Q: I’m 22, and due to severe endometriosis I just had a total hysterectomy with removal of both ovaries. Now, I am going through surgical menopause. I take estradiol once a day. How does this differ from natural menopause or having a hysterectomy later in life?
A: One thing to make clear: It isn’t the hysterectomy (removal of the uterus) that created a sudden hormonal shock to your system, it’s the removal of both ovaries (known as bilateral oophorectomy).
Many women think the term “total hysterectomy” means the uterus plus everything else is removed. This is not so. "Total" denotes the fact that the cervix is removed along with the uterus, with the ovaries left in place. In other words, having a regular or total hysterectomy will not cause the menopausal symptoms associated with hormone loss.
But a woman in her prime reproductive years who undergoes removal of both ovaries loses the main source of three key hormones produced by her body: estrogen, progesterone and testosterone.
This is, of course, what happens naturally during the course of a normal menopause. However, the symptoms of menopause that occur as a result of this hormonal loss, especially that of estrogen — hot flashes, night sweats, vaginal dryness, sleep problems, mood swings, dry skin, abdominal weight gain and fogginess of thought — are more severe when they occur suddenly.
During natural menopause, a woman’s body has had years to prepare for this loss. If someone in her 40s or 50s has similar surgery, the symptoms will be less severe. If someone after menopause has the surgery, there will be no additional symptoms.
It's good you are taking estradiol (a form of estrogen produced by your ovaries). Every woman of reproductive age who undergoes this type of surgery should be on hormonal replacement unless she has a contraindication to estrogen therapy (such as a history of uterus or breast cancer). This should be started immediately after surgery so you don’t have to “hot flash” your way through your operative recovery.
Not only will proper hormone replacement make you feel normal, it will reduce the increased risk of certain diseases that occur when a woman’s body is prematurely denied its proper hormones. Lack of estrogen in your 20s through 40s can lead to osteoporosis and increase your risk of coronary vascular disease and Alzheimer’s disease.
Fears about long-term estrogen replacement that have been detailed in some recent studies involve therapy given in later life: the 60s and 70s — years beyond the time the body would make its own estrogen. These concerns do not apply to someone your age, whose ovaries should be supplying needed estrogen for the next 30 years.
In terms of the second hormone lost through this procedure, there is no data showing that adding progesterone improves the health of women after hysterectomy. (It is possible, though, that some endometriotic implants from your originally disease remain in the abdominal cavity, and would be less likely to grow if progesterone were added.)
However, replacement of testosterone should be seriously considered by your doctor. Although the adrenal glands supply some of this male hormone — which we need for libido and sense of well-being — the contribution form the ovaries is considerable. This testosterone loss causes symptoms like lack of sex drive and muscle loss.
Testosterone replacement can be done with an FDA-approved pill, Estratest, which contains both estrogen and testosterone. Or your physician can add a compounded formulation of testosterone, ordered through special compounding pharmacies.
Raising your hormone levels should lower your risk of osteoporosis, but you should get a bone-density test in the next few years. And don’t forget to take 1500 milligrams of calcium and 800 units of Vitamin D daily and do weight bearing exercise for bone strength. You should also be diligent in checking your cholesterol levels and keeping your weight under control.
Dr. Reichman’s Bottom Line: If there are no complicating factors, a woman undergoing surgical menopause during her reproductive years should immediately begin hormone replacement therapy.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of .
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.