Coping with Menopause After Hysterectomy: What to Expect?

Last updated 12.05.2023 | by Dr. Karen Pike | 11 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


Around 600,000 hysterectomies are performed in America each year. Today, the procedure is so common than by the age of 60, almost a third of all women will have had one.

But when you have a hysterectomy, the menopausal process can begin earlier than it would do naturally. So, if you are awaiting this type of operation, it’s absolutely essential that you know what to expect.

A hysterectomy is a full surgical removal of the uterus. Sometimes, the ovaries are also removed during surgery, and when this happens, you’ll enter menopause right away. This is known as surgical menopause.

I’ve dealt with many patients over the years who are understandably apprehensive about surgical menopause, and the impact it might have on their bodies. But armed with the right knowledge and tools, most women can continue to thrive after their surgery.

Have you recently undergone a hysterectomy before your natural menopause transition was complete? Or are you waiting for the procedure and curious about the changes you should expect to see?

In this post, I’ll discuss everything you need to know about what to expect after undergoing a total hysterectomy, including the symptoms of surgical menopause and how you can deal with them when they arise.

What is a Hysterectomy?

A hysterectomy is the medical term for the surgical removal of the womb or uterus.

There are various reasons why this procedure is carried out, and depending on the nature of your condition, you may undergo what is known as a hysterectomy with bilateral salpingo-oophorectomy. This is where your uterus, fallopian tubes, and ovaries are all removed.

If this procedure happens before your body naturally reaches menopause, you will experience “surgical menopause” immediately after the operation.

Why Can a Hysterectomy Cause Menopause?

Menopause symptoms are driven by a reduction in the body’s natural production of estrogen. Estrogen is produced by the ovaries, so, when the ovaries are removed during a hysterectomy, estrogen production ceases. 

As a result, women who undergo this type of procedure experience one or more of the classic symptoms of menopause, for example, hot flashes, night sweats, and mood swings.

If you have not yet reached menopause and your ovaries are left intact during surgery, chances are that you will keep producing estrogen. In this case, menopause will only arrive once your body naturally enters this phase. However, your periods will stop immediately, since there is no longer a uterine lining to shed.

Sometimes, surgeons remove the uterus while leaving just one ovary intact. In this case, you will continue to produce some estrogen. However, in my experience, most women with just one remaining ovary tend to enter menopause within five years[1].

Surgical Menopause Vs Natural Menopause

Normally, a woman reaches menopause slowly, over several years.

First, she enters perimenopause (the build-up to menopause). During this time, her hormonal production gradually decreases, and the symptoms of menopause begin.

Eventually, her egg reserves are depleted and her ovaries cease to produce significant reproductive hormones. At this point, 12 months after her final period, she will officially reach menopause.

But when a premenopausal woman undergoes a hysterectomy and her ovaries are also removed, this gradual process isn’t allowed to happen.

Instead, estrogen is depleted suddenly. This quick and drastic change is why surgical menopause usually presents more troublesome symptoms than natural menopause does.

Surgical menopause isn’t a topic that is often discussed, and many of my female patients have been surprised to learn that a full hysterectomy will cause them to enter a sudden menopause.

So, I aim to educate women about what to expect after surgery and arm them with the knowledge they need to navigate this time of change with as much ease as possible.

Recovering From Surgery

A hysterectomy is a major surgery, but thanks to modern surgical techniques, recovery time is generally around just 6-8 weeks. However, it can be shorter or significantly longer, depending on the nature of your surgery and your overall physical health. For example, I’ve seen some of my most physically active patients bounce back within as little as a month.

During your recovery, certain symptoms such as nausea (due to anesthetic), weakness, fatigue, and pain are common. This is part of the healing process and separate from any menopausal symptoms you might be experiencing at the same time. 

After the first week, these symptoms should gradually begin to subside. However, if they continue or you are concerned, it’s important to contact your healthcare provider. Surgery of any kind leaves you at risk of infection, and other complications are possible. 

Surgical Menopause After Hysterectomy: What to Expect

Surgical menopause after a hysterectomy with ovarian removal is inevitable. That being said, the way you experience it will depend on many different factors, including your age, overall health, and genetics.

Surgical menopause presents the same set of symptoms as natural menopause; however, they appear quite suddenly, and sometimes they can be more severe.

Most women notice one or more of the following symptoms almost immediately after surgery, within just a few days.

Gradually, over time, you may also notice other classic symptoms of menopause, including:

If listing all these symptoms together fills you with fear, please be assured that most women will only deal with a handful of them at any one time. I’ve met many women over the years who were dreading the onset of surgical menopause after a hysterectomy, but to their surprise, with the right interventions, they’ve been able to carry on living their lives to the fullest.

What Treatment is Available for Menopause After Hysterectomy?

Because surgical menopause happens suddenly rather than gradually, the symptoms can be more severe than natural menopause. So, finding the right treatment plan to help you adjust to this drastic change is essential.

Hormone Replacement Therapy (HRT)

Many women take hormone replacement therapy (HRT) to ease their surgical menopause symptoms and make the transition easier.

Most women who undergo a hysterectomy are prescribed an estrogen-dominant variety of HRT[2]. HRT replaces missing estrogen, which greatly reduces the severity and frequency of symptoms such as hot flashes, night sweats, and mood swings.

HRT can also lower the risk of cardiovascular disease and osteoporosis, two conditions that can occur when estrogen levels fall.

I would recommend HRT after hysterectomy to most younger women in their 20s, 30s, and early 40s, providing they are a suitable candidate. 

However, the older you are, the higher your risk of experiencing serious side effects. So, if you’re a woman in your late 40s and onwards, the decision to pursue HRT should be carefully considered and discussed with your healthcare professional.

Older women taking HRT are at an increased risk of stroke, blood clots, and certain types of cancers. So, the risks vs benefits need to be fully weighed up before starting treatment.

Other Ways to Manage Nonsurgical Menopause

Other Ways to Manage Nonsurgical Menopause

Alongside proper medical treatment, several lifestyle changes and natural treatments can help you navigate menopause after a hysterectomy. Here are some simple interventions that have worked for my patients.

  • Calcium and vitamin D

A lack of estrogen after a hysterectomy can lead to a loss of bone density and an increased risk of osteoporosis. So, I always recommend supplementing your diet with calcium and vitamin D.

  • Exercise

Once you are fully recovered from surgery and your doctor says it’s safe, begin a regular exercise routine.

Exercise is great for both your mind and body, and it’s particularly important during menopause. Exercise can help strengthen bone and muscle mass to support your joints, and it can also help with weight loss, too. Plus, a good workout boosts endorphins and helps to balance any potential menopause-related mood swings.

In my experience, the patients with the least surgical menopause symptoms are also the most active.

  • Eat well

Changing your dietary habits can alleviate many of the most bothersome symptoms of menopause.

Heavily processed foods high in sugar and refined carbs can exacerbate symptoms of menopause. These types of food also lead to weight gain, blood sugar deregulation, mood disorders, and many other problematic symptoms and conditions.

So, cutting back on junk and eating a healthy balanced diet is an important component of managing menopause after a hysterectomy.

  • Natural medicine

While HRT is a particularly effective tool for managing the symptoms of surgical menopause after a hysterectomy, not everyone is a suitable candidate for this medication.

Thankfully, there are a range of herbal supplements available that can help to replicate the role of estrogen in the body, without the associated risks and side effects of HRT.

I often recommend soy-based foods and supplements as they contain a high concentration of phytoestrogens. To learn more about soy and its potential role in treating menopause symptoms, read my in-depth blog post here.

Black cohosh, red clover, and dong quai are other popular phytoestrogen-containing botanicals. Many women that I work with swear by these herbs to help alleviate menopause symptoms such as hot flashes, night sweats, and mood swings.

These natural medicines are generally considered to be a safer and gentler alternative to HRT. However, they could still carry potential risks of side effects, especially if you’re taking other medications. So, always speak to your doctor before adding any of these natural medicines into your routine.

FAQs

My surgeon left my ovaries intact. Can I still experience menopause symptoms after a hysterectomy?

In some cases, yes. Even if the ovaries aren’t removed, the blood supply to them can be affected, which can alter or stop hormone production. Be sure to speak to your doctor and surgeon to gain a full understanding of the type of procedure you are having and its potential effects so that you know what to expect.

When should I begin my first dose of HRT after a hysterectomy?

It’s generally advised to take your first dose of HRT no later than one week after your surgery. Your healthcare provider will guide you on the correct dose and dosage frequency.

How long should I take HRT after surgical menopause?

Most women are prescribed HRT for around 2-5 years after surgical menopause. However, the duration of your treatment will depend on your own individual circumstances.
If you begin HRT immediately after a hysterectomy, you will delay many of the most bothersome symptoms of menopause. However, once you stop taking the treatment, symptoms will arise quickly as your body adjusts to a sudden lack of estrogen.
This is why it’s important to wean yourself off HRT gradually, under the careful supervision of your doctor.

Conclusion

Menopause is a challenging time for many women, but it can be even more challenging to navigate this phase after a hysterectomy. 

The sudden and often early nature of surgical menopause can come as a shock, and it can feel overwhelming to navigate these challenges while you’re recovering from major surgery.

But understanding what’s happening to your body, what symptoms to expect, and the various treatment plans available can help you feel more prepared and in control.

Just like natural menopause, surgically induced menopause is easier to deal with when you’re as physically and mentally healthy as you can be. I’ve worked with countless pre-menopausal women who were extremely concerned about how their body would react after a full hysterectomy. But because they ate well, kept a healthy weight, and lead an active lifestyle, many were pleasantly surprised at how easy the transition was to navigate.

So, remember, while this is a potentially difficult time, it won’t last forever. There are plenty of ways to make the process easier, and gradually, as your body adjusts to a new hormonal balance, many of your symptoms will resolve themselves.

In the meantime, help and support is available. Reach out to your doctor if you have any concerns. They know your medical history and will be able to tailor a treatment plan that can help.

Author

  • Dr. Karen Pike

    Dr. Pike is a senior physician administrator and board-certified emergency room doctor actively working in northern California. She received her undergraduate degree at Dartmouth College, where she graduated Phi Beta Kappa and played collegiate soccer. She attended Georgetown University for medical school and performed her residency in emergency medicine at Stanford University. She was part of the first-ever, women-majority emergency medicine program in United States. Dr. Pike is also the primary medical consultant for “Grey’s Anatomy,” a role she has held since the pilot episode when she partnered with Shonda Rhimes as the show’s original medical consultant. At her hospital, she was the second woman Chief of Staff. Today serves as the Director of the Emergency Department. Whether in leadership or direct patient care, her dedication to excellence in communication, quality, and collaboration is unwavering.