Hysterectomy and Menopause: Midi’s Guide to Recovery and Wellness

At my 6-week follow-up appointment after having a hysterectomy, I joked with my surgeon that I want a T-shirt that says, “Ask me about my hysterectomy!” Partly it’s because, just 2 weeks post-op, I felt better than I had in years. 

But the other reason I want to talk about my hysterectomy—a procedure so common that 1 in 3 women will have one by the time they’re 60 years old—is because there’s so much confusion about what a hysterectomy entails and what to expect after you’ve had one. In fact, the first response I get when I share my new, no-uterus status usually goes something like this: “Oh no, that means you’re in menopause. How’s that going for you?”

While hysterectomy and menopause do often go hand in hand, the connection is more nuanced than many people realize. 

I had a hysterectomy to treat the heavy bleeding I was experiencing due to fibroids, but I’m not in menopause. Though I had my uterus, cervix, and fallopian tubes removed, my ovaries were left in place. (The medical term for this is called a total hysterectomy with bilateral salpingectomy.) Because the ovaries make estrogen—and I was 45 years old and still getting regular periods before my hysterectomy, which is a sign my ovaries were still pumping out hormones—I should go through menopause around the same time as I would have had I not had a hysterectomy.

It feels important to repeat this fact: Immediately going into menopause after total hysterectomy isn’t inevitable. In fact, if you still have your ovaries after a hysterectomy, you’ll likely still ovulate and experience symptoms of PMS, says Rebecca Yee, MD, an obstetrician gynecologist in San Francisco, and clinician advisor at Midi Health. 

That said, some research shows that menopause may happen a few years earlier for women who undergo a hysterectomy, possibly due to reduced blood flow to the ovaries post-procedure. (More on that below.)

The bottom line: The better we understand what a hysterectomy is, what it can involve (Spoiler: It’s not the same for everyone!) and what that means for our health and hormone status after the procedure, the better we can support ourselves and other women in our lives who undergo this common surgery. 

Consider this your comprehensive guide to understanding the connection between hysterectomy and menopause, as well as what you need to know to recover well and optimize your health after the procedure.

What Is a Hysterectomy?

Most of us probably know that a hysterectomy involves removing our reproductive organs, but we may not be so clear on exactly which ones. Here, we’re going to break it all down because, the truth is, a hysterectomy isn’t the same procedure for every person. 

What’s more, there’s often a lot of confusion about many of the medical terms used to describe the different types of hysterectomies. For example, many assume the term “total hysterectomy” means that all reproductive organs are removed, but that’s not true. And while you may have heard the phrase “partial hysterectomy,” it’s not actually a medical term.

You might think you don’t need this level of detail into all the medical terminology, but it’s actually quite helpful when it comes to having clarity about the procedure and its potential impact on your health and menopause status. 

So, what are the different types of hysterectomies, and what does each entail?

The 3 Main Types of Hysterectomies

Total Hysterectomy

This involves the removal of the uterus and cervix, and it may be performed with or without removing the ovaries or fallopian tubes.

Subtotal Hysterectomy (Supracervical Hysterectomy)

This involves the removal of the uterus but not the cervix. The cervix is the lower, narrow part of the uterus that connects the uterus to the top of the vagina. It may be performed with or without removing the ovaries or fallopian tubes.

Radical Hysterectomy

This involves the removal of the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue (sometimes including part of the vagina), and it is usually performed due to cancer.

Procedures That Can Accompany a Hysterectomy

It’s important to know that doctors may use specific terms used to refer to other parts of your reproductive system that are often removed as part of a hysterectomy:

• Salpingectomy: removal of the fallopian tubes
• Oophorectomy: removal of the ovaries
• Salpingoophorectomy: removal of tubes and ovaries

Interestingly, there’s a growing conversation around salpingectomy for the prevention of ovarian cancer, because many cases start in the fallopian tubes, and it’s become standard practice to remove the fallopian tubes during hysterectomy. Research shows that salpingectomy is not associated with an earlier age of menopause onset.

Putting It All Together

So, now that you know the terminology, let’s put it all together. If, for example, your surgeon is planning on removing your uterus, cervix, and both fallopian tubes while keeping your ovaries intact, you’re having a total hysterectomy with bilateral salpingectomy, and it should not immediately affect your menopause status (this was my situation). 

If your surgeon plans on removing your uterus, cervix, fallopian tubes, and ovaries, you’re having a total hysterectomy with bilateral salpingo-oophorectomy, and you will be in menopause immediately upon waking from your surgery.

How Hysterectomies Are Performed

Hysterectomies aren’t just differentiated by what’s removed, but also by how the various organs are removed. A few more terms to know: 

• Abdominal hysterectomy: This is when the uterus (and/or the fallopian tubes, ovaries, and cervix) is removed through an opening in the lower belly (the abdomen).
• Vaginal hysterectomy: This is when the uterus and cervix (and/or the fallopian tubes and ovaries) are removed through the vagina. A vaginal hysterectomy always includes the removal of the cervix, which is attached to the upper end of the vagina and therefore must be removed in order to remove the uterus above it. 
• Laparoscopic-assisted total or subtotal hysterectomy: This is when a surgeon makes small incisions in your abdomen and removes the uterus in sections, usually through the vagina (called a laparoscopically assisted vaginal hysterectomy, or LAVH). 
• Robotic-assisted laparoscopic hysterectomy: This is a laparoscopic hysterectomy with one difference: The surgeon uses a computer to control the surgical instruments used to remove your uterus (and/or the fallopian tubes, ovaries, and cervix). 

Common Reasons for Hysterectomy

The type of hysterectomy you have and how the procedure is performed (whether it can be done laparoscopically or not) often depends on the reason you’re having a hysterectomy. 

Some of the most common health conditions that prompt people to have a hysterectomy include:

• Fibroids: Fibroids are benign tumors of the uterine muscle that can cause heavy bleeding, pelvic pain, and what’s known as bulk symptoms. As fibroids grow, they can push up against other pelvic organs (such as the bladder and rectum), causing health issues including frequent urination, constipation, pain with sex, and many others. With very large fibroids or an especially enlarged uterus due to fibroids, a laparoscopic hysterectomy may not be possible, and an abdominal hysterectomy may be necessary.
• Abnormal uterine bleeding: This refers to heavy, prolonged, or irregular periods, often due to fibroids.
• Endometriosis: This is a condition where tissue similar to the uterine lining (called endometrial tissue) grows outside the uterus, which can cause heavy periods, chronic pelvic pain, and infertility. 
• Adenomyosis: This is a condition where the lining of the uterus (endometrial tissue) grows into the uterine muscle wall and can cause painful, heavy periods and an enlarged uterus. Adenomyosis can be hard to detect, and it’s often diagnosed after a hysterectomy, when doctors closely examine and test the uterus for potential cancerous cells.
• Chronic pelvic pain: This is often linked to the conditions listed above (fibroids, abnormal uterine bleeding due to menstrual cycle irregularities, and/or endometriosis), and hysterectomy may help ease pain.
• Lynch syndrome: This hereditary condition increases the risk of developing uterine cancer. 
• Breast or gynecologic cancers: If doctors detect uterine (endometrial) cancer, cervical cancer, or ovarian cancer, hysterectomy may be part of your treatment plan. Sometimes, as part of breast cancer treatment, a doctor may recommend an oophorectomy.

How Cancer Survivors Find Relief

Many women with breast cancer, as well as survivors or those at risk of the disease, can still find relief from their menopause symptoms.

Hysterectomy and Its Impact on Menopause

No matter what type of hysterectomy you have, why you have it, or how the procedure is performed, you’ll likely wonder about if your hysterectomy will put you into menopause. The most essential question to ask your surgeon is this: Will I be able to keep my ovaries? That’s because the ovaries are the organs that affect your hormones, which in turn impact your menopausal status and your overall recovery.

The ovaries are your body’s primary source of estrogen and play a central role in the menstrual cycle, explains Dr. Yee. 

Before menopause, the brain sends signals to the ovaries to develop and release an egg. As the egg matures, estrogen levels rise. After ovulation, the ovaries begin to secrete progesterone, which helps prepare the uterine lining for a possible pregnancy. If pregnancy doesn’t occur, hormone levels drop, leading to a period. Then, the cycle starts all over again.

As you enter your 40s (though it can happen earlier), the communication between the brain and the ovaries becomes less consistent. The ovaries stop responding to the brain’s signals as reliably as they used to, which can result in irregular ovulation or none at all. This, in turn, can lead to shifting levels of estrogen and progesterone, which is what can cause symptoms like hot flashes, mood changes, and sleep issues. 

This transition period from regular hormone production to irregular production is called perimenopause. Eventually, the ovaries stop releasing eggs altogether, hormone production drops sharply, and you reach menopause. Menopause isn’t actually a stage but a moment in time when you’ve gone 12 consecutive months without a period. 

So, if you’re having a hysterectomy, whether or not your ovaries are removed will become central to understanding if you’re going to be dealing with menopause after the procedure.

To put it simply: If you have both ovaries removed during your procedure and you haven’t yet gone through menopause naturally, you will immediately be in menopause after total hysterectomy with bilateral oophorectomy—sometimes called surgical menopause.

That immediate and abrupt drop in your body’s hormone production may cause all the trademark symptoms of menopause, and they can often be more severe. These include:

• vasomotor symptoms (such as hot flashes and night sweats)
• genitourinary syndrome of menopause (also known as GSM), which may include vaginal dryness, increased urinary tract infections, and/or pain during sex  
• anxiety, depression, and/or increased mood shifts
• fatigue and sleep issues, often as a result of vasomotor symptoms keeping you up at night
• cognitive changes, including brain fog and trouble recalling words
• changes in hair and skin

“Every patient presents a little differently when they transition into menopause,” says Lily Hanna, MD, an OB hospitalist at East Jefferson General Hospital in Louisiana and clinical team lead at Midi Health. “It’s very individual.”

Managing menopausal symptoms is a priority for women after surgical menopause, as these symptoms can significantly affect your daily life. Each symptom requires a unique management approach, and it’s essential that your care team tailor treatments to your individual needs. A menopause specialist, like a Midi clinician, can work with your surgical team to ensure that our recommended treatments are in line with your care, as well as your quality-of-life goals. Because, yes, those matter too.

Menopause Onset If Your Ovaries Aren’t Removed During a Hysterectomy

If your ovaries aren’t removed, there’s a chance you’ll go through perimenopause after hysterectomy as you would’ve if you hadn’t had a hysterectomy, thanks to your ovaries continuing to produce hormones. However, some research shows that menopause can happen up to 4 years earlier than it otherwise would have, likely due to decreased blood flow to the ovaries after a hysterectomy.

Blood flows to the ovaries from an ovarian artery (which isn’t compromised during a hysterectomy) and uterine arteries (which are removed during a hysterectomy). Reduced blood flow after a hysterectomy is thought to affect hormone production, possibly prompting a woman to enter menopause slightly earlier than she otherwise would’ve, explains Dr. Hanna. “Any shift in blood supply to any organ in the body can potentially lead to long-term changes,” she says. 

Changes in blood supply to the ovaries after hysterectomy may explain why there’s a chance you may experience some symptoms of menopause after a hysterectomy, even when your ovaries were left intact. But if that happens, it’s also important to consider your age at the time of your hysterectomy, says Dr. Hanna: If you’re in your late 40s when you have a hysterectomy, you’re likely already in the perimenopause window, which may mean any symptoms of the menopause transition you’re experiencing would be happening anyway.

This is why it’s important to stay clued in to how you feel, adds Dr. Hanna. “If you feel great after your hysterectomy and you’re not experiencing any of the telltale signs of menopause, it’s a good litmus test that points to the fact that your body is responding well to the hormones your ovaries are still making,” she says. “Once you have a hysterectomy, we can’t use bleeding as a marker for menopause. So being aware of how you feel and tracking symptoms is important.” 

Bloodwork that tests hormones to gauge menopausal status can be somewhat helpful after a hysterectomy, but this testing may not give you definitive information, given how estrogen and progesterone can greatly shift in the lead-up to menopause, explains Dr. Hanna. 

“One day a blood test may look like you’re in menopause, and the next day it won’t,” she says. “This is why we often don’t recommend testing your hormone levels if you have no symptoms of menopause. It doesn’t necessarily give us that much information.” 

Managing Menopause Symptoms After Hysterectomy with HRT

If you have a total hysterectomy with oophorectomy and will go into menopause immediately after your surgery, your healthcare professional will likely prescribe hormone replacement therapy (HRT). 

HRT is an evidence-based treatment used to relieve the symptoms of menopause and/or prevent certain health conditions that may be caused or worsened by the post-menopausal drop in estrogen. For women without a uterus, HRT usually involves taking estrogen alone. (Those with a uterus must also take progesterone to protect against endometrial cancer, since estrogen unopposed by progesterone can lead to an overgrowth of the cells that line the uterus.)

If your ovaries are left intact during a total hysterectomy, there’s no need for HRT until you start experiencing the symptoms of menopause. Your doctor may also talk with you about HRT when you reach an age where you’re likely in menopause.

“Studies show even the lowest doses of estrogen help bone health, so I’m talking to patients about the benefits of an estrogen patch even if they don’t have symptoms when they reach menopause,” says Dr. Yee. “Twenty years ago, we didn’t treat you with HRT if you didn’t have symptoms. Now, we’re re-thinking that, given the proven health benefits of HRT.”

Non-Hormonal Options to Relieve Menopause Symptoms

For people who can’t take HRT (usually due to a personal history of estrogen receptor-positive breast cancer) or don’t want to take it (often due to a strong family history of hormone-positive cancers), nonhormonal treatments may help ease the symptoms of menopause. 

These treatments can include:

• some prescription antidepressants (including SSRIs and SNRIs), which have been shown to reduce hot flashes
• a new, FDA-approved nonhormonal drug called fezolinetant, or Veozah, that targets the brain’s thermoregulatory center to reduce hot flashes
• cognitive behavioral therapy for insomnia (CBT-I), a proven treatment for improving fatigue, energy, sleepiness, and the ability to function well at work
• vaginal moisturizers that can help hydrate vaginal tissue and lubricants that can help ease pain during sex if you’re experiencing the genitourinary syndrome of menopause
• regular exercise, particularly strength training and cardiovascular exercise that involves jumping, to help prevent osteopenia and osteoporosis (which is more prevalent after menopause)

How to Prepare For—and Recover After—a Hysterectomy

As someone who’s gone through the procedure, I can tell you firsthand that the right preparation before a hysterectomy goes a long way toward making the recovery process as smooth as possible. 

Here are some of the most important points to keep in mind:

Vet surgeons thoroughly. 

When I was considering having a hysterectomy to treat the heavy bleeding I was experiencing due to fibroids, I had multiple appointments with gynecologists before landing on the surgeon who’d ultimately perform my laparoscopic hysterectomy. 

I asked a lot of questions, including: Will it be possible to preserve my ovaries? Do you have experience removing an enlarged uterus due to fibroids? What kind of pain management do you recommend after the procedure? When can I expect to be back at work?

Of course, my questions didn’t end there. And I ultimately decided on my surgeon because at each of my appointments with him, he not only answered all of my questions but also prompted me to think about others, taking his time walking me through the procedure he hoped to do (a LAVH) as well as the possibility of an abdominal hysterectomy if my uterus ended up being too large to remove vaginally.

Don’t compare your experience with others.

Remember that a hysterectomy—both the type of procedure and recovery time—can be different for everyone. One of my friends had a hysterectomy a few months after I did, also because of fibroids. But her fibroids and uterus were much larger than mine, which necessitated an abdominal hysterectomy, an overnight stay in the hospital, and many more weeks of recovery time than I went through. One experience isn’t good or bad, and knowing that your hysterectomy may be completely different from your mom’s, your sister’s, or your best friend’s can help you focus on your experience.

Anticipate physical changes.

Yes, you may experience some body changes after uterus removal. But talk with most women who’ve had a hysterectomy, and you’ll hear happy stories of flatter stomachs and even a better sex life, thanks to the removal of fibroids or endometriosis that had previously been causing pain during intercourse. For others, though, some changes may be unwelcome, as a hysterectomy can increase the likelihood of urinary incontinence. 

I’m 4 months post-op as I write this and can honestly say I still feel better and healthier than I did before my hysterectomy, likely thanks to the fact that I’m no longer anemic due to very heavy periods. But at age 46, I also realize I’m solidly in the perimenopause window, and I’m staying clued in to any symptoms of the menopause transition that may be setting in.

If your ovaries will be removed as part of your hysterectomy, be proactive about creating a plan with your care team about how you’ll manage menopause symptoms. 

Keys Takeaways

• Hysterectomies are one of the most common surgical procedures performed on women in the United States, and about 1 in 3 women will have one by age 60.
• Having a total hysterectomy doesn’t mean you’ll go into menopause right away—it all depends on whether your ovaries are removed as part of the procedure.
• If your ovaries are removed during your hysterectomy and you have the procedure done before you’ve naturally reached menopause, you’ll wake up from your surgery in menopause and will likely start using HRTif it’s right for you.
• If your ovaries remain intact after a hysterectomy, you may go through menopause a little earlier than you would have if you didn’t have the procedure.