Surgically Induced Menopause

Nov 01

Women stop menstruating permanently when they reach menopause. Natural menopause has three phases— perimeopause, menopause and post-menopause. In some cases, however, women do not always undergo natural menopause. Menopause can be induced by various medical treatments— surgery, chemotherapy, radiation therapy, etc.

Of these, surgical menopause refers to, and occurs because of, the removal of both ovaries, before the natural onset of menopause. (If the ovaries are removed after natural menopause has begun, of course there will be no real difference felt.) When the ovaries are removed surgically by bilateral oophorectomy, or damaged by radiation or chemotherapy, the effect is called surgical menopause. Surgical menopause, obviously, makes women lose their fertility, and thus causes premature menopause.

Surgical menopause, being an induced condition rather than a natural one, puts an abrupt end to the production of the ovarian hormones. This causes the symptoms of menopause, such as vaginal dryness, hot flashes, reduced sex drive, to appear. It also increases the risk of osteoporosis and heart attack, as the individual must go a longer time without the benefit of estrogen.

Bilateral oophorectomy, which causes surgical menopause, is carried out on women suffering from ovarian, cervical and endometrical cancer. It may also be carried out as a treatment for infections, uterine fibroids and endometriosis. Hysterectomy which does not involve removal of ovaries, does not cause the onset of surgical menopause—that is caused only by hysterectomy with bilateral oophorectomy.

Various surgeries involve the removal of both ovaries:

Abdominal Resection: This normally involves the removal of the lower portion of the colon and rectum; however, it can also involve the removal of both ovaries, the uterus, and part or whole of the rear vaginal wall. This is done to treat cancer of the rectum and colon.

Total Pelvic Exenteration: This occurs in case of cervical cancer and most of the pelvic organs—uterus, vagina, ovaries, bladder, urethra, fallopian tubes, etc.—are operated on.

Unlike natural menopause, surgical menopause is sudden—a woman can have a period one day, and the next, after having her ovaries removed, can become menopausal. Natural menopause, on the other hand, is gradual. Because of the absence of perimenopause, the symptoms of menopause—hot flashes, insomnia, tiredness, vaginal dryness—are all far more severe in surgical menopause than in natural menopause.

Patients undergoing surgical menopause are often given estrogen to prevent hot flashes soon after the surgery. Women with high risk of cardiovascular arrest, however, are advised to avoid taking estrogen. As an alternative, herbal therapy with Black Cohosh is often recommended. Patients of surgical menopause should not, however, ingest progestin.

Estrogen Replacement Therapy (ERT) is a method by means of which one can check the effects of surgical menopause, like insomnia, vaginal dryness and hot flashes. This therapy also prevents the onset of osteoporosis and greatly reduces the risk of heart diseases. However, the regular use of ERT increases the danger of endometrial cancer. Estrogen should be taken in combination with progesterone, as this decreases the risk of endometrial cancer.