January 31, 2023

Filipino Guardian

Sentinels of Filipino Free Press

What you need to know about surgical menopause

Helen Kemp had a complicated gynecological history. When she was 41, endometriosis, ovarian cysts and fibroids led to the surgical removal of her uterus, fallopian tubes and ovaries. She was completely unprepared for what she would go through post-surgery as she entered early menopause.

“Immediately after the surgery, I had hot flashes, coupled with insomnia, anxiety, and mood swings,” she recalls. “For the weeks and months that followed, I would have panic attacks and daily nausea and morning sickness.” Even now, nine years later, she said, “I can still be stopped by an overwhelming fatigue that seems to be a common legacy of surgical menopause .”

In one word, Kemp describes her experience as “brutal.”

What is medical menopause?

Medically induced menopause is the cessation of menstruation as a result of severe damage to the ovaries from chemotherapy or drugs, or surgical menopause to remove the ovaries. The surgery, called an oophorectomy, is performed on women who have or have a high risk of ovarian, cervical, and/or womb cancer. Women with fibroids, ovarian cysts, or serious infections can also have the surgery.

“There are surgical, infectious, toxic, endocrine, and metabolic causes that can lead to induced menopause — any external cause of menopause outside of mere aging,” explained Stephanie Faubion, MD, medical director of the North American Menopause Society (NAMS) and Director of the Mayo Clinic Center for Women’s Health.

In a soon-to-be-released study, Faubion said, NAMS found that about 13.1% of women experience premature or premature menopause that occurs before age 40 for any reason, including ovarian removal.

2019 (Photo/Helen Kemp)

What happens when someone experiences medically induced menopause?

Surgical menopause and other types of medically induced menopause cause estrogen production to decrease dramatically. This dramatic decline leads to a range of symptoms that affect far more than just the reproductive system and have more severe implications compared to natural menopause. The younger someone is when they enter medically induced or surgical menopause, the more likely they are to experience serious consequences.

“There is an increased risk of osteoporosis, heart disease, dementia, Parkinson’s disease, sexual dysfunction, eye disease and mental health problems, and early death,” Faubion said. In addition, a review found that there are increased rates of stroke, lung and colon cancer.

For this reason, Faubion said, ovarian removal should be a last resort, reserved primarily for cases where the patient is at risk of cancer or is battling cancer.

“In the past, ovaries were only removed because doctors surgically removed the uterus or something else and removed the ovaries when that wasn’t necessary,” Faubion said, adding that they were also removed for unexplained pelvic pain or endometriosis.

Read more about endometriosis >>

However, this past is not far behind. A 2021 population-based study examined rates of surgical menopause in North Carolina between 2011 and 2014. There were 11,502 menopausal surgical procedures for benign reasons in women of childbearing age. Ninety-five percent of these procedures occurred at the same time as a hysterectomy. The study also found that intervention rates increased over this four-year period, specifically among black women — an important trend to watch when considering the health effects of ovarian removal.

Another 2015 study found that 44% of women had their ovaries removed during a hysterectomy. Of these, almost one in four had nothing to do with their ovaries. About 600,000 hysterectomies are performed nationwide each year.

A lack of support for women with surgical menopausal symptoms

After Kemp went through surgical menopause, her mental health took a dangerous nosedive.

“My mental and emotional health has suffered quite a bit. I was surprised at how quickly my mood deteriorated after the surgery,” she said. “I’d managed depression since I was a teenager, but post-surgery depression felt different. It was deeper and darker, and sustained episodes of suicidal thoughts followed. I felt vulnerable, fragile and frankly totally lost.”

Read “What Dr. Virginia Lindahl wants you to know about suicide”

To make matters worse, Kemp believed she would recover within six to eight weeks and felt uninformed by her surgeon about what to expect after medically induced menopause.

“There still seems to be a worrying lack of support for women in the acute postoperative period,” she said. “Removing an organ is quite a major operation, and yet many women leave the hospital without any support or aftercare.”

Kemp’s experience led her to tell her story and compile the stories of other women who have undergone surgical menopause in Surgical Menopause: Not Your Typical Menopause, a book she edits. She wanted to provide a resource for other women preparing for surgical menopause or medical menopause.

“I don’t regret the surgery,” Kemp mused. “I regret not being better prepared, and I definitely regret not taking better care of my mental and emotional well-being before and immediately after surgery.”

How to prepare for life after surgical menopause

If your doctor recommends removing your ovaries for a benign problem, you should get multiple opinions to make sure this is the right course of action for you.

“First, we should stop removing people’s ovaries without having a very good reason,” Faubion said. “Second, if removed, women must continue hormone therapy at least until the natural age of menopause.”

Kemp recommends researching hormone therapy (also known as hormone replacement therapy, or HRT) options well in advance of your procedure so you can make an informed decision.

“For purely practical reasons, it’s worth preparing a batch of meals for the freezer and eliminating potential tripping hazards around the house,” Kemp said. “Chances are bending over will be a problem for a while, so make sure important items are at a suitable height and within easy reach.”

Most importantly, Kemp added, “Be kind to yourself while you heal and give yourself as much time as possible to recover. Life after surgical menopause can be a confusing wilderness with an ever-changing landscape.”

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