A possible reason for this is that alterations to the ovarian blood supply occurred during surgery. Another common abdominal operation performed on women, sterilisation by tying or clipping of the fallopian tubes (tubal ligation), does not seem to cause an early menopause.
Recent studies show that approximately one-third of South Australian women and one-quarter of New South Wales women have had a hysterectomy by the age of sixty-five. Included in these figures are a number of women whose ovaries have been removed and who are therefore likely to develop more severe menopausal symptoms than the others.
The most common reason for hysterectomy is irregular, heavy and prolonged bleeding (lasting more than two weeks) that does not respond to treatment. This was the case for Roberta, who was forty-six when her uterus and cervix were removed. On the first occasion of prolonged bleeding she bled for fifteen days on end, after which her doctor recommended a hysteroscopy (a procedure that allows a doctor to view the inside of the uterus by inserting a small magnifying instrument via the vagina and cervix). This investigation did not reveal anything of significance and she was given progestogens (synthetic progesterone), which brought the bleeding to an end.
When a similar thing happened a few years later, a repeat hysteroscopy revealed several fibroids (fibrous growths that start in the muscle layer of the uterus, occur in up to 30 per cent of women, and are a common cause of profuse bleeding). Doctors gave Roberta a choice between putting up with the irregular and heavy bleeding, which they expected would subside after menopause (when fibroids usually shrink), and having a hysterectomy. ‘I coped with it for several more months but eventually I couldn’t take the bleeding, the lack of energy, and the feelings of uncertainty about when it would end’.
Given that irregular bleeding often occurs in the lead-up to menopause, it comes as no surprise to learn that most of the women in the New South Wales study who had had hysterectomies were aged between thirty-five and forty-nine years, with the highest rate in the forty-five to forty-nine age group.