Whilst we’d probably all like to think we can age naturally and gradually (even gracefully!) that’s not going to be the path for all of us. I had never even heard of surgical menopause. That was until I was offered it after my cancer of the breast diagnosis as a treatment to minimize estrogen produced by my body.
It involves (amongst other things) removal of the ovaries under general anaestheic in a shortish operation in hospital. As it turns out, surgical menopause is rather like a double-edged sword. There are evident benefits and intended side effects. However, being plunged into sudden menopause, with the many and varied menopausal symptoms that brings with it, is an experience to behold! These days, I strive to continue the ageing process gracefully, having now “teleported“ through menopause!
Other names for surgical menopause
Surgical menopause is referred to by other terms also including:
- medically induced menopause
- induced menopause
- medical menopause
- surgically induced menopause
- surgery induced menopause
- forced menopause
What is Surgical Menopause
You will likely know that menopause is the ending of menstruation in women. When experienced naturally, generally anywhere in the average age region of 40 – 51, it is usually a gradual process. Natural menopause is referred to in three stages:
- perimenopause (pre-menopause),
- menopause, and
So, a woman generally has time to adjust to changes in her body and emotions. It’s the end of child-bearing years, so can have notable emotional effects on some of us!
Removal of the ovaries
Surgical menopause is the term used when a woman has her ovaries removed surgically. Further, Oophorectomy is the term used to describe the bilateral (both sides) removal of a woman’s ovaries. The ovaries are the main source of estrogen production in the female body. So, their removal will trigger menopause.
If a woman is around the age when menopause would naturally occur, as it was for me, this is one thing. However, in the case of a younger woman, menopause will also be the result. Depending upon the person, this may not be such an easy path to navigate. We’ll discuss this further in a moment.
Why is Surgical Menopause Performed?
It doesn’t sound like much fun – so why would we opt for an induced and early menopause? There are a few reasons why a bilateral oophorectomy menopause causing surgery would be offered. Reasons may be:
- ovarian cysts,
- uterine fibroids,
- heavy menstrual bleeding or
Commonly, bilateral oophorectomy is performed because of cervical, uterine and ovarian cancer. In addition, and relevant to this type of women’s cancer, surgical menopause is a treatment for reducing the chance of spread or reoccurrence of cancer of the breast.
Induced Menopause to Reduce Estrogen After Breast Cancer
Why would we opt to have our ovaries removed after this cancer diagnosis?
Around 70 to 80 per cent of cancers of the breast are sensitive to the female sex hormone estrogen. This is termed “ER-positive” and means that the cancer cells grow in the presence of the hormone, estrogen.
How is the ER-positive status determined?
In the process of diagnosing cancer of the breast, cells of the suspect lump are taken. These are tested and the responsivity of the cancer cells to estrogen – and other factors – are determined.
Diagnosis to treatment
Consequently, if a diagnosis of ER-positive cancer is determined, then it makes sense to consider ways of reducing estrogen in the body. One of these ways is to have the ovaries taken out as part of treatment. When carried out by laparoscopic surgery, it’s a relatively quick and straightforward procedure. Of course, all surgical procedures come with some risk, so it’s not something to be blasé about.
For me, as my cancerous lump was shown to be ER-positive, it was an easy decision to have my ovaries removed as a part of my treatment. I also opted to have my fallopian tubes removed. My husband had observed a work colleague accompany his wife on her worrying ovarian cancer journey. And so he felt reassured that my having both my ovaries and fallopian tubes removed minimized my chances of having that additional type of cancer being an issue in my lifetime. Having just turned 50 myself, natural menopause wasn’t far away. So, I felt I had little to lose. For younger women with a cancer of the breast diagnosis, however, the decision is clearly a significantly more complex one.
Menopause After Oophorectomy
Clearly there is a benefit of surgical menopause for some women. Removing the ovaries and experiencing surgical menopause can be lifesaving if it inhibits growth of any cancerous cells in the body. But menopause after oophorectomy is ‘full on’! None of this ageing gradually and naturally in this situation!
Menopausal symptoms arrive in a rush. Hot flashes, stiff joints and osteoporosis-like aches are typical symptoms.
Unfortunately, menopause after oophorectomy increases a woman’s risk for osteoporotic fracture and coronary heart disease (CHD). Surgical menopause also carries a number of side effects beyond those of menopause, including
- loss of bone density
- low libido
- vaginal dryness
So, if surgical menopause is something you are considering, here’s my suggestion. Asking lots of questions and finding out as much as you can – before the fact – is advisable. I confess that although I was advised about ‘hot flushes’, I did not know half of it. The level of discomfort I was to experience from stiff joints and osteoarthritis type symptoms was surprising. I know I would still have made the same decision, though. Because, the peace of mind to ward off ER-positive cancers re-growing is worth the discomfort and inconvenience.
Taking good care of ourselves after medical treatment like this is even more important than ever. Of course, your medical advisors will be sure to tell you what is right for your particular situation.
In my case, I try to be active and walk a lot and stretch to soothe stiff joints and tight feeling arms and legs. I’m quite consistent with my walking and would really like to take up yoga (again) when I can work out how to schedule it into my lifestyle!
Effects of surgical menopause you may not be told about
What our medical advisors probably won’t tell us when they are making recommendations to save our lives from cancer is the possible cognitive side effects resulting from treatments like surgical menopause. In my research I was alarmed to read:
“Accumulating evidence suggests that earlier menopausal transition may accelerate biological aging among women and subsequently contribute to a higher risk of late-life multimorbidity including cognitive decline. This has raised the hypothesis that surgical removal of ovaries in premenopausal women might lead to long-term health consequences that have been underestimated.”
But let’s not panic yet
However I was pleased to also read in an article titled “Menopausal Brain Fog Really Does Exist” (Source: https://www.livescience.com/26313-menopause-and-memory-problems.html) reports from other research studies carried out that researchers found no link between a woman’s age at surgical menopause and diseases such as dementia and Alzheimer’s disease.
Well, thank goodness for that.
So, adding to my recommendations is to work on a positive mindset with continual personal development on how the brain works and how to keep it productively occupied. Mindfulness and meditation as well as physical health is essential, in my experience.
Estrogen After Breast Cancer
In addition to surgical menopause to reduce estrogen in the body of a woman diagnosed with ER-positive cancer of the breast, there are other treatments available. The growth of cancer can be minimized by taking drugs that block the production and action of estrogens in the breasts. This is called hormone or endocrine therapy. Therapy typically takes the form of medications prescribed to a woman for a period of time after initial treatment for the cancer. Because hormone therapy can reach cancer cells almost anywhere in the body – not just the breast – it’s recommended for women with ER-positive breast cancer.
Of course, adding in hormone therapy to ensure suppression of estrogen compounds the effects of menopause. But, no one ever said getting cancer was a joy, did they!
Surgical Menopause Support Groups
In my case, menopause was just over the horizon, so speeding things up a bit did not cause me too much emotional anguish. I have three wonderful sons and a full and happy life. I know I am blessed. So, the ending of my child-bearing years did not cause me too much additional distress than realizing my third son was my last child!
However, consider the case of younger women receiving endocrine therapy. With the menstrual cycle disrupted during child-bearing years the emotional impact can be significantly higher. The decisions a woman faces will be more complex.
Treatment of pre-menopausal women is more complex than during menopause, or post menopause, in my understanding. It warrants further discussion in another article.
In the meantime, for women not yet having gone through menopause and facing breast cancer and hormone treatment, the following surgical menopause support group options are available.