Ask An Expert: Partial Hysterectomy and Menopause

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Ask An Expert: Partial Hysterectomy and Menopause

Question:

I had a partial hysterectomy more than 17 years ago. How does a woman like me know when menopause has ended when she has not had a period in so many years?

Answer:

Menopause is the change that marks the end of a woman's reproductive years. It is defined as the time after a women's last menstrual period. Since women often skip periods leading up to menopause, it can only be determined in retrospect, after a woman has had no period for one year.

The fundamental biological event that causes menopause occurs not in the uterus, which is the source of menstrual flow, but rather in the ovaries. The ovaries produce estrogen and progesterone in a cycling fashion from the onset of a women's reproductive years (menarche) at about age 11 until menopause. The ovaries naturally stop functioning at an average age of 51.

Ovarian function does not stop abruptly, but instead gradually declines over a period of several years. This time is called perimenopause. Women may notice changes in their cycle during perimenopause, including lighter flow, spotting, and skipping periods. Other symptoms may include hot flashes, sleep disruption, mood swings, and vaginal dryness. Though most women have symptoms during perimenopause, the type and degree of severity vary widely.

Women who have had a hysterectomy (removal of the uterus) but still have normal ovaries will go through a typical perimenopause. However, they will not be able to rely on a change in their cycle to detect the transition. They will still have all the other symptoms associated with the change. Blood tests to measure hormones can be done, but levels can fluctuate quite a bit from day to day, so they are not particularly helpful.

Decisions about how to manage the transition to menopause do not depend on the absence of periods or blood hormone levels. If symptoms are sufficiently disruptive to a woman's lifestyle, treatment options should be discussed with her physician. This approach is the same regardless of whether a woman has had a hysterectomy.

Joan Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.

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Last updated:	January 24, 2007