Surgical menopause results from a woman having both ovaries removed, in an operation known as a bilateral oophorectomy.
In this blog, written for us by Helen Kemp the author of ‘Not Your Typical Menopause,’ she talks about surgical menopause – what it is, the impact it can have on those going through it and what to consider when you’re welcoming back a colleague to the workplace after their operation.
Before I underwent surgery that put me into immediate menopause in 2013, I hadn’t given much thought to menopause. In fact, I hadn’t given it any thought whatsoever. Neither periods nor, not surprisingly, menopause, were ever spoken about growing up at home. I don’t recall learning about menopause in school.
My surgeon assured me that most women make a full recovery within 6-8 weeks. From that I made the assumption that I’d be back to work by the 3-month post-op mark at the very latest. No problem.
The reality turned out to be somewhat different, and I now know I am far from alone in my experience. I had no clue. Which is why I am now a passionate advocate for increasing awareness around the topic of menopause as a whole, but surgical menopause in particular. Whilst it may be the case that after 6-8 weeks, you might look for all intents and purposes on the outside, ready to ‘rock n’ roll’, there will still be a significant degree of healing going on internally. If you had an abdominal incision, then muscles that were cut need time to strengthen and that simply doesn’t happen in a hurry.
With hindsight, maybe I should I asked my surgeon what they meant by the term ‘full recovery’. But for various reasons, I didn’t.
Surgical menopause can in some respects be quite brutal. And I appreciate that’s an emotive word, but the repercussions from having both ovaries removed can be significant. The fall out falls a long way, and both a woman’s physical and emotional health can take quite a battering.
But, back to the beginning. Surgery that involves the removal of both ovaries results in instant menopause. That’s what we mean when we refer to a “surgical menopause”. There are many reasons for this type of surgical procedure, known as a bilateral oophorectomy. For example, women who have an inherited risk of certain cancers may elect to have surgery to reduce their risk of later developing cancer. Or, it may be part of treatment for other issues, for example ovarian cancer, or the condition known as premenstrual dysphoric disorder (PMDD). Whatever the actual reason, it will result in menopause.
A woman in early (under the age of 45) or premature (under the age of 40) menopause has an increased risk of osteoporosis, cardiovascular disease, and may experience sexual dysfunction. For younger women, they face a loss of fertility. If having children was not on your radar screen, that’s fine, but for some women it can trigger powerful reactions of grief.
It’s not straight forward to find accurate figures for the number of oophorectomies performed each year. In the USA it’s thought to be around 200,000 per year. In Australia, it’s said to be 165 per 100,000 women and in the UK, some stats suggest 42 per 100,000 women which is significantly lower than parts of Europe, with 236/100,000 in Germany for example.
Whatever the number though, the very fact that it will happen to even one woman is reason enough to take it seriously. The resultant menopause is so much more than hot flushes and/or night sweats. Don’t get me wrong,either of those can be distressing and debilitating. But the symptoms that often floor women are the emotional and psychological ones. The rage, panic attacks, anxiety, mood swings, depression and paranoia. Combine just one of those with the often-present insomnia and you potentially have a perfect storm. Women end up walking away from their careers and in some instances their lives. I was almost one of them. I don’t think it’s a complete coincidence that the highest rates of suicide amongst women in England fall within the 45-49 year age range.
I walked away from my career of 20 years in 2014. I’d managed a forensic lab, worked with the Australian Federal Police and the FBI. And yet when I returned to work after surgery, I couldn’t think straight. I found being around other people overwhelming. I would be gripped by anxiety daily that made my hands shake. I was short-tempered, forgetful and I just wanted to tell everybody where to go in extremely explicit language. I was not a particularly nice person to be around. I was also confused, a little scared, and didn’t know where to go for help. I felt very vulnerable.
I was in hospital for 4 days after my operation and upon discharge, I took to the internet for information and insight, and signed up to an online community at www.hystersisters.com which allows women to track their recovery trajectories alongside those at similar stages in recovery. It’s a superb source of advice and support.
It was from this community that I learnt to expect pale pink/brown vaginal discharge around the 7-10 days post-op stage of recovery, as some of the internal stitches in the vaginal vault/cuff dissolve. Why though was that information not in my discharge documents? I left hospital with just two pieces of advice: lift nothing heavier than the equivalent of a kettle full of water for six weeks, and abstain from sex for the same period. That was it.
Menopause is not something that only happens to women in their early 50’s. The years leading up to menopause, the so called ‘perimenopause’ are when many women can start to struggle. I now recognise I was already in perimenopause before I had surgery to remove my ovaries and uterus. And yet once again, at the time, I had no awareness.
Surgical menopause was not the end of my health issues. I had swapped one set of symptoms (erratic, heavy & painful periods, bloating, pelvic pain) for a raft of others including gingivitis, seborrheic dermatitis, nausea, dizziness, hair loss, and the very delightfully termed ‘genitourinary syndrome of menopause’ or GSM for short.
It’s usually around this point that I start to feel the need to apologise, because good grief I sound like an absolute misery. But, here’s the thing. With the right help and support, I believe it is possible to rediscover joy, life can begin to have meaning again, we can thrive. Early intervention and effective, timely management are key though. As is having realistic expectations of someone in your workforce who is about to go through, or has gone through, a surgical menopause. Surgical menopause is not your typical menopause. Trust me.
Empathy and understanding are vital. Sounds easy, but in reality, those two can be the hardest to muster. It’s so much easier to just buy a desk fan and allow more frequent rest breaks. But unless empathy and understanding underpin a return-to-work policy, chances are you may well lose that member of staff in the medium, if not short term.
A woman returning to work after major surgery to remove her ovaries (and possibly her uterus too) will need time to adapt to her role. She will need time to adapt to the working environment again, to simply being around other people. It goes without saying that a phased return to work should be just the basic starting point. The job description may need to be adapted to reflect the (usually temporary) restrictions on various physical aspects of the job.If surgery included removal of the uterus, then there can be significant implications for the pelvic floor. Lifting or lugging around heavy items may not be possible for a while, or indeedin some instances, at all, ever again.
Adjustments to clothing may also be necessary. Not just in terms of fabric composition and colour, where pure cotton and light colours will be your friend, but for ease of wearability. Due to the nature of the surgery, many of us experience “swelly-belly” which can persist for months. I wasn’t in my pre-op trousers until the 6-month post-op mark. However, even then, if I had to be on my feet for any length of time, as the day went on, my abdomen would swell up. Sitting down, getting my legs up and resting was the only solution. Any garment that is tight around the waist can be uncomfortable, so loose fitting is the way to go.
I need to mention the tiredness. Many of us in surgical menopause report a “crushing fatigue” which seems to persist for years after surgery. It can strike at any point, even after a good night’s sleep. It’s not something that you can push through. It stops you in your tracks. The only way through it, is to stop, rest, and then continue. The rest period maybe a few hours, it maybe a few days. None of us ever know how long it will take.
Even in the case of laparoscopic surgery, without a large abdominal incision, the internal surgical work carried out will likely be equally extensive. In much the same way as matters involving our mental & emotional well-being, the fact that you cannot see very obvious scars, doesn’t mean we are 100% fully fit. Absence of evidence is not evidence of absence.
Some women in surgical menopause will decide not to, or will not be able to take HRT. That means they could be trying to find ways to manage the hot flushes and night sweats, the insomnia and anxiety etc, and that can take time. For a while, and this may even be a few years, it can be a case of ‘symptom whack-a-mole’, and that can be demoralising. We may continue to need time off to attend medical appointments. Compassion, empathy and understanding once again, are key. Patience and an open-door policy are enormously helpful. Having a line manager who is able to have a frank conversation about how vaginal atrophy is making it painful for their staff member to sit down for long periods, will help them to feel not quite so alone and isolated.
Please don’t shy away from the challenging conversations. That can potentially make the woman feel more shame than perhaps she already does. I had never mentioned my pre-existing mental health challenges, I’d navigated depression since my mid-teens, to anyone within my places of work. I was concerned I would be seen as unreliable and weak, and I know that feelings of shame prevented me from even bringing up the topic of how I wasn’t coping at all well at work after surgery. As the Texan researcher Dr Brené Brown says “shame thrives in secrecy”.
Why not consider offering your returning employee a few sessions with an independent trained councellor? There can be so many conflicting feelings and thoughts swirling around when we return to the workplace. There may be a sense of relief at having had the surgery, after all, it is major surgery, combined with feelings of bewilderment and loss. We are the same and yet we are undeniably changed. We may feel a burden, less feminine, less capable even. Chances are we may well be different to the person we were before surgery, and invariably we will need time to process that perplexing maelstrom of feelings and emotions.
What would have helped me, would have been knowledge that my HR Department had a living and breathing menopause in the workplace policy. An email from someone in HR to say, “I’m aware you’ve undergone a surgical menopause, please know there is someone here who is trained to listen and support you, now and in the future”. We need menopause buddies/champions, call them what you will, but women need to know they will be supported in the workplace.
Life after a surgical menopause can be a baffling wilderness with an ever-shifting landscape. Listen, support and continue to offer support not just in the weeks and months, but long after that. After all, a member of staff who feels listened to, understood and appreciated will likely stay in their post. And that is beneficial for everyone, employee and employer alike.
My story ends on a positive note. I found my way through the menopause jungle and now help other women do the same. Empowered women empower women. It’s that simple. I’ve started to enjoy life again. My energy levels and general motivation are better than they’ve ever been. My mood is more stable and I’ve found a creativity that I never had. What works for me is a multi-pronged approach.
Staying well is something that I have to actively work at, but it is worth it. I take medication in the form of antidepressants as well as HRT (oestrogen-only patch and testosterone). Exercise is now a non-negotiable part of my life and I run and indoor-row. Qigong and meditationalso underpin the other tools in my wellness toolkit, as does a whoppingly healthy dose of self-compassion. To quote the Dalai Lama – “If you want to be happy, practice compassion. If you want others to be happy, practice compassion”
Helen is a writer, editor, advisor and mentor. She is autistic and dyslexic, both of which make her life perplexing and exciting in equal measure. Dismayed by the lack of helpful information, she decided to publish the book she wished had been around before her surgical menopause. ‘Not Your Typical Menopause’ was published in April 2021 and is a unique collection of narratives around the topic of surgical menopause. Helen lives in deepest Scotland and shares her garden with a merry band of red squirrels.
You can connect with Helen on Twitter @SurMenoNYTM and on LinkedIn
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