The Perimenopause Experience After a Hysterectomy

We get asked this question a lot by women who have gone through a variety of hysterectomy procedures.

So what will perimenopause look like after a hysterectomy?

As you can guess, the answer isn't straightforward and depends on a few factors. 

Let's start from the beginning and work through it together...

What Is A Hysterectomy?

A hysterectomy is the surgical removal of the uterus (womb), with or without the cervix, often leaving the ovaries in place.

If one or both ovaries are removed this is called an oophorectomy. 

The ovaries maintain the health of our reproductive system producing the hormones oestrogen and progesterone which work together to promote the healthy development of female sex characteristics during puberty and to ensure fertility. 

If the ovaries are removed, within 24 hours estrogen levels will reduce by 50% and result in surgical induced menopause.

Reasons For a Hysterectomy

“Conditions that may be treated by hysterectomy include:

• Fibroids – non-cancerous growths that form within the muscular walls of the uterus, outside the uterus or within the uterine cavity
• Heavy or irregular menstrual periods – however, new techniques now used to treat this include endometrial ablation (which is surgical destruction of the uterus lining) or use of a levonorgestrel-releasing inter-uterine device (IUD)
• Severe period pain (dysmenorrhoea) – due to adenomyosis or severe recurrent endometriosis
• Cancer of the cervix, uterus, ovaries or fallopian tubes
• Endometriosis – a condition in which cells similar to those in the lining of the uterus grow in other areas of the body, especially around the ovaries and peritoneum (lining inside the abdomen) in the pelvis
• Adenomyosis – a condition where endometrial-like cells grow in the muscle of the uterus
• Prolapse – the uterus falls into the vagina because of loose ligaments or damage to the pelvic floor muscles, usually from childbirth
• Pelvic inflammatory disease (acute or chronic PID), caused by bacterial infection, often from sexually transmitted infections (STIs).” 1

Types of Hysterectomy

“There are five types of hysterectomy:

• Total hysterectomy – where the uterus and cervix are removed
• Subtotal (partial) hysterectomy – where the uterus is removed, but the cervix is left in place. While removal of the cervix is generally advised because it is a potential cancer site, some women feel that it serves a purpose during penetrative sex. If the cervix is kept, regular cervical screening is still necessary
• Hysterectomy and bilateral salpingo-oophorectomy – where the uterus, fallopian tubes and ovaries are removed. This operation is performed if the woman has cancer of the ovaries or the uterus, or for chronic pain due to recurrent pelvic infection or recurrent endometriosis
• Radical hysterectomy – the most extensive version of the operation. It involves the removal of the uterus, fallopian tubes, ovaries, upper part of the vagina, and associated pelvic ligaments and lymph nodes. This is performed if the woman has cancer of the cervix, ovaries, fallopian tubes or uterus
• Hysterectomy with prophylactic bilateral salpingectomy –most doctors now recommend removing the fallopian tubes at the time of hysterectomy due to research suggesting that early ‘ovarian’ cancers originate in the tubes.”1

What Perimenopause Looks Like After Hysterectomy

If one or both ovaries are left, then they have the ability to continue to produce estrogen and progesterone.  This means you will go through a natural transition to perimenopause without bleeding, otherwise known as hidden cycling. Some studies have suggested that after a hysterectomy, the transition might start earlier. 

It can be hard to track (and really frustrating) where you are in perimenopause when you have had your uterus removed as you have no cycles to track. It can be helpful to use a diary and track other perimenopausal symptoms, as you will have years of high estrogen and 'premenstrual' symptoms, such as mood changes and breast pain.

What Perimenopause Looks Like After A Hysterectomy And Oophorectomy Of Both Ovaries

With the removal of both ovaries, within 24 hours estrogen levels will reduce by 50% and this will result in surgical induced menopause. This low estrogen state, causes the sudden transition into menopause and you will likely skip the usual transitionary stages. This abrupt onset produces stronger symptoms than natural perimenopause and nearly always requires estrogen plus progesterone therapy.

Working With a Women’s Health Professional

Working with a health professional who understands women’s health and in particular, menopause and the transition to menopause, is imperative if you have experienced either a hysterectomy or oophorectomy (or both). 

We recommend checking out this registry with the Australasian Menopause Society, of doctors who have a special interest in perimenopause and menopause.

Resources

• Better Health 
• Association of Ovary-Sparing Hysterectomy With Ovarian Reserve
• Hormone Repair Manual, Lara Briden ND