What is Surgical Menopause and How Do I Cope?
I’m Melanie, I’m Gen X, and I’m in medically-induced menopause. Are you ready for this? I had a laparoscopic hysterectomy with bilateral salpingooophorectomy. Look it up. It’s a thing. I no longer have a uterus, cervix, Fallopian tubes, or ovaries. Go big or go home. Bonus points for using robots. Now I’m just collecting dust and going through menopause with a touch of mid-life crisis. It’s a hoot.
Like most Gen Xers, I’d had some perimenopause symptoms--most notably extreme periods. We’re talking crime-scene level. Quentin Tarantino could take notes from me. I could actually feel a little dam breaking and knew a clot had worked its way loose and all bets were off. I didn’t leave the house because there was no guarantee the tampon or pad (or sometimes both) wouldn’t give out. Not ideal when wearing shorts or at the gym (ask me how I know). This, paired with endometriosis, fibroids, and a cyst, made me a great candidate for surgical menopause.
If you’re considering any type of hysterectomy or surgical menopause option, there are some important things you need to discuss with your doctor. My doctor and I spent quite a bit of time talking about what was right for me based on my symptoms, age, other options (e.g., ablation), and recovery time. Surgery shouldn’t be taken lightly no matter how fun I make it sound.
I didn’t have a lot of pain or bleeding after my surgery (your mileage may vary), but I did start having hot flashes every fifteen minutes (yes, I timed them); they eventually subsided. I still get them, and they suck, but they’re not consistent. Even so, my husband is a little tired of me saying loudly, “OH MY GOD! TURN ON THE AIR CONDITIONER! WHY IS IT SO HOT IN HERE? ARE YOU DOING THE FROG IN A POT EXPERIMENT? BECAUSE I’M ON TO YOU!”
I know I’m not Melanie Nelson, First of Her Name to Go Through Menopause, so I talked to a professional, Dr. Sheila Goldsworthy, MD, FACOG (Fellow of the College of Obstetrics and Gynecology), to clarify a few things about hysterectomies, HRT, and general life stuff you should expect after THE CHANGE.
A few things to know:
- Hysterectomy: Removal of the uterus
- Total hysterectomy: Removal of the entire uterus and the cervix
- Oophorectomy: Removal of the ovaries--this is a separate procedure from a hysterectomy, but can be done at the same time; if you do this, you’re going into menopause immediately
- Salpingooophorectomy: The mother of them all--everything gone and immediate menopause
Dr. Goldsworthy says “Surgical menopause (removing the ovaries) is like jumping off a cliff if you are premenopausal. All hormones gone, all at once.”
So what about hormone replacement therapy (HRT)? “For most women, the risks and the benefits end up as a wash, so it comes down to quality of life. Are you sleeping or not? Are you burning up at inconvenient times? Mental fog? Sex drive? If these symptoms are disruptive enough to get a prescription then yes, by all means take some hormones...For women having their ovaries removed premenopause, I suggest they consider taking HRT until the early 50s, when they would have gone through menopause anyway. But some don’t need anything. We just watch their bones then,” she says. Take your calcium, ladies.
If you’re having a hysterectomy, you shouldn’t necessarily expect big hormone changes. Having said that, your ovaries are definitely going to be in shock, but they almost always go back to normal. So if you’re still having PMS and mood swings, that’s normal, but at least you’re not bleeding. Go ahead, buy the white pants.
OK, that’s all well and fine. Monthly pain and crime-scene periods are a thing of the past. BUT. I wasn’t prepared for what came next. While I was absolutely on board with the salpingooophorectomy, I had no idea how my body was going to change. Cue poochy tummy (some people call it swelly belly) and weight gain. It’s a year later, and I still can’t get my old body back. (Still better than the Stage 4 endometriosis and absurd periods, so I’ve got that going for me, which is nice.) But for reals, what’s the deal?
“Intestines are sluggish and gas gets trapped,” says Dr. Goldsworthy. “But longer lasting pooches are actually most commonly related to anterior pelvic tilt and high tone pelvic floor dysfunction. Your intestines are intended to sit in the pelvic bowl. If the pelvic floor is tense (a common response to pelvic surgery) and/or the pelvis is tilted forward, the intestines spill out and make the pooch. Also, if the pelvic floor is tense, the transverse abdominus goes “offline” so the normal muscular support is not there to “hold it in” so to speak. Low back pain, pain with sex, constipation, urinary urgency and/or incontience are all other symptoms that go with this. Kegels make it worse.
“Other things that can cause belly swelling would be dietary, but if exercise is a trigger, your pelvic floor is probably out of sync...I often suggest that my patients see a pelvic floor PT after they have recovered from surgery (the six-week mark) to have an assessment of pelvic floor function and teach them to manage intra-abdominal pressure (to prevent future prolapse).”
Please, if you’re considering removing any of your lady parts, have a frank discussion with your gynecologist. A few things to ask:
- Which surgery, exactly, are you going for and why?
- How will that surgery affect hormones and will they rebound?
- Is HRT something you need to consider? What are the pros and cons?
- How will your body change and how will it recover?
- Will the doctor prescribe physical therapy as part of the healing process?
- If you have an autoimmune issue (e.g., Hashimoto’s), how will your surgery affect it?
- How long is the recovery period and what does it look like?
Many thanks to Dr. Goldsworthy for her time and for answering all of my questions. Things make so much more sense now.
I’d love to chat more, but I have to call my PT.