Questions regarding menopause

debaseinstall Fertility

I often am asked about “not going through menopause (surgical)” with surgical removal of the ovaries.  Unfortunately, the answer is a long story.  We do few hysterectomies in our practice but when needed might be the best option.  Most of our patients are on estrogen anyway for supplementation in the 38-44 age group when hysterectomy might be a possible surgical approach, yet they are fearful of menopause and “going crazy” like a friend or family member.  Menopause is defined as the last period when a uterus is present representing indirectly the complete cessation of ovarian function and estrogen production.  We don’t promote removal of ovaries, but for some their quality of life would be much better without the continued disordered hormone production of ovaries nearing menopause; the true  cause of “going crazy” with menopause.  The higher levels of progesterone combined with lower estrogen cause the extreme bloating that most women experience.  The endometriosis with diminished ovarian reserve patient will experience menopause naturally on average at age 44-46, so for most patients facing hysterectomy, this process is not far off.  Hysterectomy actually ages ovaries 2 years on average, bringing menopause that much closer.  For patients, that have surgery and experience menopause without hormone replacement, symptoms are severe.  Most women that are placed on estrogen after hysterectomy are under treated and levels are never checked.  These women also will suffer most if not all of the menopausal symptoms.  In contrast however, the woman who experiences surgical or natural menopause and is immediately replaced with normal levels of estrogen, will not experience ANY menopausal symptoms and in many cases will feel better than before.  Most of our patients in this age range are experiencing various aspects and degrees of estrogen deficiency and we have already started them on estrogen supplementation long before surgery is contemplated.  For these patients, simple dose adjustments prevent menopause symptoms.  So for nearly all patients who are replaced with level monitoring, menopause is simply a technical event on paper and the emotional disaster presented by most is never experienced. 
The other aspect mentioned regarding ovarian ageing with hysterectomy is responsible for some women to experience menopause very soon if not immediately after menopause thus requiring estrogen replacement to prevent symptoms at that point.  Hope this helps.  

Michael D. Fox, MD
Advanced Reproductive Specialists