Here is a question that many of you may be wondering about. What happens during menopause if you’ve had a hysterectomy?
First of all, the change of life happens to all women. Our hormones start declining in perimenopause, and we stop having periods at menopause. And then we live the rest of our life in a post-menopausal state.
Women who have to have a hysterectomy may notice that menopause can be a little different for them.
First of all, a hysterectomy is a procedure that surgically removes your uterus. It may also involve the removal of the fallopian tubes, cervix, and ovaries. The critical factor is whether or not you’ve had your ovaries removed. If your ovaries are removed during a hysterectomy, you no longer can make any of your own sex hormones. While your adrenals make DHEA, which is converted into testosterone and then into estrogen, it’s not as much as your ovaries make. So, if you’ve had a hysterectomy, and especially if your ovaries are removed at a young age, you will need to be on hormone replacement therapy for a long time.
Even if their ovaries are preserved, some women notice that their hormones don’t kick back in right away after a hysterectomy.
It’s like they’re going through menopause with hot flashes, insomnia, brain fog, irritability, and moodiness. This is because the ovaries can be in shock by the surgical manipulation. And there’s a very under-appreciated communication system between the ovaries, fallopian tubes, uterus, and hypothalamus. Meaning when the uterus is removed, the communication loop gets out of whack. It then takes many months for your hypothalamus to reestablish communication directly with your ovaries. So, your hormones may be a little flat for a while.
But, what happens if you’ve kept your ovaries and your hormones come back right after having a hysterectomy? What’s going to happen when you go through menopause?
Clinical studies show that women who’ve had a hysterectomy tend to go through menopause four to five years earlier. Earlier then if they maintained their reproductive organs.
Conventional medicine is not sure why that is. But my hypothesis is that it has to do with the disruption in the hypothalamic-pituitary-ovarian axis. This also includes the hormone receptor sites in the uterus, which are now missing.
You might think of it as a GPS system where you get live information on routes from other travelers on the road. Travelers that report back to the GPS system about accidents and road closures. Without the live reporting, routes are not up to date. This is the same with your reproductive organs. Losing your uterus is like not having live reports of the road conditions.
Your uterus reads the quality and quantity of your sex hormones. Without your uterus, it takes longer to establish communication.
This creates a lot of hard work for the hypothalamus, pituitary, and ovaries in order to communicate without the receptor sites in the uterus and fallopian tubes.
If you’ve had a hysterectomy, you’re going to go through menopause sooner. This means that you’re probably going to experience perimenopause sooner. So let’s say your mother went through the change of life at the age of 50. You can expect to go through menopause at 45. Your mom would have started perimenopause between 40 and 45. So you’re probably going to start perimenopause between 35 and 40. There’s a significant reduction in the lifespan of reproductive hormones by having a hysterectomy.
Your bladder loses some of the support it had from your uterus during menopause.
When you remove the uterus, the bladder no longer has the same suspension. You’re more likely to have urethral and bladder prolapse. This means more stress incontinence, meaning you urinate whenever you cough or sneeze. During menopause, your estrogen levels are lower, and you’re losing the natural collagen in the vagina and the pelvic floor which also helps to suspend the bladder.
For some women, orgasm is not the same after having a hysterectomy. Your uterus requires a lot of blood flow, and during sexual arousal, blood flow increases not just to the vagina to increase lubrication, but to the uterus as well. When the release of that blood flow occurs with orgasm, this sensation is greater. When your uterus is removed, the orgasmic sensation may lessen. So some women report that their orgasms are not the same after having a hysterectomy.
Now certainly if you have uterine cancer or incredibly large fibroids that have not been reduced with other methods, the benefits of having a hysterectomy outweigh the risks. Fibroids usually stop growing when you run out of hormones in menopause. But if you’ve been on hormone replacement therapy, your fibroids can grow after menopause. Sometimes, they grow large enough to cause discomfort, such as increased bladder pressure. Large fibroids can push down on the bladder, causing more stress incontinence. So the decision to have a hysterectomy is definitely a very personalized one that needs to be discussed between you and your health care provider.
Just remember that having a hysterectomy will affect the timing of your menopause.
One of the positive aspects of having a hysterectomy premenopausal is that you will not experience the erratic bleeding that happens in perimenopause through menopause.
These are tough questions to consider. If you’d like more support, you can join our Hormone Support Group, where you’ll get access through our Hormone Reboot Training. There I answer your questions on a regular basis, plus you get access to lots of information about everything your hormones affect. I’m not just talking about your sex hormones but also your adrenals, thyroid, the gut connection with your hormones, your metabolism, and your immune system. I hope you’ll join us!
Research Reference: Sexually Differentiated Neuron Populations in the Ventromedial Hypothalamus Contribute to Sex-Specific Regulation of Energy Balance, Research provides new insights into menopause and weight gain, The human hypothalamus in mood disorders: The HPA axis in the center.