Natural, Surgical and Medical Menopause:

What’s the Difference?

Menopause is often described as a natural stage of life that happens gradually during midlife. However, not everyone experiences menopause in the same way.

For some women, hormonal changes develop over several years. For others, menopause can begin suddenly following surgery or as a result of medical treatment.

Understanding the difference between natural, surgical and medical menopause can help women know what to expect, recognise possible symptoms and understand the importance of getting the right support.

What is natural menopause?

Natural menopause occurs when the ovaries gradually reduce their production of hormones, including oestrogen and progesterone, and menstrual periods eventually stop.

The transition leading up to menopause is known as perimenopause. During this time, hormone levels fluctuate, and women may begin noticing changes to their periods, sleep, mood, energy levels and overall wellbeing.

The average age of menopause in the UK is around 51, although it can occur earlier or later.

Because the hormonal changes usually happen gradually, symptoms may develop over time. Some women experience relatively mild changes, while others find that their symptoms significantly affect their daily lives.

Possible symptoms include:

• Hot flushes and night sweats.

• Difficulty sleeping and persistent tiredness.

• Changes in mood, anxiety or low mood.

• Vaginal dryness and discomfort during sex.

• Changes in sexual desire.

• Joint and muscle discomfort.

• Difficulty concentrating or remembering things.

Not every woman experiences all these symptoms, and their severity can vary considerably.

What is surgical menopause?

Surgical menopause happens when both ovaries are removed during an operation.

The ovaries produce important hormones, including oestrogen and progesterone, as well as androgens such as testosterone. Removing both ovaries causes an immediate reduction in their hormone production, meaning menopause begins suddenly rather than gradually.

This can be a very different experience from natural menopause.

Some women may develop hot flushes, night sweats, sleep difficulties and other symptoms soon after surgery. The sudden hormonal changes can make symptoms feel particularly intense for some individuals.

Surgery involving the ovaries may be considered for various medical reasons, including certain ovarian conditions, endometriosis or cancer treatment. In some circumstances, surgery may also be recommended to reduce an individual’s risk of particular cancers.

The reasons for surgery, the person’s age and their medical history all affect the decisions surrounding treatment and recovery.

Does a hysterectomy always cause menopause?

No. This is an important distinction.

A hysterectomy is an operation to remove the womb. If the ovaries remain in place, they can continue producing hormones, so the operation does not automatically cause immediate menopause.

However, some women who have had a hysterectomy may experience menopause earlier than they otherwise would have.

Because periods stop following a hysterectomy, it can also be more difficult to recognise the usual menstrual changes that might otherwise indicate the menopause transition.

If you are experiencing symptoms following a hysterectomy, a healthcare professional can help assess what may be happening and discuss the appropriate next steps.

What is medical menopause?

Medical menopause, sometimes called induced menopause, occurs when medical treatment suppresses ovarian function or affects the ovaries’ ability to produce hormones.

There are several circumstances in which this can happen.

Medication that suppresses the ovaries

Some treatments used for gynaecological conditions, including endometriosis and certain cases of fibroids or heavy menstrual bleeding, work by suppressing ovarian function.

Medications such as GnRH analogues can reduce ovarian hormone production and bring on a temporary menopause-like state.

Depending on the treatment and the individual, ovarian function may return after the medication is stopped. However, this cannot be assumed in every situation.

Chemotherapy and radiotherapy

Some cancer treatments, including certain chemotherapy regimens and pelvic radiotherapy, can affect ovarian function.

The effect may be temporary or permanent. It depends on several factors, including the treatment used, its intensity and the individual’s age and ovarian reserve.

For women undergoing cancer treatment, understanding the possible effects on fertility and hormone levels can be an important part of planning their care.

Medical menopause is not always permanent, but its likely duration and effects should be discussed with the treating team.

Why can surgical and medical menopause feel different?

One of the main differences is how quickly hormone levels change.

During natural menopause, hormonal changes generally develop over time. With surgical menopause, the removal of both ovaries causes an immediate reduction in ovarian hormone production. Some medical treatments can suppress ovarian function relatively quickly as well.

When these changes happen suddenly, symptoms may appear over a short period and can be difficult to manage without appropriate support.

There can also be important long-term considerations, particularly for women who experience menopause at a younger age.

Oestrogen plays a role in bone health and other body systems. A prolonged period of reduced ovarian hormone production may have implications for bone health and cardiovascular health, among other aspects of wellbeing.

This does not mean every woman will experience the same problems. Individual risks vary, which is why medical history, age, treatment type and ongoing symptoms should all be considered.

Can you take HRT after surgical or medical menopause?

Hormone replacement therapy (HRT) may be an option for some women experiencing surgical or medical menopause, but it is not suitable for everyone.

When appropriate, HRT can help manage menopause symptoms by replacing some of the hormones that have been lost. The most suitable approach depends on the individual’s circumstances, medical history, symptoms and the reason menopause has occurred.

For younger women experiencing menopause because of surgery or medical treatment, the potential benefits and risks of hormone treatment deserve particular consideration.

Cancer history can make these decisions more complex, but it should not be assumed that HRT is automatically ruled out in every cancer-related situation. Suitability depends on the specific diagnosis and treatment, and specialist advice may be necessary.

For women who cannot take HRT, or who prefer not to, other approaches may be available. These can include appropriate non-hormonal medicines, menopause-specific cognitive behavioural therapy and practical support for sleep, wellbeing and other symptoms.

The right approach should be discussed with a qualified healthcare professional who understands the individual’s circumstances.

Why is it important to discuss menopause before surgery or treatment?

When possible, conversations about the potential effects of treatment should happen before surgery or medical treatment begins.

Women should have the opportunity to understand how their ovaries may be affected, whether menopause is likely to occur, what symptoms might develop and which treatment options could be available afterwards.

Useful questions to ask your healthcare team include:

• Could this treatment cause temporary or permanent menopause?

• Will one or both ovaries be affected or removed?

• Could my fertility be affected?

• What symptoms might I experience after treatment?

• Could HRT be suitable for me, or are there alternatives?

• Who should I contact if symptoms develop after surgery or treatment?

It is also important to discuss symptoms and treatment options after treatment, rather than assuming that support will only be needed if problems arise.

NICE recommends that people likely to experience menopause as a result of medical or surgical treatment should have the opportunity to discuss menopause with a healthcare professional who has expertise in this area, both before and after treatment.

Good preparation can help women make informed decisions and understand where to seek help.

You do not have to struggle through menopause alone

Whether menopause occurs naturally, following surgery or as a result of medical treatment, the experience can be different for every woman.

Some women need reassurance and information. Others may need a detailed assessment of their symptoms, advice about HRT or alternative treatments, or ongoing support as their circumstances change.

The important thing is to recognise when symptoms are affecting your quality of life and to seek appropriate advice.

Menopause care should be individualised, with time to discuss concerns, understand the available options and make informed decisions about treatment.

Support with menopause symptoms

If you are experiencing perimenopause or menopause symptoms, or you have concerns about menopause following surgery or medical treatment, speaking with a healthcare professional can help you understand your options.

MenopauseCare Online offers online consultations with Miss Kavita Verma, Consultant Gynaecologist and Advanced Menopause Specialist, with face-to-face appointments also available in selected locations.

A free 15-minute discovery call is available for women who would like to find out whether a full consultation may be suitable for them.

Visit https://menopausecareonline.co.uk/ to find out more.

This article is for general information and does not replace individual medical advice. Treatment decisions, including whether HRT is appropriate, should be made with a qualified healthcare professional.