.
Medical menopause describes a treatment that stops ovarian function. This can be temporary or long term. A temporary medical menopause may be as a result of medication for severe endometriosis or cancer treatment. Ovaries can be “stunned” but may recover to differing degrees. However, some medical treatments precipitate early menopause; some types of chemotherapy, drugs used after cancer treatment and radiotherapy.
Surgical menopause occurs when you have both ovaries removed (bilateral oophorectomy). This may occur during a removal of your womb (hysterectomy). The reasons for a surgical menopause are wide ranging, including severe endometriosis, cancer, fibroids and other gynaecological issues.
If one or both ovaries are left in place, this will not result in an immediate menopause but may result in an earlier menopause. This is thought to occur due to interruption to blood flow to the ovary that can occur during surgery. Studies have shown that up to a third of women who have a hysterectomy with their ovaries preserved have an earlier menopause. If your womb is removed, it also can make it difficult for these women to identify perimenopause/menopause so tracking symptoms, blood tests and being self-aware of changes is important.
The abrupt nature of a surgical or medical menopause and can have a huge effect on an individual both psychologically and physically. The sudden loss of hormones overnight can lead to sudden, significant impactful symptoms and the need to consider long term implications of the lack of these hormones.
Many of the patients I have looked after following a surgical or medical menopause are coming to terms with cancer or another significant diagnosis. Compounding this with the sudden onset of menopausal symptoms means that it can be a very confusing and difficult time.
What should happen
Prior to any treatment (medical or surgical) you should have an opportunity for discussion around what this treatment means for you in relation to ongoing fertility and menopause. It is important you are able to have a holistic conversation with a health care professional with knowledge of this area about treatment options to enable you to make an informed choice. This may be your gynaecologist, GP or menopause specialist. If you aren’t given this opportunity, please talk to your GP. If they are unable to answer your questions, they can refer you on to the appropriate health care professional or menopause specialist.
If you are under the age of 51, it is recommended that you replace hormones if you are able to take HRT safely. Our sex hormones help reduce the risk of developing bone thinning (osteoporosis), cardiovascular disease, diabetes, depression and dementia. However, if you are unable to take HRT, an assessment of bone health with a DEXA scan, lifestyle advice and other medication options are available which can all significantly reduce your risk too.
HRT and lifestyle management
Your own medical team can advise you on whether it is suitable for you to take HRT and what options are safe for you. For many women, HRT can be very helpful, and you may benefit from replacement of oestrogen, progesterone and/or testosterone depending on your individual situation. Also, don’t forget topical vaginal oestrogen if needed. 1 in 4 women need this as well as their systemic HRT. Younger women may need higher doses of oestrogen to help manage symptoms.
Non – hormonal medications to help treat some symptoms for women who are unable, or choose not to take hormones eg. Clonidine, SSRI, Gabapentin, Pregabalin.
DEXA (bone scan) – recommended for all women who have had an early menopause (under 45.)
Eat a healthy balanced diet, whole foods plenty of vegetable, legumes and fruit. Ensure you are including 700mg calcium a day – Calcium can be found in dairy/non - dairy sources.
Take Vitamin D - 1000-2000 iu/daily.
Give up smoking, drink alcohol in moderation and get support, if needed to achieve a healthy weight.
Cognitive Behavioural Therapy for Menopause – supportive, safe and effective treatment for menopausal symptoms.
Support for mental well-being is really important, don’t suffer in silence, please reach out and seek help from your support network and GP.
Talk to your workplace prior to your return to work following treatment to discuss any adaptations that may help you manage menopausal symptoms e.g. fans, flexible working, etc.
Become empowered to find out what options are available for you to flourish into this next chapter of life.
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