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December 2024.

Dr Ben writes a new Blog at the start of every month for our Man Shed section.

Don’t forget HRT in early surgical menopause

I received a very warm message from a loyal Menopause Matters reader last month and I must say her note was most welcome as it’s pretty chilly here in my frosty Man Shed today.

The lady – I’ll not use her real name, let’s call her Pauline – was generous in her praise for my last Man Shed blog post, in which I wrote about perimenopause and menopause. “I really enjoyed reading it,” she said. “It was well written and accurate.” Well, thank you, Pauline, you are too kind.

Everything seemed to be going well so far with this nice reader’s letter. (By the way, if anyone else wishes to drop me a line, please do. I’ll be pleased to hear from you and you can email me on [email protected].)

Pauline continued: “The only thing I'd like to mention is that it focused on natural menopause, explaining to men the need to be supportive of their female partners who are nearing the end of their fertile life, but let's not forget surgical menopause too.”

Pauline is spot-on. In fact, it’s not uncommon for women to have hysterectomy or surgical removal of the ovaries due to complications early in their fertile life.

Pauline went on: “Many younger women need to have a total hysterectomy well before the onset of natural menopause and are plunged into surgical menopause which can be brutal.

“I belong to a hysterectomy support group online and a topic that comes up frequently on there is that these women's male partners just don't understand that they are struggling with the sudden onset of a huge array of menopause symptoms, including mental health challenges.

“Sadly, many of these women are not offered HRT by their doctors, being told instead, ‘See how you go’, ‘Maybe you won't need it’, or ‘We don't like to prescribe it due to the risks.’”

I’m grateful to Pauline for raising awareness of this issue because historically the hormonal implications of this type of surgery have not been understood. And this is also rarely understood by the male partners of young women.

Hormonal regulation requires a complex cycle between the brain, ovaries and uterus as part of the wider system balancing a female metabolism. The shock of sudden removal of the ovaries sends the body into a rapid downward spiral unless carefully mitigated. Even removal of the uterus alone with ovaries being conserved can result in reduced ovarian function due to interference to the blood supply of the ovaries during surgery.

And let’s not forget these consequences need to be compassionately communicated to the patient and awareness raised with their loved ones.

This type of early menopause is often dramatic and unexpected, sometimes resulting from emergency surgery, perhaps even while the patient is unconscious, waking to find that their natural fertility and hormones have been lost in order to save them from life-threatening complications.

This can be a terrible shock and no one can anticipate the ensuing emotions as the significance of a future lack of fertility sinks in.

The majority of men in their 20s and early 30s have no awareness of these issues, but the impact comes later when we are faced with the prospect of adoption or complicated attempts at fathering a biological offspring.

If you are in a couple facing early surgical menopause, seek advice before the operation and ensure a hormone specialist consultation is part of your immediate aftercare.

I’d also advise you both to attend all appointments together so that you can be on the same page, enabling mutual support for each other.

Consider counselling early as this is a loss which needs to be grieved for and processed as part of your journey.

Pauline told me she was part of a support group, which is always to be recommended in such cases as other people may have advice to share having already travelled this challenging path themselves.

If you’ve got a question for Our Man in The Man Shed Dr Ben Sinclair, you can email him on [email protected]

Welcome to The Man Shed and I’m delighted to be your man in it!

My name is Dr Ben Sinclair (please just call me ‘Dr Ben’, everyone does), and I’ve been a GP for nearly 20 years. Bear with me a sec while I shift these spare paint tins and get my laptop set up…

If you’ve got a question for Our Man in The Man Shed, Dr Ben Sinclair, you can email him on:
[email protected].

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