Surgical menopause at 39, please help!

[Annab1983]

Hi all am about to get a hysterectomy, everything out, next month. Surgery is scary but I have severe endometriosis and adenomyosis and have tried everything else.. am more worried about immediate menopause as I was on Zoladex and Tibolone previously and felt horrendous. Any tips or experience that might help alleviate my anxiety about all this? Thanks in advance!

I had a surgical at 40. The recovery from the surgery itself was fairly easy (back at work 3 weeks later), however the menopause knocked me for 6 for a good 3/4 years. Your surgeon should start you on HRT the day after surgery and this could help.

You need to discuss this with your surgeon before the operation and have a continued care plan.
Zoladex and Tibolone are not comparable with modern HRT so you should be on transdermal estrogen - gel or a patch.

It should include HRT automatically, and also possibly testosterone for muscle strength and libido if you are losing your ovaries. Only consultants can prescribe this and it's 'off label' as the product available in the UK is for men but women use a smaller dose.

If you need more info on this google and Nick Panay is one gynae who has had a lot to say about it.

Thanks for replying lama, would you have any tips on coping with the menopause? Have had a rough few years and am worried about the next few!

Thank you Jingling will have a look!

Is removal of ovaries necessary? Friends in similar situation left ovaries in for hormonal reasons.

If it is necessary, I had my ovaries removed at similar age. I didn't do hrt, few hot flushes, but not bad at all. Dr said I could also go on pill. There are definitely options, but au naturel wasn't bad at all.

@Annab1983

Thanks for replying lama, would you have any tips on coping with the menopause? Have had a rough few years and am worried about the next few!

Annab If you get the right hrt that suits you, then you ought not to even notice the menopause.

It's a lot easier to use just estrogen as you will have no womb.

At 40 you will be advised to use it to at least 51 and after that it's up to you how long you use it- you can stay on it for life.

@Jenny70

Is removal of ovaries necessary? Friends in similar situation left ovaries in for hormonal reasons.

If it is necessary, I had my ovaries removed at similar age. I didn't do hrt, few hot flushes, but not bad at all. Dr said I could also go on pill. There are definitely options, but au naturel wasn't bad at all.

@Jenny70 It's medical advice now to use HRT up to age 50 at least to prevent bone loss and heart disease. Women who lose their ovaries at a young age are very much at risk.

Have you had a DEXA bone scan at all? You ought to as even without meno symptoms you have no idea what your bone density is.

IMO all women should have this scan at 50 - it's more important than smears- because 1:2 women will get osteoporosis and 1:3 will break a hip.

The thinking apparently is the endo (that’s everywhere) will continue to be fed by the ovaries and could still be a problem, it’s not just the bleeding it’s constant pain that radiates down my legs even without bleeding, also painful cysts on ovaries that have needed removed before.. that’s my understanding anyway! I did have another Doc tell me it was extreme to take ovaries too which has put doubt in my mind a bit.. thanks to everyone who has responded!

I do also think I am likely in peri menopause now as have symptoms and my amh was very low even 5 years ago so am hoping beyond hope I will feel better once I get over the op and settled on HRT, it’s such a huge and irreversible thing though am somewhat terrified!

@Annab1983 Have you had a couple of opinions- from specialists?

It's worth taking your time over such a move.

I know there are a few really good experts on endo in the UK and if I were you I'd be looking for one and not just going with anyone who is the closest (location) or the one your GP sends you too.

It's quite a specialist area to treat correctly so it' s worth getting someone who really knows what they are doing.

Have you had all the investigations needed to show where the endo is in your body?

I have had several surgeries in recent years and a mri recently which showed it all over and a large chocolate cyst also. Both a NHS and a private consultant agree the surgery is necessary but one questioned the ovary removal issue but agreed to do the surgery anyway which has left me a little confused!