Menopause After Your Hysterectomy

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Q: I'm a 50-year-old woman who had a sub-total hysterectomy 10 years ago due to fibroid tumors in the uterus. The doctor left the ovaries intact to allow my body to go through menopause naturally, without the need for supplemental hormones. The thing is, I don't have a menstrual cycle and I'm having hot flashes and night sweats. How can I tell if I'm menopausal and what can I do to naturally alleviate my night sweats and hot flashes?

A: Menopause is usually diagnosed "after the fact," when a woman has not had a menstrual period for 12 months. However, since you had a hysterectomy at age 40, this is not an option. Instead, a blood test known as a follicle stimulating hormone (or FSH) test may be used in conjunction with your symptoms to better assess whether you are transitioning into menopause. That said, there might be other reasons for hot flashes and night sweats and it's best to speak with your personal physician.

What's a hysterectomy?

A hysterectomy is a surgical procedure to remove a woman's uterus. It is usually performed after non-invasive (medication, hormone therapy) or less-invasive alternatives (ablation, myomectomy, nerve block) have failed in their attempt to provide relief for health concerns such as uterine fibroids, endometriosis, persistent pain and bleeding. There are three main types of hysterectomies:

Total hysterectomy—removes the uterus and cervix, whereas a total hysterectomy with a salpingo-oophorectomy removes the uterus and cervix in addition to the ovaries and fallopian tubes.
Subtotal or "partial" hysterectomy—removes the uterus while leaving the cervix in place and the ovaries intact.
Radical hysterectomy—removes the uterus and its supporting structures, as well as the cervix, ovaries and possibly the lymph nodes. This type of procedure is more common in those with cancer of the uterus, ovaries or cervix.

Menopausal symptoms

Menopause occurs when a woman's ovaries no longer contain functioning eggs. As a result, there is a drop off in her hormonal levels of estrogen and testosterone. While many women experience few if any symptoms, others may relate changes to their mental and/or physical well-being. These may include but are not limited to one or more of the following symptoms:

Hot flashes or flushes of heat that last 30 seconds to several minutes at a time. They seem to flare out of the blue and often cause a feeling of warmth throughout the body. A red skin flush followed by perspiration may occur. While some women in their perimenopausal years experience these "flashes," it's more common around menopause and usually stops within five years (but may last up to 10 years) of the transition.
Vaginal dryness, itching or pain that may be most pronounced during sexual intercourse
Increased frequency of urinary tract infections due to the changes in the thinning tissues lining the urethra (the tube from the bladder that drains out when urinating) and vagina
Increased risk for urinary incontinence
Increased irritability and fatigue, rapid changes in mood
Difficulty falling or staying asleep, possibly due to night sweats, anxiety or depression
Cosmetic changes such as increased body fat and decreased muscle mass, a thicker waist and dry skin
Decreased libido (sex drive)

Additionally, if you have reached the perimenopausal or menopausal years, it is important to speak with your physician regarding measures to take that will decrease your risk for other medical concerns such as osteoporosis, high cholesterol and heart disease.

A time for change

Even though most women reach menopause between 48–55 years of age (the average is 51), there are a variety of factors that may stimulate an early start to this transition. These include but aren't limited to the following:

Your state of health (autoimmune disorders that may cause premature ovarian failure; hormonal concerns; cancer)
Smoking of tobacco
Family history of early or late menopause
Radiation therapy and/or chemotherapy
Surgical history (potential complications from abdominal or pelvic procedures, oophorectomy and total hysterectomy, etc.)
Eating disorders leading to poor nutrition and/or underweight

Since your ovaries were left in place after your surgery, your doctor will review the previously mentioned symptoms and risk factors for early menopause. Additionally, certain blood tests may be suggested that will help to determine whether you are reaching the time of your transition. While no one test is perfect, high levels of the FSH test may help to determine your transition into menopause. However, note this caveat: If you have not yet reached menopause and are in your perimenopausal years, the FSH levels may fluctuate from day to day in relation to your estrogen levels. In this case the FSH test would need to be repeated over time.

Other tests that may be suggested include an estradiol level (a type of estrogen that decreases in menopause) as well as a thyroid stimulating hormone (TSH). This last one is also important as thyroid disorders may trigger some symptoms (lack of or decreased frequency of menstrual periods; changes in mood or energy levels; heart palpitations; increased sweating; etc.) experienced during menopause.

Natural approaches to menopausal symptoms

While there are traditional medications (hormone therapy with creams, patches, pills, etc.) for the management of menopausal symptoms, there are also many natural and integrative approaches (used in conjunction with traditional ones) to boost your mental and physical well-being. These may include the following:

Regular exercise to boost your mood, muscle strength, and libido, and improve heart and bone health, while decreasing the risk for weight gain
Yoga and/or tai chi and Pilates to increase flexibility and improve memory and concentration
Kegel exercises to enhance sexual enjoyment and decrease the risk for urinary stress incontinence
A well-balanced diet including fish high in omega-3 fatty acids (salmon, sardines), fruits, whole grains and vegetables
Drinking adequate amounts of water while limiting caffeinated and sugary drinks
Avoidance of tobacco products and limiting alcohol intake
Social interaction including volunteerism, interacting with friends, re-engaging in hobbies
Stress reduction through activities such as reconnecting with spiritual beliefs, talking walks in nature, etc.
Keeping the mind active by learning new subjects (such as a new language), reading, and doing puzzles

Additionally, supplements including calcium, vitamin D, black cohosh (though note this is not regulated by the FDA) and vaginal lubricants may provide relief, but should first be discussed with your physician to see if they would be safe and beneficial. Also, acupuncture, meditation techniques, biofeedback and deep breathing exercises have been found to be helpful for some of the symptoms that may occur during this time.

Lastly, it's important to know that your night sweats and hot flashes may be the sign of a more serious medical concern and should be discussed with your physician.

For further information, please visit the American Academy of Family Physicians and the Red Hot Mommas.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)