Navigating the changes: Understanding surgical menopause

Posted in surgery; Posted 6 months ago by Andreas Obermair

Menopause is often a natural biological process that marks the end of a woman's reproductive years, typically occurring in her late 40s or early 50s. However, some women may experience menopause earlier due to various reasons, one of them being surgical menopause. This article will shed light on what surgical menopause is, the reasons behind it, and the challenges women may face during this transitional phase.

Defining surgical menopause:

Surgical menopause, also known as induced menopause or surgical oophorectomy, occurs when both woman's ovaries are surgically removed. The ovaries are the primary source of estrogen and progesterone, the hormones responsible for regulating the menstrual cycle and supporting reproductive health. Removal of both ovaries results in an abrupt and irreversible cessation of hormone production, mimicking the hormonal changes that happen during natural menopause. If only one ovary is removed, it typically does not result in surgical menopause. The remaining ovary can still produce hormones.

As a rule of thumb, I recommend keeping the ovaries if medically possible if my patient is 50 years or younger. However, it is ultimately always my patient’s decision whether we preserve or remove the ovaries.

Reasons for surgical menopause:

There are various reasons why a woman may require having the ovaries removed surgically and undergo surgical menopause:

• Hysterectomy: A hysterectomy involves the removal of the uterus and may or may not involve the removal of the ovaries. Only if the ovaries have to be removed during the procedure, surgical menopause is induced. For the majority of patients with endometrial cancer and some women with cervical cancer the risk-benefit may favour to remove the ovaries. Some patients with severe endometriosis may also benefit from surgical menopause.  
• Oophorectomy: This surgical procedure involves the removal of one or both ovaries and is sometimes done to treat conditions such as ovarian cancer.
• Cancer treatment: In cases of breast or gynaecological cancers, removal of the ovaries may be recommended as part of the treatment plan to reduce the production of hormones that could fuel the growth of cancer cells.

Challenges and symptoms:

Experiencing surgical menopause can be challenging due to the sudden and severe hormonal changes. Some common symptoms include:

• Hot flushes: Sudden, intense feelings of heat and sweating.
• Mood swings: Hormonal fluctuations can contribute to mood swings, irritability, and anxiety.
• Vaginal dryness: Decreased estrogen levels can lead to changes in the vaginal tissues, resulting in dryness and discomfort.
• Bone health: Estrogen plays a crucial role in maintaining bone density, and a sudden drop in estrogen levels can increase the risk of osteoporosis.
• Sleep disturbances: Changes in hormone levels may disrupt sleep patterns, leading to insomnia or restless sleep.

Coping strategies:

• Hormone replacement therapy (HRT): HRT involves replacing the lost hormones with medications to alleviate symptoms.
• Non-hormonal medication: There is medication other than hormones that may be useful for women who are unable to have hormones. Your GP or a menopause specialist may know about these options.
• Lifestyle modifications: Healthy lifestyle choices, including regular exercise, a balanced diet, and stress management, can help manage symptoms.
• Support networks: Joining support groups or seeking counselling can provide emotional support during this challenging period.
• Bone health measures: Adequate calcium and vitamin D intake, along with weight-bearing exercises, can help maintain bone health.

Women should carefully evaluate their options and consider various factors before making a decision about surgery. It's important to gather information about the potential benefits and risks of the procedure, as well as alternative treatments or management strategies available. Seeking advice from healthcare professionals and discussing concerns or questions can also help in making an informed choice that aligns with individual preferences and circumstances.

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