HRT: WHEN DOES MENOPAUSE HAPPEN?
If you still have your ovaries, you will continue to produce oestrogen. Without a uterus, however, you will have no periods, so you won’t be aware of the irregular and unpredictable winding down of periods that heralds the natural menopause. Eventually, your ovaries will start to produce less oestrogen, and you will begin to notice the typical menopausal signs, such as hot flushes. This will probably happen up to two years earlier than it might have done if you hadn’t had a hysterectomy because it is thought that the uterus may release certain hormones which control levels of oestrogen, and without a uterus these oestrogen-controlling hormones are no longer produced. Many quite young women stop producing oestrogen within two or three years of a hysterectomy, even though they still have their ovaries.
If you had just one ovary removed (a unilateral oophorectomy) you may continue to produce some oestrogen. If you had both ovaries removed (a bi-lateral oophorectomy) you will no longer produce any oestrogen; this operation produces an instant menopause. For this reason, ask the surgeon who performs your hysterectomy to discuss with you beforehand whether he will remove the ovaries, and if so, why. Many surgeons remove them at the time of the hysterectomy to ensure that they won’t become cancerous in later years. This is a valid medical point, but to remove otherwise healthy functioning ovaries can cause severe menopausal symptoms after the operation. If you have this operation before the normal menopausal age, the loss of oestrogen can produce a striking and rapid appearance of menopausal symptoms. These symptoms are so severe that it is almost certain that you will be prescribed hormone replacement therapy (HRT) straight away. If you are not, ask for it, and be prepared to keep taking it until about five years or more past what would have been your normal menopausal age, that is until you are about 55, or longer if you get on well with it. The sudden fall in oestrogen also increases the risk of developing the serious bone disease osteoporosis.
A premature menopause – whether natural or surgical -is one which occurs before about the age of 45; some doctors say before 40. If you have a premature menopause you have a greatly increased risk of developing osteoporosis and also arterial diseases that could lead to heart attacks and strokes, and you should seriously consider taking HRT from the time your premature menopause or hysterectomy or oophorectomy occurs, and be prepared to take it until you are about 55. The National Osteoporosis Society reports that of women aged 60-65 who have osteoporosis, a disproportionately high number had a premature menopause.
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