Natural menopause occurs over a number of years, normally between the ages of 45 and 55, and is part of the female ageing process. During this process a woman’s egg store begin to decline, her menstrual cycle may become more erratic and eventually stop and she will gradually begin to experience menopausal symptoms as her estrogen and progesterone levels begin to fluctuate.
Surgical menopause, also known as induced menopause or medical menopause, refers to the onset of menopause resulting from the surgical removal of both ovaries (bilateral oophorectomy) in women who have not yet reached natural menopause. This procedure leads to an immediate and permanent cessation of ovarian hormone production, including estrogen and progesterone and this sudden drop in the production of hormones can lead to acute and sometimes debilitating symptoms which require further management.
The principal reasons that a bilateral oophorectomy is typically performed are to treat or prevent certain medical conditions, such as ovarian cancer, certain types of breast cancer, endometriosis, or severe pelvic inflammatory disease. In some cases, it may be done as a preventive measure for women at high risk of developing ovarian cancer. Another reason some women take this option is to reduce symptoms of endometriosis or chronic pelvic pain however it must be noted that this is not always an effective solution.
Since the ovaries are responsible for producing hormones, the sudden removal of both ovaries leads to a rapid decline in hormone levels. This can result in intense menopausal symptoms, which may include hot flashes, night sweats, vaginal dryness, mood swings, decreased libido, fatigue, sleep disturbances, and changes in urinary function. There are studies that suggest a greater risk of heart disease and a decreased libido with surgical menopause compared to natural menopause. In order to reduce the negative effects of surgical menopause, consultants will often recommend starting on Hormone Replacement Therapy (HRT) which will in turn lower the risk of heart disease and help prevent bone density loss and osteoporosis. It is important to note that the duration and intensity of these symptoms can vary greatly between patients and it is important that each individual is presented with an individualised, tailored approach to their medication.
Hormone replacement therapy is often recommended for women who undergo surgical menopause to alleviate the symptoms and reduce the long-term health risks associated with estrogen deficiency proving there are no contraindications such as a history of hormone-dependent cancers. HRT typically involves the use of estrogen alone or a combination of estrogen and progesterone (in women with an intact uterus) to mimic the hormone levels present before surgery.
For some woman the removal of the ovaries can save their lives as an oophorectomy can be used as a preventative measure to stop women who have a family history of ovarian cancer from developing it. However, surgical menopause doesn’t come without its risks. Estrogen plays a crucial role in maintaining bone density, cardiovascular health, and overall well-being in women. Therefore, the abrupt loss of estrogen due to surgical menopause may increase the risk of osteoporosis, heart disease, and other health conditions. HRT can help mitigate some of these risks, but it’s important to discuss the potential benefits and risks with your consultant. Surgical menopause can also have an emotional and psychological impact on women, as it often signifies the end of fertility and can lead to feelings of loss, grief, or a sense of change in identity. Support from healthcare professionals, friends, and family members, as well as counselling or support groups, can be beneficial in managing the emotional aspects of surgical menopause.
It’s important to note that surgical menopause differs from natural menopause, If you have concerns or questions about surgical menopause, it is best to consult with a healthcare professional who can provide personalised advice and guidance based upon your specific situation.
