Dr. Jacqueline Gerhart: Hysterectomy and Menopause
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears weekly on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I think I'm going through menopause because I have hot flashes. But I'm not sure because I've had a hysterectomy. How do I know?
Dear Reader: Menopause is defined as the loss of your period (or absence of menstruation) for 12 months. Since you have had your uterus removed, you no longer have periods. So you can't use that as a guide to when you are going through menopause. Because of this, you need to look for other signs and symptoms associated with menopause, and sometimes may need further testing to rule out other disorders.
Almost on a daily basis I have patients come in to ask me about testing for menopause. Usually, they ask me to test their hormone levels in hopes of determining if they are menopausal, and "how far into menopause" they are. Unfortunately, hormone testing won't be able to tell you that.
Menopause is a clinical diagnosis, meaning we define it based on your age, your symptoms and the absence of other disorders. Lab tests for "female hormones" such as estrogen and progesterone vary throughout the month.
In other words, if you are still having a period or if you are still ovulating (releasing an egg each month), every single day will result in a different hormone level, depending on where you are in your cycle. So the range for your hormone tests varies widely to include all parts of your cycle.
The "precursor" hormones to estrogen and progesterone are LH and FSH. These are other hormones that patients often ask to be tested. Unfortunately, these also vary depending on the time of your cycle. They only reach a more "steady state" once you have gone through menopause. So we can't accurately tell where you are in the process of menopause using simple blood tests.
Women usually go through menopause in their 40s and 50s. The average age of menopause (or the cessation of periods) is 51. Usually, women will start having irregular periods (like one every two to four months) about one or two years before "official menopause." Other "pre-menopause" or "peri-menopause" symptoms are vaginal dryness, mood changes, weight gain, slowed metabolism, night sweats and hot flashes.
A hysterectomy that removes your uterus but not your ovaries doesn't cause menopause at the time of surgery. This is because your ovaries still release eggs and produce estrogen and progesterone. But a surgery that removes your ovaries will cause menopause right after surgery. Your periods will stop immediately and you likely will have hot flashes and possibly severe menopause symptoms, since these changes occur abruptly rather than over time.
Also, about 1 percent of women will experience "premature menopause" before age 40 due to "primary ovarian insufficiency," which is when the ovaries stop producing the normal levels of reproductive hormones. For these women, we may recommend hormone treatment until the natural age of menopause to help protect them from heart or bone disease.
For information on non-hormonal ways to manage menopause, check out this UW Integrative Medicine patient handout: Supplements for Hot Flashes during Menopause (pdf)
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 07/03/2013