After hysterectomy menopause: What you need to know

Perimenopause is the transition out of child-bearing years, and it typically starts during your 40s. Once you have gone 12 months without a period, you're in menopause. Most women reach menopause by age 51 or 52.

Some women may experience menopause after a hysterectomy, regardless of their age. Understanding why this happens and what you can expect can help you prepare for life after the procedure.

A hysterectomy involves removing all or part of the uterus to treat cancer, fibroids, uterine prolapse and other conditions. Surgical menopause, also known as induced menopause, is when menopause occurs suddenly as a result of a hysterectomy.

When it occurs naturally, perimenopause happens over a period of years, culminating in menopause when  your ovaries stop releasing eggs and your periods stop. If a hysterectomy involves removing the ovaries as well as the uterus, your supply of eggs is suddenly gone and your body will go through menopause all at once.

There are different types of hysterectomy procedures. In some cases, the surgeon may need to remove the ovaries and fallopian tubes along with the uterus, leading to surgical menopause.

If your ovaries remain intact, you will most likely not go through menopause after a hysterectomy. Instead, you will most likely enter into perimenopause sometime during your 40s or early 50s. However, surgery can restrict blood flow to the ovaries and accelerate your body's progression to natural menopause or, in rare cases, cause surgical menopause.

What people experience due to surgical menopause is similar to the general symptoms of menopause. They include:

• Hot flashes, a feeling of warmth that travels over the body
  
• Night sweats
• Vaginal dryness
• Problems sleeping
• Increased need to urinate
• Irritability
• Mood swings
• Depression
• Dryness of the skin, eyes and/or mouth
• Breast tenderness
• Headaches
• Joint and muscle pain
• Problems concentrating
• Loss of sex drive
• Changes in body shape with more body fat in the belly area
• Hair thinning or hair loss

Because estrogen levels fall dramatically when the ovaries are removed, symptoms of surgical menopause may be more intense than those of natural menopause.

Symptoms of surgical menopause are temporary. As your body adjusts to lower estrogen levels, some symptoms of surgical menopause may gradually subside. How long this will take varies, but in many cases, symptoms can persist for several months or years.

Depending on your age, overall health and the severity of your symptoms, your healthcare provider may suggest managing symptoms of surgical menopause through self-care, medicinal interventions or a combination of the two. Some potential treatments and remedies for surgical menopause symptoms include the following.

If you go through surgical menopause at a young age, your OBGYN may recommend hormone replacement therapy (HRT) after surgery to prevent severe surgical menopause symptoms as well as to protect your bones and cardiovascular health. If you don’t have medical contraindications to hormone replacement therapy, your OBGYN will likely recommend taking hormones until you reach the natural age of menopause.

Hormone replacement therapy increases your body's supply of female sex hormones to ease symptoms of menopause. It comes in a variety of forms, including:

• Creams
• Gels
• Patches
• Pills
• Sprays
• Vaginal rings

Although HRT can alleviate menopause symptoms, it can increase the risk of blood clots, stroke, gallstones and other medical conditions. Your provider will help you carefully weigh the risks and benefits of HRT.

If you have had a hysterectomy and need hormone replacement therapy, you will only need to take estrogen. You won’t need progestin, which accounts for many of the undesirable side effects of hormone replacement therapy.

Hot flashes are a common symptom of menopause, and avoiding caffeine and spicy foods may reduce their frequency and severity. Your medical provider may also recommend eating foods that contain plant estrogens known as isoflavones. Some foods that contain isoflavones include:

• Beans
  
• Chickpeas
• Flaxseed
• Lentils
• Soybeans
• Whole grains

These foods also supply dietary fiber, vitamins, minerals and other beneficial nutrients for optimal overall health.

Regular exercise can improve sleep, reduce hot flashes, ease stress and support overall health and well-being during surgical menopause. Choose activities you enjoy, like brisk walking, cycling, swimming or playing a sport. Stretching and yoga can also help you manage stress.

Talking to a mental health professional after a hysterectomy can help you work through your feelings about the procedure and your health issues. Through talk therapy, you can understand the causes of anxiety, depression and stress and find positive ways to cope.

Antidepressants that increase levels of the feel-good chemicals in your brain may help with mood swings and address symptoms of anxiety and depression. Some may also decrease hot flashes and night sweats. Some medications that your provider may prescribe include:

• Citalopram (Celexa)
  
• Escitalopram (Lexapro)
• Paroxetine (Paxil)
• Venlafaxine (Effexor)

Your healthcare provider can explain what will happen during your hysterectomy and tell you whether you're likely to experience surgical menopause afterward. If you go through menopause after a hysterectomy, arming yourself with information, making lifestyle changes and considering treatments like HRT can help ease your symptoms. Some women also opt for over-the-counter menopause products in order to relieve specific symptoms related to menopause.

Published April 2023.