Question 12 - Menopausal Symptoms With Ovaries

Hi Dr. N,

I'm 36. In February, 1999, I had a hysterectomy (leaving the Ovaries). Over the past 2-3 months I have been having hot flushes and mood swings. What I want to know is am I going through the menopause and if so, what treatment will I require.

Thanks,
Debbie

Reply:

I'm glad to hear from you, but I'm sorry that you're having a problem. It's always better to leave the ovaries if medically reasonable in someone as young as yourself as they often continue to produce adequate amounts of sex hormones for several years. The presence of your own natural hormone levels provide the benefit of preserving your quality of life and protect you from cardiovascular disease and osteoporosis without the need for hormone replacement.

Unfortunately, medical studies have demonstrated that strategy doesn’t always work. The remaining ovaries fail to function within 3 years of the surgery approximately 50% of the time. This probably happens as a result of impairment of the blood supply due to the surgery.

So, let’s address your questions. First, you want to know if you’re menopausal. Think of it this way; I presume you never had hot flashes or the type of mood swings that you are experiencing now. There are some medical conditions that cause hot flashes, such as an overactive thyroid, but the most likely reason is that your hormone levels are declining or that your ovaries are "struggling" to continue to produce your normal levels of hormones.

Now, let’s think about how to find out. There is a hormone produced by the pituitary gland, FSH (follicle-stimulating hormone), which signals the ovary to produce more estrogen and as the ovary fails the pituitary produces more FSH in an effort to "whip" the ovary into producing more estrogen. Your doctor can take a

blood test for FSH and if it is elevated it is an indication that you’re becoming menopausal. Your level of estradiol, the bio-active estrogen can be determined as well and may be helpful. However, you can’t rely on this 100%. I have seen many patients who have had similar symptoms and normal levels of FSH and estradiol whose symptoms were alleviated by HRT. One would presume that these patients would fall into the category of having "struggling ovaries" but do not yet demonstrate changes in the levels of these hormones in the blood. The fact that their symptoms are improved by HRT is a solid indication that this is true. Some doctors may be reluctant to prescribe HRT for patients in this category. A little coaxing or if necessary a change of physician may be indicated. An indirect indication that your ovaries are still functioning is if you continue to notice much of the cyclic monthly phenomena, menstruation excepted, that occurred when your uterus was present. For example, fluid retention, mood swings, lower back pain or irritability. Of course, a woman could have these symptoms and "struggling ovaries" as well.

Addressing your second question, if you determine that you are menopausal, the treatment indicated is a reflection of your own personal comfort and needs. My own bias is to replace hormones in patients who are hormone deficient especially if they are as young as you are, as the prolonged exposure to low hormone levels intensifies any potential negative effects. There are a number of options available for you to choose from and you can discuss them with your personal physician. Reading the sections of the web site about HRT or reading one the books listed on the book page may be helpful. The oral and transdermal estrogen replacement methods are the most frequently utilized. If necessary, testosterone replacement can be added as well. I do not prescribe progesterone for patients who do not have a uterus. If you prefer not to use HRT, a book by Sadja Greenwood, Menopause Naturally: Preparing for the Second Half of Life, listed on the book page, may be a helpful reference for you.

Please let me know how things turn out for you.

Dr N