While it is true that perimenopause and menopause are completely natural, they can be annoying and disruptive parts of the normal life cycle. For some women they come abnormally early (premature menopause), or as a result of surgical or medical interventions (hysterectomy or as a result of some cancer treatments like radiation and chemotherapy).
In some cases, you may be able to treat your menopause symptoms under these circumstances with HT (Hormone Therapy).
In the meantime, let’s take a look at what we’re talking about.
Hysterectomy
We women love to change things up: our hairstyle, our hemlines, our wardrobes. And if we don’t like something—that couch, that old dress—we toss it and get a new one. Well, let me stop you right there, because if your doctor tells you that you should have a hysterectomy, make sure you get a second opinion, and maybe a third. After all, a hysterectomy is forever.
How are these for some startling stats? The CDC reports that 600,000 women have their uterus removed every year. More than one-third of women will have had a hysterectomy by the time they turn 60, the National Women’s Health Network reports.
As Peg Rosen wrote in More magazine, just because you’re done having babies, don’t throw the uterus out with the bathwater. Not only will the procedure cost you six weeks in pain and out of work, it could leave you incontinent, put the kibosh on your sex life, and maybe shorten your life. If that’s not enough, a landmark study showed that removing ovaries along with the uterus ups the likelihood of heart disease and bone loss, according to study coauthor William Parker, MD, of the UCLA School of Medicine.
Only 10% of hysterectomies are performed to treat cancer. Most of them are done to treat bothersome but benign bleeding from fibroid tumors—even though there may be other ways to treat them, such as uterine fibroid embolization, a non-surgical technique that introduces microbeads via a small catheter to block the blood supply to the tumor, thereby reducing its size and alleviating symptoms. Other less invasive treatments include hysteroscopic myomectomy (removing the fibroid through the cervix rather than slicing you open) and endometrial ablation.
If you do indeed need a hysterectomy, due to cancer or prolapse, ask your doctor about laparoscopic surgery, which is completed through small incisions rather than one large incision. Be sure to talk to your doctor before surgery, so that you can have a plan in place to deal with the hormonal and other physical and emotional effects of the procedure.
After the procedure, a woman may no longer become pregnant. If she has not yet entered menopause at the time of surgery and her ovaries are left in place, they will continue to produce estrogen. However, she still may enter menopause at an earlier age.
If her ovaries are removed during the hysterectomy, she will enter menopause and encounter symptoms caused by a lack of estrogen, such as hot flashes, vaginal dryness, and sleep problems. She may also be at risk of developing osteoporosis at an earlier age, according to The American College of Obstetrics and Gynecologists.
FYI, a woman still needs regular Pap tests to screen for cervical cancer if she has a partial hysterectomy and does not have her cervix removed, or if her hysterectomy was performed as a treatment for cancer, says Lauren Streicher, MD, Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s Feinberg School of Medicine in Chicago. Any woman who has had a hysterectomy should still have regular pelvic exams and mammograms.
Dr. Anees Chagpar, Associate Professor of Surgery (Oncology) and Director of The Breast Center at Smilow Cancer Hospital at Yale-New Haven, suggests “annual screening starting at age 40, but tailor this recommendation to individual patients.” Women under 40 need not bother sticking their girls in the mammo waffle iron unless there’s a strong family history of breast cancer diagnosed at an early age.
Dr. Rebecca C. Brightman, Assistant Clinical Professor OBGYN and Reproductive Science at the Mount Sinai School of Medicine in New York City, points out that for many women, the OBGYN is the one and only healthcare provider. “We frequently screen for and diagnose other medical conditions. Women confide in their OBGYNs and seek advice in many areas from mental health concerns to social problems. So it’s way more than just a Pap smear!” Anyway, who would want to miss putting on that gorgeous gown and saddling up in those stirrups?
There can be emotional effects from a hysterectomy as well. “Very few women are thrilled about having to have a hysterectomy. Even though intellectually you know it’s the right thing to do and will benefit you in the long run, it’s a complex decision that is often psychologically difficult,” says Dr. Streicher. Some women feel depressed because they can no longer have children, and, if they have entered menopause after the surgery, hormonal changes can cause emotionally difficult symptoms. Still, she may feel relieved because the symptoms she was having are no longer present.
What does hysterectomy mean for your love life? Some women experience more sexual pleasure post-surgery because of the loss of symptoms, as they no longer are having discomfort or heavy bleeding during sexual intercourse, according to a study by Jan-Paul W. R. Roovers, MD, an obstetrics-gynecology professor at the University Medical Center in Utrecht, the Netherlands.
However, because the uterus has been removed, the uterine contractions that the woman may have felt during orgasm will no longer occur and can decrease sexual satisfaction for some women, says Dr. Streicher. A minority of women report developing sexual dysfunctions following a hysterectomy. Reduced estrogen levels are the main cause of vaginal dryness, says the Mayo Clinic. I know that when my estrogen levels began plummeting, my vagina took a trip to the desert. It was dry and parched!
Premature Menopause
Perimenopause arrives unscheduled and uninvited. Most women first begin to experience perimenopause in their early to mid-forties, but some women begin to have symptoms in their thirties, or even in their twenties and achieve full menopause (no period for 12 consecutive months) before the age of 40. I wish I could tell you that you will receive a “Hold the Date” notice so that you’ll know exactly when your menopausal journey will begin—sorry, no dice.
The loss of ovarian function at an early age is often referred to as premature menopause, early menopause, premature ovarian failure, or premature ovarian insufficiency (POI). Where are the naming police?
There are many factors that contribute to menopausal timing, including autoimmune and genetic disorders, chemotherapy, radiation therapy, and surgical history. However, sometimes the cause is unknown. Women who undergo an oophorectomy or radical hysterectomy in which the ovaries are removed jump right over perimenopause into full menopause.
According to an article published in JAMA Internal Medicine, which looked at a group of nearly 1,500 women with frequent symptoms of the onset of menopause, women who began to experience hot flashes and night sweats at a younger age tended to have them over a greater period of time. That means women who experience early or premature menopause symptoms may experience these symptoms longer than average.
But it’s not all bad news.
When I first met Christine Eads, she was co-host of the popular radio show “Broadminded” on Sirius XM Radio 107. Now Christine is the co-host of the digital radio show, “The Mom Squad Show.” Christine opened up and shared her powerful story about her own struggle to find hormone happiness. When she was 24, her period stopped. For the next five years, she saw doctor after doctor, looking for a solution. They told her the problem was caused by everything from depression to weight gain to weight loss to sexually transmitted disease! All the while, she was experiencing terrible mood swings and waking up in pools of sweat—both typical menopausal symptoms.
Ultimately, she went to a specialist at the National Institutes of Health, who discovered that she suffered from primary ovarian insufficiency (POI). Christine was devastated! She wasn’t ready to have kids at that point in her life, but she had always dreamed of having a huge family with tons of children. She was really angry at the doctors who didn’t diagnose her properly. After five years of suffering needlessly, Christine was put on hormone therapy. The therapy curtailed her symptoms and ultimately she was able to conceive!
What saved Christine in the end was her determination to find an answer. “You have to be your own advocate. No one cares about your health more than you. Don’t blow it off and say that it’s normal or it will go away. If you don’t feel right in any way, get to a specialist and ask a million questions until you are satisfied. Don’t be embarrassed to talk to family and friends about what is happening with you. You may not know that POI, or other disorders, run in your family, for instance, and you might find strength sharing your experience with another person who is feeling the same way. It is worth taking the time and doing the research to feel better.” she says.
I couldn’t have said it better myself!
Suffering in silence is OUT! Reaching out is IN!
Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause.