Going into menopause after a hysterectomy can affect the experience you have – and the treatment you might be offered. Find out more with our simple guide…
What is a hysterectomy?
A hysterectomy is an operation to remove your womb (uterus). Once you’ve had this surgery, you won’t be able to get pregnant and you’ll no longer have periods. It’s usually advised for one of the following reasons:
- You have painful or heavy periods that don’t improve with other treatments
- You have a condition such as uterine fibroids, which are growths in the womb, or endometriosis, where uterine tissue grows outside of the womb, and other treatment hasn’t helped
- You have a prolapsed womb, where it drops out of position due to weakened ligaments and muscles
- You have a gynaecological cancer – for example, of the ovaries, womb or vagina – or you’re at high genetic risk of cancer
If you have a high genetic risk of ovarian cancer, your doctor may recommend your ovaries are removed along with your womb. This is known as a total or radical hysterectomy and is usually only advised to prevent you developing ovarian cancer. Your surgeon may also recommend a radical hysterectomy if you’ve already been through menopause, to protect against ovarian cancer developing in the future, even if you’re not at high risk. It’s a personal decision, as the ovaries continue to produce small amounts of bone-protective oestrogen after menopause, along with testosterone, which is important for your libido.
How does a hysterectomy affect menopause?
If you have a radical hysterectomy and haven’t yet been through menopause, you’ll go into what’s known as a surgical menopause, however old you are. This means you’ll start experiencing menopause symptoms immediately after having the surgery. For some women, though not all, this can mean you have quite dramatic and troublesome symptoms straight away, which can be difficult to deal with when you’re also recovering from the physical and emotional impact of a hysterectomy. And if you’re already having some menopause symptoms, they may ramp up after a hysterectomy. This isn’t always the case, though, as Live Better With Menopause Community Forum member Pauline 11166 reports on our forum after having a hysterectomy: "I worried about menopause. I was getting hot flushes but knew they could get worse – but at the moment, they haven’t."
If one or both ovaries is left intact, you won’t go straight into menopause but studies show you’re more likely to have an earlier menopause, probably in the five years following the surgery. Doctors aren’t sure exactly why this happens but it may be linked to disruption of blood supply to the ovaries - or it may be associated with the underlying condition that led to the hysterectomy in the first place.
Taking HRT after a hysterectomy
HRT is usually prescribed for women having a surgical menopause, unless there’s a reason it’s not suitable for you – for example, because you have a history of breast cancer. Having a hysterectomy affects the kind of HRT you’ll be offered. When oestrogen is given on its own, it can raise the risk of the womb lining building up, which in turn can raise the chances of womb cancer. That’s why most women are given progestogen – manufactured progesterone – along with oestrogen. But women who don’t have a womb can have oestrogen-only HRT as they are not at risk of developing womb cancer.
For any woman having HRT, it can take a while to get the type and dosage right. Over on our forum, MelGuer says she was prescribed HRT after a hysterectomy and has been struggling to get the right prescription to control her symptoms.
If you can’t or don’t want to take HRT, there are alternatives that may help so speak to your doctor.
Related article: Everything you need to know about HRT and menopause