Menopause occurs when a woman has not had her period for 12 months or longer.

This process naturally happens as a woman ages, as the ovaries stop producing or produce reduced amounts of female hormone. This usually occurs when she is in her 40s or 50s.

However, some woman may go through menopause at a younger age. This is certainly the case for women who have had their ovaries removed.

The ovaries are small organs situated either side of the uterus. They produce hormones, such as estrogen and progesterone, that control a woman's menstrual cycle.

Without ovaries to release hormones, a woman will go through menopause at an earlier time. This can have both short- and long-term effects on women that they should prepare for and be aware of.

Causes

Surgical menopause, which is also known as a bilateral oophorectomy, is a procedure in which a woman's ovaries are removed.

In most cases, the procedure is minimally invasive, meaning a surgeon will make small cuts in the lower abdomen to access and remove the ovaries.

Sometimes, a doctor will perform an oophorectomy along with other gynecological surgeries, including:

• hysterectomy, which is the removal of the uterus
• salpingectomy, which is the removal of the fallopian tubes that are near the ovaries
• salpingo-oophorectomy, which is the removal of both the ovaries and the fallopian tubes

Preventive surgery and surgical menopause

There are several reasons why a doctor may perform an oophorectomy, which induces menopause. These include:

• endometriosis
• non-cancerous ovarian tumors or cysts
• ovarian cancer
• ovary torsion, where an ovary becomes twisted and blood flow is affected

Some women have an oophorectomy to reduce their risk of developing ovarian or breast cancers. Doctors call this a prophylactic oophorectomy.

Women who have ovarian or breast cancers in their family history are at greater risk for developing these types of cancers. Some women undergo genetic testing to identify whether they have mutations in the BRCA1 and BRCA2 genes. These genes produce proteins that suppress cancerous tumor growth.

However, if a woman has inherited genetic mutations to these genes, she is more likely to develop cancer types, such as ovarian and breast cancers.

According to the National Cancer Institute, mutations in the BRCA1 and BRCA2 genes account for 15 percent of all ovarian cancers. These gene mutations also account for 20 to 25 percent of hereditary breast cancers. Women who have these genes are more likely to get cancer, and at an earlier age.

The ovaries produce hormones that can cause cancerous cells to grow more quickly, potentially increasing the risk for breast cancer. Removing the ovaries may reduce a woman's risk of developing the disease.

The BRCA1 and BRCA2 gene can be identified through blood or saliva samples. If a woman has a family history of breast or ovarian cancers, some insurance companies will cover the costs of genetic testing and counseling to determine if she is more at risk.

A positive result does not mean that a woman will develop breast or ovarian cancer, but she is at greater risk. A medical specialist known as a genetic counselor can discuss a woman's specific risks with her.

Some women may opt for an oophorectomy due to having an increased risk of cancer. However, they should only have this surgery with a full understanding of the potential health effects of experiencing menopause early.

Side effects associated with surgical menopause

Any surgery comes with some risks because a person is being put under anesthesia and a doctor is introducing instruments into the body.

Immediate complications that could occur after surgery include infection, damage to nearby organs, or a blocked intestine.

A surgically induced menopause may result in some long-term effects that a woman must also consider. Without her ovaries, a woman's supply of estrogen and progesterone decrease dramatically. This can cause a number of side effects, including:

• Menopause symptoms: These symptoms include hot flashes, reduced vaginal lubrication, difficulty sleeping well, and memory problems. While these symptoms do not always appear immediately after surgery, women who have had an oophorectomy are likely to experience them sooner than women who have not had the procedure.
• Osteoporosis: Estrogen can help to support strong bones. When the amount of estrogen decreases, a woman is at higher risk for osteoporosis, a bone-thinning disease. Having osteoporosis means that a woman is more likely to break her bones.
• Risk for heart disease: Less estrogen is associated with an increase in heart disease. This can lead to stroke, heart attack, and may affect heart function. If a woman did not have healthful habits before surgery, such as exercising, not smoking, and eating a nutritious diet, it is important that she adopts them afterward.

A woman should discuss these risks and more with her doctor so that she can make the most informed choice about having surgery.

Treatments

Doctors may prescribe hormone therapy after surgery to reduce the risk of side effects associated with surgical menopause. Hormone therapy is associated with an increased risk for breast cancer.

However, women who undergo oophorectomy to prevent breast cancer before age 45 and do not take hormone therapy are at greater risk for health problems. These include premature death, cancer, heart disease, and neurological disease.

As well as hormone therapy, there are many ways a woman can reduce her surgical menopause symptoms at home. These include:

• Avoiding habits that increase the risk for hot flashes: These include not drinking alcohol and caffeine, not eating spicy foods, reducing stress, and limiting exposure to warm temperatures.
• Keeping cooling items to hand: Having a portable fan and ice water bottle nearby can help to provide some relief. Dressing in layers can also help, as a woman can take layers off if she experiences a hot flash.
• Using a water-based vaginal lubricant during sex: This can reduce the discomfort of vaginal dryness.
• Keeping the bedroom cool and quiet for better sleep: Other useful tips include avoiding large meals and smoking before bedtime. Going to bed at the same time every night and waking up at the same time every morning can also help promote good sleep rhythms.
• Taking steps to relieve stress: Relieving stress can go a long way in reducing menopause symptoms. Getting enough sleep, exercising, writing in a journal, meditating, and practicing yoga can all help.

Some women may also join a support group for those with menopause or surgical menopause. Reaching out to friends and family or seeing a counselor may also help a woman relieve stress.

Outlook

Women who have BRCA mutations can dramatically reduce their risks for breast and ovarian cancer through oophorectomy. Women who do have the BRCA mutations and have an oophorectomy reduce their breast cancer risk by as much as 50 percent and their ovarian cancer risk by 80 to 90 percent.

However, it is possible that a woman may still develop breast or ovarian cancer for reasons unrelated to the BRCA genes.

Surgical menopause can be an uncomfortable and unpleasant side effect associated with oophorectomy. However, there are medications and home remedies that can reduce symptoms whenever possible. Exploring these options with a physician can help a woman live a healthier life.