Editor’s Note: This article has been updated to add additional sources and further clarification.
Surgical menopause is a necessary side effect of a treatment option faced by many impacted by breast cancer and gynecologic cancer.
Often a topic reserved only for doctors’ offices only, we’re here today to talk about surgical menopause, including what Breasties can expect, to break stigmas for our peers facing menopause in their 20s, 30s, 40s, and beyond.
What is Surgical Menopause?
Let’s clarify what we mean.
Surgical menopause occurs after the removal of both of the ovaries—a bilateral oophorectomy—resulting in a loss of the primary endogenous source of female hormones, those being estrogen and progesterone, explained Dr. Anna Kuan-Celarier, a board-certified gynecologic oncologist. When the fallopian tubes are also removed, the procedure is called a salpingo-oophorectomy.
When we asked Dr. Kuan-Celarier why there may be confusion that a hysterectomy also induces surgical menopause, she shared: “Typically, outside of the surgical menopause conversation, we define menopause in gynecology as when a person goes for one year without a menstrual cycle.”
“Usually removing both of the ovaries will result in an abrupt cessation of any kind of bleeding, and any bleeding after removal of the ovaries should be worked up by a gynecologist.”
Surgical Menopause & Cancer Care
There are many reasons why someone impacted by cancer might enter into surgical menopause as a part of their treatment plan or as a risk-reduction strategy.
Patients with certain hormone-driven breast cancers face years of medical menopause to reduce their risk of recurrence. In certain scenarios, patients may consider removing their ovaries to reduce the hormones being produced naturally. Again, this is always a unique decision made between a patient and their medical team.
For patients with gynecologic cancers, the ovaries are sometimes removed because the cancer could have started there, such as in. ovarian, fallopian tube, or primary peritoneal cancers, or because there is a chance that cancer could have spread there, such as with uterine or cervical cancers.
Some types of cervical cancer, like cervical adenocarcinoma, have a higher risk of spreading to the ovaries.
RELATED: The Breasties Guide to Gynecologic Cancers
Many gynecologic cancer previvors—those who carry hereditary cancer syndromes, like the BRCA-1 or -2 genetic variants or Lynch syndrome—may choose to remove their ovaries to reduce their risk of developing ovarian cancer and ovarian removal may be recommended at the time of risk-reducing hysterectomy. Current guidelines recommend removal of the fallopian tubes and ovaries between ages 35 and 40 for BRCA 1 carriers, and for BRCA 2 carriers, age 45-50. With removal, the risk of breast cancer can be reduced by up to 75 percent and of ovarian cancer, by up to 95 percent.
Given the early ages at which these surgeries are recommended, however, many struggle with the knowledge that they may develop menopausal symptoms earlier in life, as well as the loss of the protective effects of estrogen for bone health, heart health, and even memory.
Breasties co-founder and breast cancer survivor Allie Brumel said, “At 36, I made the decision to move forward with risk-reducing bilateral oophorectomy and hysterectomy—not only to lower my risk, but also to ease the constant anxiety I carried about a future ovarian cancer diagnosis.”
Making the decision to remove your ovaries is not an easy one, even if it is life-saving.
Before undergoing surgery, it is important to speak to your medical team to understand the impacts, both long- and short-term, that this surgery might have.
In addition to asking about risks of the procedure itself, consider asking your team about how you can avoid long-term impacts to your bone and heart health, or what you might be able to expect due to the abrupt loss of hormones. If future pregnancy is something that is important to you, consider asking about fertility preservation options before surgery.
If you are preparing for an oophorectomy, two-time endometrial cancer survivor Amanda Fitzpatrick recommends packing loose-fitting clothing, a phone charger, panty liners, a book or something to keep you busy, headphones, and a small pillow to keep you comfy.
After Surgical Menopause
After entering into menopause, surgical or otherwise, Dr. Kuan-Celarier said everybody still needs to see their gynecologist regularly.
“Patients can still develop abnormalities of the vulva and vagina, which are commonly undetected by patients because it’s hard to see down there,” said Dr. Kuan-Celarier.
“Gynecologists oftentimes wind up being the primary folks in charge of things like making sure patients are up to date with screening, mammograms, colonoscopies, osteoporosis prevention, and other menopause-related challenges or healthy aging.”
Xenia Ryback, an endometrial cancer survivor, said that after her surgery, in addition to changes to her mood, “I wish that someone would have told me that the loss of estrogen would make my hands hurt and think I had developed arthritis.”
While symptoms like the ones experienced by Ryback might be common, Dr. Kuan-Celarier said: “I think it’s helpful to keep in mind that estrogen is only one piece of the puzzle, and that there are lots of other things that can be done to promote a healthy heart, healthy bones, and memory.” Maintaining a heart-healthy diet, low in saturated fats and processed foods, and getting adequate exercise of 150 minutes of cardiovascular activity and two strength sessions per week, are some of the most important things women can do to promote long-term health after menopause.
As far as managing the symptoms of menopause, there are a wide variety of treatment options that can include lifestyle changes, cognitive behavioral therapy, non-hormonal medications, and hormone replacement therapy (HRT). For many, HRT may still be an option that Breasties can discuss with their medical teams. It is important to talk about your individual risk factors, along with any symptoms of menopause you may be facing, to make the best decision for your care.
For those facing surgical menopause, there are more resources to support you now than ever before. These can include adding a menopause specialist to your team, using resources like the North American Menopause Society to help you prepare for doctor appointments, leaning on your Breasties to learn about individual experiences that might mirror your own.
That is exactly what breast cancer survivor with a BRCA-2 genetic variant, Jess Suarez, plans to do ahead of her own risk-reducing salpingo-oophorectomy.
“Part of me can’t make sense of another surgery. Another life-altering procedure that separates me from my peers,” said Suarez, who shares that she balances between the loss that comes with having an elevated cancer risk and gratitude for being able to take action.
“I worry about being isolated from the people and things I love,” said Suarez. “And l feel comforted by my community who understands the nuance. The grief. They uplift me in ways I never expected. With that support, I know I will be okay.”
Self-advocacy is self-care. You deserve to feel empowered to navigate decisions related to surgical menopause and all that comes after.
