Menopause After Hysterectomy No Ovaries Menopause Again

Key points

• Removal of both ovaries (bilateral oophorectomy) earlier a adult female has gone through her natural menopause is called "surgical menopause".
• Bilateral oophorectomy may exist done at the time of hysterectomy for benign affliction or gynaecological cancers, or every bit part of risk reduction treatment in women with an inherited increased chance of developing ovarian cancer.
• Negative effects include a sudden and severe onset of menopausal symptoms, increased risk of osteoporosis and cardiovascular illness, sexual dysfunction and loss of fertility.
• MHT/HRT is advised for all women who undergo a surgical menopause under the age of 45, provided they practise not accept contraindications to MHT/HRT (due east.chiliad. personal history of chest cancer.)

AMS Surgical Menopause 353.34 KB

What is surgical menopause?

Menopause ways the last menstrual menstruum. The average age of menopause is around 51 years, but most women will start to observe menopausal symptoms from effectually 47 years.  This may be noticed every bit the onset of hot flushes, dark sweats or vaginal dryness or a change in menstrual periods to more infrequent and sometimes heavier menstrual bleeding (1). Removal of both ovaries (bilateral oophorectomy) before the normal menopause is called "surgical menopause".

Indications for surgical menopause.

Surgical menopause is usually performed at the fourth dimension of hysterectomy for beneficial (non cancerous) illness, virtually commonly for heavy menstrual bleeding or fibroids (two). Another common reason to remove normal ovaries at the time of hysterectomy is to reduce the hazard of ovarian cancer. This has been shown to exist beneficial in women with an inherited increased hazard of developing ovarian cancer (cistron mutations such every bit BRCA1 or BRCA2 or HNPCC) (three), and for some women with very strong family histories of ovarian cancer,  just is not recommended for other women as the disadvantages of removing normal ovaries at the fourth dimension of hysterectomy are likely to be greater than their very small risk of ovarian cancer (four).  Very little is known near the impact of removing normal ovaries from postmenopausal women.

Some premenopausal women will elect to have their ovaries removed for other indications, such equally endometriosis or chronic pelvic pain.  Depending on the circumstances, removal of the ovaries may improve pain, but information technology is not ever effective.  Some doctors may suggest a trial of a drug to bring on a short term "chemical menopause" before surgery to try and mimic the furnishings of surgical menopause. However, it is non currently possible to predict how surgical menopause will affect individual women.

There are other reasons why the ovaries are sometimes removed from younger women such as recurrent ovarian cysts and premenstrual syndrome, but the evidence to support a do good for this is weak and normal ovaries should not be removed from younger women for these indications.

Although surgical menopause is common, there take been remarkably few studies which take followed women before and after oophorectomy to endeavor and understand how surgery affects their menopausal symptoms and short and long term health.

Potential positive effects of surgical menopause

• Reduced hazard of ovarian cancer in women who are known to be at high inherited risk. Having this performance likewise usually reduces feet most developing ovarian cancer. In some high risk women, surgical menopause may also reduce their run a risk of breast cancer.
• Reduced pelvic pain for women with endometriosis or dumbo adhesions around the ovary.

Potential negative effects of surgical menopause

• Sudden and more severe onset of menopausal symptoms: in item; hot flushes, night sweats and vaginal dryness
• Loss of bone density and increased risk of osteoporosis and fracture
• Impaired sexual function due to reduced want and to discomfort from vaginal dryness
• Reduced sex drive (libido) associated with loss of ovarian testosterone production
• Loss of fertility
• Increased hazard of cardiovascular (heart) disease

Surgical menopause may take other adverse furnishings on wellness including affecting mood (increased depression), noesis (thinking), dementia and potential increased take a chance of

Parkinson's disease just the evidence for these is non well established. Big population based studies have reached different conclusions about whether surgical menopause impacts on cardiovascular, cancer or all crusade mortality(5).

Use of Menopausal Hormone Therapy (MHT), also known every bit Hormone Replacement Therapy (HRT) may reduce these risks, but again there is bereft prove. The proven value of MHT afterward surgical menopause is in managing vasomotor symptoms and maintaining bone density.

Management of surgical menopause

Ideally, a menopause specialist should review younger women prior to surgical menopause to explicate the potential consequences of surgery and to make a plan for symptom direction and long-term health.

Current international guidelines (6) advise utilise of MHT for all women who undergo menopause under the age of 45 years provided that they do not have other contraindications to MHT (6).  Treatment should keep until the average age of menopause (51 years) and then be reviewed. Those with a personal history of chest cancer should avoid both MHT and tibolone, as they have been associated with an increased hazard of breast cancer recurrence (7). For high adventure (BRCA1 and BRCA2) women without a personal history of breast cancer, observational data suggest that MHT appears to be safe (8).  Women should exist aware that discontinuation of MHT volition exist associated with a recurrence of hot flushes and night sweats in around 50% of cases.

Use of MHT will resolve hot flushes and sweats in 80-xc% of women, although in that location is evidence that hot flushes and night sweats every bit well as vaginal dryness may persist despite MHT utilize in younger women (ix).  In that location are no specific guidelines on the type of MHT to use only oestrogen only MHT is generally prescribed for those women who have had a hysterectomy (removal of the uterus). Women who retain their uterus should use an oestrogen and progestogen combination training (refer to AMS information sheets - Combined Hormone Replacement Therapy and Oestrogen Only Therapy)

For women who have had both hysterectomy and bilateral oophorectomy (both ovaries removed) for endometriosis, taking MHT has the potential to reactivate residue disease. This has been reported with all MHT preparations including tibolone. There is no consensus on MHT regimens in this population, just information technology seems reasonable to employ low dose oestrogen only preparations in younger women and to discontinue oestrogen if symptoms of endometriosis recur and consider using a non-hormonal agent to treat hot flushes. In some circumstances, specially if endometriosis has involved the bowel, progestogen may be added to the oestrogen.

In those without contraindications to MHT, advise starting treatment inside a calendar week following oophorectomy.

Offering patients a follow upward within vi weeks to ensure treatment is acceptable. Consider adding vaginal oestrogens to systemic MHT for vaginal dryness and ensure that bug regarding sexual role are addressed.

Consider supplemental testosterone in younger women with reduced libido following surgical menopause (10).

Ongoing management of women after surgical menopause

• Discuss evidence based lifestyle strategies for maintaining os and cardiovascular health. These may include, diet, exercise, smoking cessation and adequate calcium and Vitamin D levels.
• Ensure that vasomotor symptoms and vaginal dryness are effectively managed. Younger women may require higher doses of oestrogen to manage their symptoms, but there is very lilliputian evidence to support this and low doses should be used in the offset instance to minimise exposure.
• Women who are postmenopausal below the age of 45 years are entitled to Medicare Bone Density (DXA) scans. These should be performed at 2 yearly intervals. MHT (unless contraindicated) is the best direction option for these women with depression bone density.
• Because of the increased risk of cardiovascular disease associated with early menopause, and in detail with surgical menopause, assessment of cardiovascular risk factors (including claret force per unit area, serum fasting glucose and fasting lipid levels) should exist considered with further management as appropriate. It remains unclear whether MHT protects confronting cardiovascular disease after surgical menopause.
• Consider psychological support in view of the potential increased risk of low in this population.

Farther Information

• Cancer Australia http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer
• The International Premature Ovarian Failure Association (IPOFA) website: http://www.ipofa.org
• The Daisy Network Premature Menopause Support Group: http://www.daisynetwork.org.uk
• New Zealand Early Menopause Group: http://www.earlymenopause.org.nz

References

1. Harlow SD, Gass Thou, Hall JE, Lobo R, Maki P, Rebar RW, Sherman Southward, Sluss PM, de Villiers TJ, for the Straw x Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19(four):387-95.
2. Hickey One thousand, Ambekar M, Hammond I. Should the ovaries be removed or retained at the fourth dimension of hysterectomy for benign disease? Human Reprod Update. 2009;xvi(2):131-41.
3. Rebbeck TR, Kauff ND, Domchek SM. Meta-analysis of risk reduction estimates associated with chance-reducing salpingo-ooprhorectomy in BRCA1 or BRCA2 mutation carriers. JNCI. 2009;101(2):lxxx-seven
4. Parker WH, Shoupe D, Broder MS, Liu Z, Farquhar C, Berek JS. Elective oophorectomy in the gynecological patient: when is information technology desirable? Curr Opin Obstet Gynecol. 2007;19(iv):350-4.
5. Duan L, Xu X, Koebnick C, Lacey JV Jr, Sullivan-Halley J, Templeman C, Marshall SF, Neuhausen SL, Ursin K, Bernstein 50, Henderson KD. Bilateral oophorectomy is non associated with increased mortality: the California Teachers Written report. Fertil Steril. 2012;97(i):111-7.
6. Hickey Thousand, Davison Due south, Elliot J. Hormone Replacement Therapy. BMJ. 2012; Feb 16;344:e763.
7. Hickey M, Davis SR, Sturdee DW. Treatment of menopausal symptoms: what shall we do now? Lancet. 2005;366(9483):409-21.
8. Rebbeck TR, Friebel T, Wagner T, Lynch HT, Garber JE, Daly MB, Isaacs C, Olopade OI, Neuhausen SL, van 't Veer L, Eeles R, Evans DG, Tomlinson Chiliad, Matloff Due east, Narod SA, Eisen A, Domchek S, Armstrong K, Weber BL. PROSE Report Group. Effect of short-term hormone replacement therapy on chest cancer risk reduction afterward bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE Study Grouping. J Clin Oncol. 2005;23(31):7804-x.
9. Finch A, Metcalfe KA, Chiang JK, Elit 50, McLaughlin J, Springate C, Demsky R, Murphy J, Rosen B, Narod SA. The impact of safety salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation. Gynecol Oncol. 2011;121(i):163-8.
10. Wierman ME, Basson R, Davis  SR, Khosla  Southward, Miller G, Rosner W,  Santoro North. Androgen therapy in women: an Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab. 2006;91(10):3697-710.

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Content created Jan 2017

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Source: https://www.menopause.org.au/hp/information-sheets/surgical-menopause