Hysterectomy Causes Early Menopause Even If Ovaries Left In

Hysterectomy Causes Early Menopause Even if Ovaries Left In

Discover what you need to know. Mache Seibel, MD

The decision to have a hysterectomy is a major one for women. And it happens amazingly often.There are about 600,000 hysterectomies annually in the United States. Many times a doctor may recommend taking out the ovaries at the same time to reduce the risk of ovarian cancer. If that happens, you will be in surgical menopause and be a candidate for taking estrogen.

But what happens to your ovarian hormone levels if you have a hysterectomy and your ovaries are not removed?

 It would seem that if the ovaries were not removed, they would continue to work just like they did before the hysterectomy. But this is not the case.  Many of the who have a hysterectomy go through a type of delayed surgical menopause, meaning they go into menopause as if their ovaries were removed. Women who have a total abdominal hysterectomy (TAH – meaning their uterus is removed through an abdominal incision but their ovaries are not removed) go through menopause an average of five years earlier than women who have not had a TAH. Within the first 6 months after surgery, 25% lose ovarian function and within 3 years, 40% lose ovarian function. The average time an ovary continues to function after hysterectomy is 7 years. That is true whether the surgery is done through the abdomen or through the vagina (vaginally). Indirectly, a hysterectomy without removing the ovaries can cause surgical menopause.

Why does this happen? When blood flow to the ovaries is measured by special testing at the time of TAH, blood flow was decreases  by 80%. That decrease in blood flow causes ovarian tissue death called infarction, much like a temporary reduction in blood flow to the heart causes a myocardial infarction or heart attack.

Even though the ovaries look normal at the time of surgery, a study done one year later showed the ovaries from all women who had a TAH had some area of infarction. This is important information for all women undergoing a hysterectomy to know and discuss with their doctor if you have a hysterectomy if you are young, you may go into early menopause even if your ovaries are not removed The most frequent age for having a hysterectomy is age 40 to 44 years and 35 to 39 years is the second most common time to have a hysterectomy.

The average age for a hysterectomy is 46.1 years. By age 54, 1/3 of all women will have had a hysterectomy.  Most of those women will have gone through early menopause. Now you can understand why my patient Sandra was taken aback by her symptoms and said, "I can't be going through menopause; I still have my ovaries." This information can help a woman make a decision to have her ovaries out if she is at significant risk for ovarian cancer and if she does not have her ovaries out, have her blood tested for FSH and estradiol levels done at the time of surgery and followed in the months and yeas to come to see if she is going into early menopause.

If the blood test for FSH is going up and the blood test for estradiol is going down, that indicates that the ovaries are not as active and you are going into menopause. If so, you can talk with your doctor about the risks and benefits of estrogen. In my new book called The Estrogen Window due from Rodale in April 2016, this and many more points about the risks and benefits of estrogen and when and how to take it safely are explained.

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