In recent times, the conversation around menopause has intensified, spotlighting a broad spectrum of symptoms and experiences that accompany this pivotal phase in a woman's life. This increased attention is both timely and vital.
Yet, one pathway to menopause that often remains under-discussed is surgical menopause, a route fraught with its unique characteristics and considerable challenges.
It is distinguished from natural menopause in significant ways, meriting it the descriptor 'cliff-edge menopause.'
Full disclosure – I have not been through a surgical menopause. I am somewhere in the midst of a 'natural' menopause. This makes me feel slightly fraudulent talking about this. My passion for highlighting the cause of women going through early menopause came about from witnessing friends endure it and grappling with the stark contrast in their treatments and the significant effects it brings.
While it is true that the diet and lifestyle support for surgical menopause mirrors that of natural menopause to a great extent, it is crucial to acknowledge and address the unique hurdles that surgically menopausal women might encounter. Through this post, I want to highlight awareness where these women feel seen, and heard.
It is essential to note that these experiences can vary greatly, painting a spectrum of outcomes rather than a universal narrative.
Understanding Surgical Menopause
Surgical menopause arises from the removal of both ovaries, a procedure termed bilateral oophorectomy, typically conducted before a woman reaches the natural menopausal age. This action results in an abrupt decline in hormone levels because the primary sources, the ovaries, are no longer present.
This intervention triggers an almost immediate and lasting onset of menopause, bringing about profound physical and emotional symptoms. The severity of these symptoms can vary, mainly depending on the individual's age at the time of surgery; younger individuals may experience a more substantial hormone drop and, consequently, more intense symptoms.
This is compared to natural menopause, a gradual, albeit often bumpy, process that spans several years, typically between the ages of 45-55
The Reasons Behind Opting for Surgical Menopause
Embarking on the path to surgical menopause is seldom a hasty decision. Many women who opt for it have faced years of considerable distress due to persistent pain, heavy bleeding, and emotional turmoil. Although envisioned as a resolution, it sometimes replaces one set of issues with another
Navigating the Different Forms of Hysterectomies:
It is imperative to comprehend the various hysterectomy types and the distinct surgical approaches involved. Getting well-acquainted with the specifics of your surgery is essential.
Undergoing a hysterectomy, which entails the removal of the womb and cervix, will stop menstrual periods.
However, it doesn't equate to immediate menopause. Menopause often arrives earlier than naturally expected, potentially within 5 years post-surgery, partly due to effects on the blood supply to the ovaries and subsequent inflammation.
In contrast, if someone has the ovaries removed during an oophorectomy — which might be performed independently or alongside a hysterectomy — they will transition into surgical menopause right away.
Despite a common misconception, retaining the ovaries post-uterus removal doesn't guarantee their normal function. It's critical to realise early menopause remains a viable outcome. While keeping one ovary may have benefits, the results are unpredictable, emphasising the importance of fully grasping the potential consequences.
So, what sets surgical menopause apart from natural menopause?
Surgical menopause is a complex phenomenon that drastically differs from the natural progression of menopause. While the core symptoms remain the same, the sudden cessation of hormone production can lead to more immediate and severe effects.
Your body is thrown into a hormonal abyss overnight, going "cold turkey" as it loses its normal hormone levels abruptly. This change is felt acutely due to hormone receptors throughout the body, initiating a quick and extensive impact.
Symptoms can emerge within days to weeks following the surgery, potentially lasting many years.
The journey through surgical menopause is akin to braving a relentless storm comprising invasive surgery, an abrupt onset of menopause, and potentially grappling with a cancer diagnosis. It's a turbulent, jarring shift likened by Helen Kemp (Surgical Menopause: Not Your Typical Menopause, 2023. Flying Stoat Books) to a plane crash landing in a desert, rather than a turbulent, but controlled, gradual descent to a runway.
While the procedure can be life-saving in many ways, For younger women, this surgery often marks the end of their fertile years, a monumental life chapter closing prematurely.
The toll isn't just physical; the emotional burden is substantial, with feelings of loss and change in self-perception becoming overwhelming often in a very short space of time.
'It's like being hit with a sledgehammer' – has been one description.
The existing data, primarily based on older women, suggests that those undergoing surgical menopause are almost twice as likely to experience severe hot flashes and more profound overall symptoms than those undergoing natural menopause.
This abrupt transition also increases the risk of adverse health effects such as:
Decreased bone density
a heightened probability of fractures
a surge in cardiovascular diseases by 40%
and potentially cognitive decline
Underscoring the necessity to comprehensively understand and anticipate the changes to adapt and preserve long-term health.
Unsurprisingly, many women focus intensely on the surgical procedure, somewhat overshadowing the consequential post-surgery period, a focus often heightened when paired with a cancer diagnosis.
This is why it is vital for women to engage in detailed discussions with their healthcare consultant to understand fully the nuances of the surgery.
The conversation should encompass what to anticipate before, during, and after the surgery, fostering a healthcare approach that centres on the patient's well-being and individual circumstances.
Maintaining open dialogue is crucial in helping women comprehend the process deeply, allowing them to better prepare and devise strategies to manage the post-operative consequences.
The emotional aspect is also different. It is way more than just a physical alteration. Some find the change in their body and the loss of self debilitating. If fertility is a part of this discussion, it can be overwhelming in many ways. Please be aware that before surgery, you will be asked to take a pregnancy test – this can be an added pain.
Typically, women are informed that the recovery period spans between 6 and 8 weeks. While this timeframe might hold true for some individuals, especially those undergoing laparoscopic surgery, many find the healing process extends much longer.
This extended duration is perfectly reasonable, considering the significant nature of the surgery.
Understandably, there is often a high expectation of the surgery bringing relief and a new beginning. It is common for individuals to yearn for a swift recovery, partially driven by a desire to return to normalcy and ease the burden on their families.
However, if the recovery doesn't proceed as anticipated; it can give rise to feelings of frustration and even a perceived sense of failure.
Managing Symptoms
Menopause, whether occurring naturally or induced through surgery, introduces a range of symptoms that can markedly affect everyday living. The strategy to manage these symptoms shares many similarities between the two types of menopause, albeit with subtle variations.
HRT
Current guidelines recommend offering HRT to women under 45, advising its continuation until the average onset age of natural menopause, except when specific health concerns, such as hormone-dependent cancers, deter its usage.
Surgical menopause often necessitates adjusting HRT dosages; the sudden oestrogen drop in younger women generally means initiating treatment at a medium dose (rather than a low dose), potentially increasing it to manage symptoms effectively.
When a hysterectomy is part of the surgery, HRT primarily involves only oestrogen, as progestogen isn't required to safeguard the absent womb lining. However, adding progestogen might aid in alleviating insomnia and anxiety in some individuals.
In cases of extensive endometriosis identified during surgery, a combined regimen of oestrogen and progestogen in HRT is often a consideration to navigate the complexities involved appropriately.
Testosterone Supplementation
Introducing testosterone into the treatment plan may offer many benefits, from restoring libido to enhancing overall life zeal and equilibrium. Regaining this sense of joy can be vital, given the battering that women may experience when dealing with everything. Furthermore, it can help to support mood and diminish depression and anxiety that often accompanies the tumultuous journey.
It is, however, essential to consult a knowledgeable healthcare provider to discuss the advantages and potential risks, given the evolving landscape of research in this area.
Local Vaginal HRT
Considering local vaginal HRT is often beneficial, offering support to the vaginal health and positively influencing bladder function.
Like any HRT, pinpointing the optimal hormone balance is a process of experimentation and personalisation.
Selecting the Right Healthcare Provider
Choosing a healthcare provider who understands these differences is paramount. The National Institute of Health Care Excellence (NICE) mandates "that all women who are likely to experience menopause through surgery should be offered support by a healthcare professional, knowledgeable and experienced in this specific area of the menopause. "
Now, I fully realise that most women do not get a choice. BUT, it is worth doing what you can to find someone who knows 'the deal' and can support you appropriately.
Non-Hormonal Approaches
My role and passion is to help every woman navigating menopause to understand the profound effect that diet and lifestyle changes can have, not only during this pivotal time but also as they move forward in life.
This stands unequivocally true for those undergoing surgical menopause, where the pillars of well-being and self-care attain heightened significance. Sometimes, minimal shifts can yield substantial improvements. Given that HRT may not be suitable or preferred for everyone, spotlighting non-hormonal avenues becomes vitally important.
Seeking and establishing a robust support system is integral to this process. It could be through online platforms like Facebook groups or other support networks.
Focus areas for fostering well-being include:
Nutrition: Cultivating a nourishing diet that caters to your evolving bodily needs.
Exercise:Regular physical activity tailored to your comfort and preferences, fostering bodily health.
Sleep:Ensuring quality sleep to aid in recovery and maintain a healthy mental state.
Stress:Identifying and working towards alleviating stress triggers through various techniques and self-care practices.
This portrayal might make surgical menopause seem solely daunting. Still, it is crucial to acknowledge the silver linings in the process. These include:
a diminished risk of ovarian and potentially breast cancer
alleviation of endometrial pain
the cessation of menstrual periods — which many regard as a substantial relief.
Many women find themselves reclaiming their lives and experiencing a newfound freedom post-surgery.
Admittedly, it can be a challenging journey, but with the right strategies in place, not only is managing the changes possible but flourishing in this new chapter of life is well within reach.
As a nutritionist, I can support you in this journey, helping to craft a personalised approach to diet and lifestyle that promotes optimal well-being during and after the transition.
Together, we can work to ensure that you nourish your body with the essential nutrients it requires, fostering resilience, vitality, and a harmonious balance that encourages healing and flourishing in your day-to-day life.
Thriving through this phase is not just a possibility but a reachable reality with the proper guidance and support.
Please do contact me, even just to chat. Click below or email me via: nicola@nicolavinall.com
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