Effects of Low Estrogen After a Hysterectomy

If prior to menopause, both ovaries and the uterus are removed during a hysterectomy, the result is what's called surgical menopause. Natural menopause occurs when the ovaries gradually stop functioning, usually at about 50 years of age. Surgical menopause occurs abruptly, with rapidly falling estrogen levels. Consequently, some of the menopausal symptoms may be more severe than in natural menopause, especially hot flushes, vaginal dryness and painful intercourse. Most symptoms can be effectively treated, so talk to your doctor about which treatments are best for you.

Hot Flushes

Hot flushes, or flashes, are due to sudden opening of the blood vessels close to the skin, usually due to hormonal fluctuations. They are commonly associated with the decrease in estrogen levels resulting from natural or surgical menopause. A hot flush is a sudden sensation of extreme heat in the upper body, typically lasting several minutes. They may cause night sweats, mood swings and sleep disturbances. Although hot flushes were once thought limited to a period of about 2 years, research now suggests that symptoms may last up to 10 years, according to the American College of Obstetricians and Gynecologists Practice Bulletin published in 2014 1. Several effective hormonal and nonhormonal treatment options exist.

Painful Intercourse

As estrogen levels drop, the vaginal lining becomes thinner and less elastic, and vaginal lubrication decreases. This may result in pain during intercourse and occasional spotting or bleeding afterward. According to a study reported in the May 2015 issue of “Journal of Sexual Medicine,” women who undergo surgical menopause have less vaginal lubrication than women who transition through menopause naturally due to the more abrupt decline in circulating hormone levels 3. Vaginal estrogen replacement therapy may improve symptoms of painful intercourse after natural or surgical menopause.

Bone Loss

Lower estrogen levels from natural menopause are associated with loss of bone mass, also known as osteoporosis. This especially affects the spine and hips. Early menopause, whether natural or as a result of surgical removal of the ovaries, is associated with greater reduction in bone mass or density during the postmenopausal years. The likelihood of a fracture, however, may not be higher in women who have undergone surgical menopause compared to the general population. Although oral estrogen replacement therapy has been used to treat postmenopausal bone loss, nonhormonal treatments for osteoporosis are also in widespread use.

Urinary Tract Infections

Because of changes in the lining of their vagina, such as thinning and decreased blood flow, postmenopausal women are particularly susceptible to developing urinary tract infections. These infections usually occur when bacteria that normally live on the skin or in the gastrointestinal tract ascend up into the bladder. Treatment with vaginal estrogen replacement therapy reduces the risk of urinary tract infections in postmenopausal women.

Cardiovascular Disease

Entering menopause is well known to increase the risk of heart disease in women. Deleterious changes in the function of the heart and blood vessels may be more prevalent and more severe in women whose ovaries are removed surgically prior to natural menopause. Unlike hot flushes and bone loss, heart disease is not considered a reason to start estrogen replacement therapy in women.