Hysterectomy and Menopause, How Will I know?

Ask Dr. Jen

I am a 57 year old female who had a hysterectomy 17 years ago. My doctor says that my hormone levels do not indicate that I am in menopause. I find that hard to believe.

-Instagram

Short Take

You are almost certainly menopausal and blood work to tell whether you are or are not is not indicated.

Tell Me More

Menopause starts with the final menstrual period or FMP. As you can’t tell if it is your final period until some time has passed so you are sure it is your final one, medically we say menopause has occurred when you are one year from your final menstrual period. 

Okay, that’s great, but what if you have had a hysterectomy?

Honestly, if you are over the age of 40 being precise about the age of menopause doesn’t matter. Medically there are only two reasons we need to know the date of your final menstrual period:

• If you need contraception

• To decide how to investigate uterine bleeding, because when this happens after menopause the risk of cancer increases.

Neither of these situations are applicable to someone who has had a hysterectomy!

Many symptoms of menopause, such as hot flushes/hot flashes, night sweats, and vaginal dryness, can start before the final menstrual period in what we in medicine call the menopause transition. But you may have also heard this referred to as perimenopause or premenopause. Treatment for those symptoms, should they be bothersome, has nothing to do with whether you are menopausal, meaning they are more than one year from your final menstrual period, or not. Treatment is based on whether you are bothered, not your period.

The average age of menopause is 51 years and in the SWAN study the latest age of menopause was 56 years. While there are always outliers, for example there is a documented pregnancy and delivery at age 59 (I know right??), the likelihood of you being an outlier at age 57 is very low. Like very, very low. Especially as you have had a hysterectomy, which we know slightly lowers the age of menopause. The hypothesis here is that the inflammation from the surgery has a negative impact on ovarian function.

While it’s true that an earlier age of menopause is associated with more risks, for example a greater risk of osteoporosis or dementia, knowing if your menopause was at 48 or 52, something you can’t know if you have had a hysterectomy, doesn’t change how we screen you for these conditions. If menopause is before the age of 40 that is different, but as your hysterectomy was age 40 that doesn’t apply here.

What if you had a hysterectomy and your menopause happens between the ages of 40 and 45? At this age we typically recommend menopausal hormone therapy until at least the age of 45 as it lowers the risk of complications related to an earlier menopause, but how would we know? For someone in this age range we would use our best guess based on symptoms and what your periods were like leading up to the hysterectomy. We might also do blood work, but it’s important to understand the limitations here as blood work is often not definitive. There is a lot of shared decision making here. If you want to know more about the limitations of blood work for diagnosing menopause, I recommend reading more about in it The Menopause Manifesto.

And one more thing, blood tests should not be used to diagnose menopause for women ages 45 or older. So if your doctor says, “let’s check your hormones to see where you are” and you are 45 or older, I’d get another opinion.