“I’d be crying one minute, angry the next, happy the next,” says Lamar, now 50, of Fenton, Mo.
Lamar’s emotional upheaval is typical for women who are plunged in to instant menopause following the removal of their ovaries. Their symptoms are worse than those of women in natural menopause, which occurs gradually over several years. In addition, having ovaries removed rather than experiencing their natural shutdown means not only a loss of estrogen but also a loss of testosterone — whose presence may reduce hot flashes, maintain sexual desire and stabilize moods.
“They’re getting a double hormone whammy,” says Martha Richardson, MD, an assistant director of obstetrics and gynecology at Harvard Vanguard Medical Associates in Boston.
More Doctors Preserving Ovaries
The word hysterectomy is often misunderstood to mean the removal of the uterus and ovaries. In fact, it only refers to the uterus. Women undergo hysterectomy for many reasons, the most common of which is relief from heavy bleeding caused by uterine fibroids.
Until just a few years ago, doctors routinely performed oophorectomy (removal of the ovaries) during hysterectomies in women on the verge of menopause. The thinking was that their ovaries were about to shut down anyway and that taking them out would completely eliminate the possibility of a much more serious condition.
“My doctor said for women under 40, they leave ovaries, if you’re over 40, they take them out — so you don’t have to worry about ovarian cancer,” says Lamar, whose hysterectomy was prompted by heavy periods that lasted about 3 weeks out of every month.
Now, more and more doctors are preserving the ovaries, no matter what the patient’s age. New research shows the chances of a woman getting ovarian cancer over her lifetime (less than 2%) are much smaller than the risk of cardiovascular disease (more than 36%). Even after menopause, the ovaries produce small amounts of hormones, protecting postmenopausal women from heart disease and stroke, as well as bone loss.
One exception to the keep-the-ovaries mind-set: women with a family history of ovarian cancer may still be advised to also undergo oophorectomy when having their uterus removed. Such women may even choose to have their ovaries taken out if no hysterectomy is needed, especially those who test positive for BRAC gene mutations, which further increase their risk of ovarian cancer.
There is some evidence hysterectomy can effect hormone production even when the ovaries are preserved. For the most part, though, doctors say that keeping the ovaries allows women to go through natural menopause even without a uterus.
Most symptoms of surgical menopause are the same as those of gradual ovarian shutdown, but much more severe. They include hot flashes, difficulty falling asleep and staying asleep, lower libido, dry skin, vaginal dryness and mood swings.
Surgical menopause may also result in memory loss not seen in women who undergo natural menopause, according to an article in Menopause, published by the North American Menopause Society (NAMS).
“There are women who actually feel like they’re in this totally different body after they have a hysterectomy and have their ovaries removed,” Dr. Richardson says.
Relief from Menopausal Symptoms
Lamar enjoyed immediate relief from heavy periods, and her incision eventually healed. She struggled, though, with her hot flashes and erratic moods along with vaginal dryness, insomnia and a lower sex drive for about a month after her surgery.
Then her doctor prescribed Enjuvia (a plant-derived synthetic estrogen), and her libido lifted, her mood improved and her hot flashes diminished — in the space of one week. Lamar says she is happy to get relief but somewhat concerned about the other consequences of menopausal hormone therapy (MHT), which include an increase in a woman’s risk of breast cancer, stroke and cardiovascular conditions.
“I do worry about heart disease, because my father died when he was 48 from heart disease and diabetes,” Lamar says.
Women who have a personal or family history of breast cancer may need to take Nolvadex (tamoxifen) or some other estrogen inhibitor when undergoing MHT. Before prescribing hormones for hot flashes alone, some doctors first advise women to seek relief with antidepressants, herbs such as black cohosh or a soy-rich diet.
According to NAMS, how good a woman feels after having her uterus and ovaries removed depends on several factors, including whether they have MHT. Those who were depressed or had sexual difficulties before surgery may see those conditions worsen. Women who enjoyed satisfactory well-being and sexuality before surgery, however, may actually experience improvement in those areas, especially if they have hormone therapy.
While some women report weight gain after hysterectomy and oophorectomy, Lamar is pleased she headed that off by working out and cutting back on her portions. She’s lost 15 pounds since her medical procedures and says her surgery has inspired her to focus on healthy living.
“I think it was a chance for me to look at my life and say, OK, you’re approaching 50,” Lamar says. It’s time to start taking really good care of yourself.
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