If I Have a Hysterectomy, Will I Go Through Menopause?

Undergoing a hysterectomy—surgery to remove all or part of the uterus—can raise many concerns, including the possibility of menopause. While it's true that some women do enter menopause right after a hysterectomy, this depends on whether or not the ovaries are also removed during the procedure—a decision that hinges on the purpose of the surgery and your overall health. Knowing what to expect in either case can prepare you for this change, whenever it comes, and the symptoms you may experience.

A hysterectomy refers to the surgical removal of a woman’s uterus. It may be performed for a number of reasons, both benign (for example, uterine fibroids) and cancerous (such as uterine cancer).

Depending on the reason behind why a hysterectomy is being done, a doctor may also remove the ovaries and fallopian tubes (the tubes that connect a woman's ovaries to her uterus).

With the removal of the ovaries, a premenopausal woman will immediately go into menopause, called surgical or induced menopause. Since she no longer has ovaries to produce estrogen, she may experience classic symptoms of estrogen depletion like hot flashes and/or vaginal dryness.

In addition to these symptoms, there are also health conditions associated with the low-estrogen state of menopause, like osteoporosis (when your bones weaken and become prone to breaking). 

If you are premenopausal and your ovaries are not removed during a hysterectomy, your body will continue to produce estrogen. However, you will not have periods anymore, as there is no uterine lining to shed.

There are a number of symptoms linked to both natural and surgical menopause; two of the most common ones include vaginal dryness and hot flashes.

Vaginal Dryness: With the loss of estrogen, the lining of a woman’s vagina becomes dry and itchy—a phenomenon called vaginal atrophy. This vaginal dryness, itching, and burning often make sex painful and, in turn, can lower a woman’s desire to have intercourse.

Hot Flashes: Estrogen deficiency throws off how a woman's brain regulates body temperature, and this may lead to hot flashes. A hot flash is a sudden, intense feeling of heat or burning in the face, neck, and chest, often accompanied by redness. 

A night sweat refers to a hot flash that occurs during sleep. Night sweats can negatively impact a woman's sleep cycle, which may lead to tiredness during the day. 

Other Symptoms of Surgical Menopause: There are a number of other symptoms of surgical menopause, although some of them are believed to also be caused by increasing age. 

These symptoms include:

• Mood changes, like depression and anxiety
• Weight gain, especially around the waist
• Dry skin and hair loss
• Increased urinary problems, especially urinary tract infections and urinary incontinence (loss of urine without any control)

It’s important to note that for women who have undergone surgical removal of their ovaries, menopausal symptoms tend to be more intense than for a woman who experiences menopause naturally. Of course, this is not a hard-and-fast rule; menopausal symptoms vary widely and in degree from woman to woman.

Even so, this greater intensity of menopausal symptoms is attributed to the abrupt removal of the ovaries, which are a woman's primary source of estrogen. In natural menopause, the ovaries gradually lose their ability to produce estrogen, so the body can (usually) adjust more easily.

Women who have their ovaries intact, but without their uterus, won't get their period anymore. You may, however, still experience premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) because the hormones made by the ovaries will cause your body to continue to "cycle" monthly.

Occasionally, women whose ovaries were not removed during a hysterectomy experience hot flashes and other menopausal symptoms. This is mostly due to the disturbance of the blood supply to the ovaries during surgery.

In addition, some women may undergo menopause a few years sooner than they normally would if they never underwent a hysterectomy (the average onset age for menopause is 51). 

After a hysterectomy, it's common for women to feel a sense of loss. This is true whether a woman has had her ovaries removed or not. Emotional distress can be especially strong when an unexpected hysterectomy prevents a woman and her partner from having the biological children they planned on. 

The good news is there are resources out there to aid you through this difficult time, like support groups. Please seek out guidance from your doctor so you can heal and thrive after surgery.