Hysterectomy and menopause

A hysterectomy is an operation to remove the womb. The NHS website says that if you had not already been through menopause, your periods stop after it, whatever your age, and you can no longer get pregnant.

The NHS website lists several kinds: total (womb and cervix removed, the most common), subtotal (the cervix left in place), total with the fallopian tubes and ovaries removed too, and radical, which also takes the surrounding tissue.

For menopause, the question that matters is the ovaries. Women's Health Concern explains that through your fertile years your ovaries make estrogen. The womb is where a period comes from. The ovaries are where the hormones come from.

If your ovaries were removed

You go into menopause straight after the operation. This is surgical menopause, and it has its own page.

If your ovaries were kept

Your periods stop, but your ovaries carry on working until they wind down on their own. The NHS website says there is a chance this happens sooner than it would have without the operation. Because there are no periods to watch, the start of perimenopause is easy to miss.

The symptoms are the same as any menopause: hot flushes, night sweats, broken sleep, mood changes, an aching body. What is missing is the period clue that would tell you why.

If your ovaries were removed, the NHS website says you will usually have severe menopausal symptoms after the operation, and that vaginal dryness is more likely if you are not taking HRT.

The NHS website also says some women feel a sense of loss after a hysterectomy, particularly if they had not been through menopause and can no longer have children. Some feel less "womanly". It notes that a hysterectomy can sometimes trigger depression.

Diagnosis goes on symptoms

NICE NG23 and the Pakistan Menopause Society agree: after a hysterectomy, menopause is recognised from the type and combination of your symptoms, hot flushes and sweats especially. Women's Health Concern adds that blood tests may be used, because periods are no longer a guide. See is there a test?

The researchers behind the STRAW+10 staging system say women who have had a hysterectomy cannot be staged by bleeding at all. They recommend waiting at least three months after surgery before testing hormones, because pelvic surgery can raise them for a while, and say a single result can mislead, so a repeat test is often needed.

Using Where am I?

On Where am I?, choose "I cannot tell" for the question about your periods. It will not name a stage then; your result works from your age and symptoms instead, which is what a doctor would go on.

The NHS website says that if you have a surgical menopause after a hysterectomy, you should be offered HRT.

Which kind depends on what was removed. The Pakistan Menopause Society says estrogen-only HRT suits women who have had a hysterectomy, while women with a womb need a progestogen as well. The British Menopause Society adds two exceptions to raise with your doctor. After a subtotal hysterectomy some womb lining may remain, and it suggests checking for this before settling on estrogen alone. After a hysterectomy for widespread endometriosis, it advises combined HRT. The choice is your doctor's to make with you.

Before surgery, ask what will happen to your ovaries and your hormones. The Menopause Society recommends keeping the ovaries when the womb is removed for a reason other than cancer, in women who have not reached menopause and have an average risk of ovarian cancer. The Asia-Pacific Menopause Federation says the same. NICE NG23 recommends that women likely to go through menopause because of surgery are given support and information about menopause and fertility, before and after the operation (1.2.6).

After it, book an appointment if hot flushes, sleep problems or mood changes start, even years later. The NHS website says to see a GP if low feelings after a hysterectomy will not go away.

For some women the hardest part is not the hormones but what the operation means at home. In families where a woman's worth gets tied to children, losing the womb can bring comments that sting.

The NHS website says talking to other women who have had a hysterectomy can help, and that your GP or hospital may know of a support group.