Menopause can be a significant life event for many, bringing a mix of challenges, questions, and changes. For those who have undergone a hysterectomy, this phase can feel even more complex, adding layers of adjustment.
A hysterectomy is a major operation, and its impact isn’t always straightforward. This procedure carries its own risks and considerations. Whether you’re preparing for surgery or navigating its aftermath, understanding what lies ahead can ease your concerns and help you make informed choices.
The different types of hysterectomy operation
- Subtotal Hysterectomy: The uterus (womb) is removed, but the cervix remains intact.
- Total Hysterectomy: Involves the removal of both the uterus (womb) and cervix. If the ovaries and fallopian tubes are also removed this is known as a Total Hysterectomy with Bilateral Salpingo-oophrectomy.
- Radical Hysterectomy: A more extensive operation that includes removing the uterus, cervix, and the upper part of the vagina. This is usually carried out due to cancer and may also involve the removal of the ovaries, fallopian tubes and nearby lymph nodes.
A hysterectomy can be life-changing and may be carried out for women facing conditions such as:
- Fibroids (noncancerous growths in the uterus)
- Uterine prolapse (when the uterus or other pelvic organs protrude out of place)
- Unusual or heavy menstrual bleeding
- Early detection or treatment of cancer (1)
Each year, more than 100,000 women in the UK undergo a hysterectomy (2, 3). Approximately half of these include removal of the ovaries, which can profoundly affect hormonal levels (4, 5). For many, this surgery occurs during premenopausal years, with the highest number in women aged 40 to 44.
If you’ve recently undergone this procedure or are considering it, it’s natural to wonder: What will the consequences be? How will it affect my body, my hormones, and my sense of self?
These are deeply personal questions, and while the answers may not always be simple, they are within reach. In this article, we’ll walk through what you can expect after a hysterectomy, explore the differences between natural and surgical menopause, and share strategies for navigating this journey with care and confidence.
Do you go through menopause after a hysterectomy?
The answer isn’t always straightforward: it depends on whether your ovaries were removed during the procedure.Hysterectomy with ovaries removed
If your ovaries are removed during the hysterectomy, you will experience what is known as surgical menopause. This occurs regardless of your age at the time of surgery. Because the body’s primary source of oestrogen is removed, menopause symptoms can appear suddenly and may be more intense than in natural menopause.
Common symptoms of surgical menopause include (6):
- Hot flushes: Sudden waves of heat that can be intense and frequent.
- Mood swings: Emotional changes like irritability, sadness, or anxiety.
- Memory changes: Some women report difficulties with focus or memory.
- Bladder issues: Challenges with continence can also arise.
- Sleep issues: Trouble falling or staying asleep.
- Vaginal dryness: Discomfort or itchiness, which may lead to painful intercourse (3).
Studies show that these symptoms may last longer and feel more pronounced for women who enter surgical menopause compared to those going through natural menopause (6, 7).
Hysterectomy with ovaries preserved
When your ovaries are left intact, they can continue producing hormones, meaning you won’t enter menopause immediately. However, you will no longer experience menstrual periods since the uterus has been removed and premenstrual symptoms (PMS) may still happen.
That being said, research suggests that women who keep their ovaries after a hysterectomy are still likely to experience menopause earlier than they would have otherwise. This may be due to changes in blood flow to the ovaries caused by the surgery (2).
When they occur, the symptoms of menopause for those with ovaries intact after a hysterectomy will be similar to natural menopause.
It is important to be aware of these symptoms and to seek medical support if you experience them. You won’t have the common symptoms of a change in your periods to help guide when your menopause is happening.
Remember that menopause symptoms vary greatly from woman to woman. Your experience will be unique to you, and knowing what to expect can help you navigate this transition with greater confidence. Book a consultation with one of our dedicated menopause specialists for personalised guidance and support.
What are the benefits and effects of having a hysterectomy?
Benefits of a hysterectomy
- Pain relief: Many women report improvement in pelvic pain, back pain, and urinary symptoms after a hysterectomy, whether it was total or subtotal (8).
- Bleeding cessation: If you have been experiencing heavy bleeding, this will stop following a hysterectomy.
- If ovaries are removed during the hysterectomy, this reduces the risk of ovarian cancer.
Impact of a hysterectomy
While the benefits are clear, it’s important to understand the potential effects:
- Hot flushes and hormonal changes: Even if your ovaries are preserved, some women experience hot flushes due to hormonal fluctuations and reduced blood flow to the ovaries after surgery (9).
- Sexual function: Recent studies suggest that sexual function is not significantly impacted for most women (10). However, this may depend upon whether or not the ovaries have been removed. When we talk about sexual satisfaction women who have their ovaries removed report a greater negative impact compared to those who retain their ovaries (11). This is probably because ovaries are linked to testosterone production (and ovaries produce half of the testosterone in premenopausal women), which plays a role in libido, arousal, and orgasm (12, 13). This hormonal shift may lead to vaginal dryness, which also is linked with reduced sexual satisfaction. Lubricants and vaginal moisturisers can provide significant relief and enhance comfort.
Individual experiences
Sexual response and overall well-being after a hysterectomy are highly individual and can be influenced by:
- Pre-existing health conditions
- The reasons for the hysterectomy
- Mental health
- Relationship dynamics
- The type of surgery and whether the ovaries were removed or remained
It’s also not uncommon to feel low in mood after surgery, as the physical and emotional adjustments can be overwhelming. If you have had your ovaries removed, the sudden hormonal changes, coupled with the emotional weight of the procedure, can contribute to feelings of sadness or anxiety (14). Support from your doctor or nurse, counselling or connecting with support groups can often help in managing these emotions and finding a sense of balance.
Long-term risks
For those who undergo a surgical menopause, where ovaries are removed alongside the hysterectomy, particularly before the age of 45, there are increased risks to consider:
- Cardiovascular disease: The loss of oestrogen is associated with a higher risk of heart disease (15).
- Osteoporosis: Reduced oestrogen levels can result in thinning of the bones over time.
- Cognitive and psycho-sexual health: Some studies have suggested that an early surgical menopause may be linked to cognitive dysfunction, including a higher risk of dementia, as well as challenges with sexual health (16).
Come talk to our menopause care team if you feel worried or want to know more about what to expect. Our doctors are experts at guiding you through potential challenges and can help make a difference in your recovery and overall well-being.
Ways to manage menopause symptoms after a hysterectomy
Managing menopause symptoms after a hysterectomy, whether due to surgical or natural menopause, is possible with the right strategies and support.
Hormone Replacement Therapy (HRT) for menopause symptoms after a hysterectomy
HRT is particularly beneficial for managing the sudden onset of surgical menopause:
- Counterbalancing hormone loss: Especially when ovaries are removed, HRT can alleviate symptoms like hot flushes and mood swings (6).
- Improving sexual health: HRT may help address vaginal dryness and improve sexual function (12).
- Protecting bone and heart health: Oestrogen-only HRT is shown to support bone density and reduce cardiovascular risks (3).
HRT is important, but lifestyle adjustments like maintaining a balanced diet, regular exercise, and managing stress can also complement treatment effectively.
Types of HRT to explore
For women undergoing hysterectomy, the choice of HRT depends on individual circumstances. It comes with its own risks and benefits.
- Oestrogen-Only HRT: Typically recommended for women without a uterus, as there’s no need for progestogen to protect against Endometrial cancer.
- Combination HRT: May be recommended in specific cases where it is important to add progestogen, for example if there is a history of endometriosis (7).
- Testosterone Supplementation: seems to improve sexual function and mental well-being. However, these findings should be interpreted cautiously, as they are based on small sample sizes and have limitations (4, 13, 14).
Discussing your options with your doctor or nurse is crucial, as less than 50% of women with surgical menopause currently receive oestrogen therapy. Advocating for yourself can ensure you get the care you need.
Long-term use of HRT after a hysterectomy
There is a lack of clear guidelines regarding how long women can safely take HRT.
Studies show HRT’s positive effects on bone and cardiovascular health, as well as overall quality of life for postmenopausal women, even taken for a long time (17). However, combined estrogen-progestogen HRT may increase certain risks, such as breast cancer, depending on personal and family medical history (3).
Your doctor will guide you on the appropriate type and duration of HRT based on your medical history, the type of hysterectomy performed, and any underlying conditions.
Getting support for menopause symptoms after surgery
While the challenges may seem overwhelming at times, understanding your options after hysterectomy—from hormone replacement therapy to tailored medical advice—can make a difference on your well-being. Remember, support is always available, and with the right care, it’s possible to manage symptoms and maintain a fulfilling quality of life. If you have questions or need guidance, reach out to your doctor or our dedicated menopause care team.
¹Hysterectomy and the Menopause NHS, Liverpool Women’s, NHS Foundation Trust.
²Effect of hysterectomy with ovarian preservation on ovarian function Moorman et al. (December 2011)
³Should the ovaries be removed or retained at the time of hysterectomy for benign disease? Hickey et al. (March 2010)
⁴Sex, hormones, and hysterectomies Guzick and Hoeger (September 2000)
⁵The future of hysterectomy Garry (February 2005)
⁶⁷Options for hormone therapy in women who have had a hysterectomy Haney and Wild (May 2007)
⁸Hysterectomy Clayton (January 2006)
⁹¹⁰Hysterectomy and sexual function: A systematic review and meta-analysis Dedden et al. (March 2023)
¹¹Psychological reactions and sexual life after hysterectomy with and without oophorectomy Nathorst-Böös and von Schoultz (February 1992)
¹²Hysterectomy and sexual function Mokate et al. (December 2006)
¹³Androgen deficiency in the oophorectomized woman Shifren (April 2002)
¹⁴¹⁵Increased cardiovascular mortality after early bilateral oophorectomy Rivera et al. (January 2009)
¹⁶Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause Rocca et al. (September 2007).
