Natural And Surgical Menopause: How They Differ

Natural And Surgical Menopause: How They Differ

Is menopause the same for natural and surgical menopause?

In a word, “No.” These are two very different experiences.

As I write in my best selling book, The Estrogen Fix:


  1. Natural or spontaneous menopause: When a woman’s ovaries naturally stop making enough estrogen to produce a menstrual cycle.


  1. Surgical menopause: When a woman’s ovaries are removed by surgery prior to natural menopause. The woman is in menopause from the time the ovaries are removed. If the ovaries are removed before age 46, the woman is in early menopause. Having a hysterectomy (surgical removal of the uterus) will stop menstruation, but it does not cause menopause unless both ovaries are removed, which is called a bilateral oophorectomy. It’s important to know that if you have a hysterectomy, even if your ovaries are left in, you will most likely lose some of your ovaries’ hormone-producing ability within the first few years after surgery.


Surgical menopause is important to understand because about 600,000 hysterectomies are performed annually in the United States. Many times a doctor may recommend taking out the ovaries at the same time to reduce the risk of ovarian cancer. If that happens, you will be in surgical menopause and a candidate for taking estrogen.


But what happens to your ovarian hormone levels if you have a hysterectomy and your ovaries are not removed? It would seem that if the ovaries were not removed, they would continue to work just like they did before the hysterectomy. But this is not the case. Many women who have hysterectomies go through a type of delayed surgical menopause. Women who have a total abdominal hysterectomy (TAH–meaning their uterus is removed through an abdominal incision but their ovaries are not) go through menopause an average of 5 years earlier than women who have not had a TAH. Within the first 6 months after surgery, 25 percent lose ovarian function and within 3 years, 40 percent lose ovarian function. The average time an ovary continues to function after hysterectomy is 7 years. Indirectly, a hysterectomy without removing the ovaries can cause surgical menopause.


Why does this happen? When bloodflow to the ovaries is measured by special testing at the time of TAH, bloodflow is decreased by 80 percent. That decrease in bloodflow causes ovarian tissue death, which is called infarction, much like a reduction in bloodflow to the heart causes a myocardial infarction, or heart attack. Even though the ovaries look normal at the time of surgery, a study done 1 year later showed the ovaries from all women who had a TAH had some area of infarction and accelerated loss of the number of eggs.


This is important information for all women undergoing a hysterectomy to know and discuss with their doctor. If you have a hysterectomy when you are young, particularly age 44 or younger, you may go into early menopause even if your ovaries are not removed, which is important to know because most hysterectomies are done in women before they enter menopause.


Hysterectomy Rates per 1,000 Women in the United States





45-49 9.7
40-45 9.6
35-39 6.5
50-54 5.6



The average age for a hysterectomy is 46.1 years. By age 54, one-third of all women will have had a hysterectomy. Most of those women who have a hysterectomy before age 46 will have gone through early menopause. One of my patients, Sandra, was taken aback by her symptoms and said, “I can’t be going through menopause; I still have my ovaries.” This information can help a woman decide whether to have her ovaries removed if she is at significant risk of ovarian cancer; if she does not have her ovaries removed, she can have her FSH and estrogen levels followed in the months and years to come to see if she is going into early menopause.


After menopause, the adrenal glands slowly begin to produce lesser amounts of another hormone–androstenedione. Because the testosterone and androstenedione drop slowly, postmenopausal women who experience natural menopause often don’t have a loss of libido. If there is a loss of libido and testosterone isn’t low, taking supplemental testosterone won’t make a difference. Other causes for loss of libido, such as side effects of some medications, anxiety or depression, painful sex, chronic illness, financial challenges, family dynamics (problems with children, sick parents), lack of privacy, mental illness, and marital strife must be considered.


Along with early menopause, there are other risks associated that are discussed in my book The Estrogen Fix. It’s one of the reasons women visit me as a patient or if they live farther away, contact me for I’ll talk about these issues in a future writing.




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