Chemical (Lupron) vs Surgical vs natural menopause

I'm currently undergoing chemical menopause due to a three month Lupron (GnRH/Prostap) injection. So far it's been fine and far better than before the injection despite feeling boiling hot for a few hours every day and having a big bleed.

Some of the things I need to decide are whether to go through with a hysterectomy at all or just have an endometriosis clean up and, if I do opt for a hyst, whether to leave my ovaries or not.

Why is is that surgical menopause following ovary removal is said to be so hideous compared to natural menopause? Is it just that it comes on so much faster that we don't have time to adapt to and cope with the symptoms or are the symptoms genuinely much worse?

If I'm doing OK, although it's early days, with chemical menopause is surgical menopause going to be any worse than this?

Do women tend to find that their experience of chemical menopause following Lupron injections prior to surgery is similar to their menopause experience following their hysterectomy?

I guess I hoped that if I took the Lupron first then I'd be half way adapted and used to coping with the menopause aspect of things before any hysterectomy menopause symptoms kicked in. Am I being hopelessly hopeful?

Hi Ruby2010,

One major feature of surgical menopause is that IT IS FOREVER! Well, for the rest of your life, anyway. You can't ever go back to the way you were if you find it difficult. I never had Lupron, so never experienced ovarian suppression, but from what I can gather through research, it is just that, suppression, not the complete elimination of ovarian function. There's a big difference.

In spite of what many doctors tell you, the ovaries do much more than make estrogen and eggs while we're young. They continue to make several hormones well after menopause and are an important part of the whole endocrine system, even the parts that aren't related to sex. Though it's true that the adrenal glands do take over most of that function after menopause, women experience varying degrees of awfulness after having their ovaries removed from "I can handle this" to "I wish I was dead". Some of that seems to be related to whatever led to the surgery in the first place, some to how close to natural menopause they are at the time of surgery. I have read posts from women here who had been through natural meno, then had their ovaries removed and had a return of hot flashes and all the other delightful symptoms they experienced before. So obviously their ovaries were still producing some estrogen. I don't know where you are on the timeline, but I'm assuming you are still cycling, hence the Lupron.

So to answer your question, yes, surgical menopause usually hits much harder than natural menopause because it happens within hours in the OR instead of over years like the natural form. It also eliminates all ovarian function immediately instead of just reducing it. My own experience was fairly typical, I think. I was still cycling when I had my surgery at 50, was put on an estrogen patch on the OR, felt OK for about two months and then WHAM - anxiety, depression, hot flashes, shaking, etc. It took me another six months before I found the right hrt to feel normal again.

Now I know someone will post with a "they took my ovaries and I never looked back" story. But if I could have (I couldn't), I would have kept my ovaries. Preserving ovarian function is important for many reasons, physical and psychological. And it's not just my personal opinion, there is research to back this up :

" Bilateral oophorectomy during hysterectomy for benign disease is associated with a decreased risk for breast and ovarian cancer but an increased risk for all-cause mortality, coronary disease, and lung cancer, according to the results of a prospective, observational study reported in the May issue of Obstetrics & Gynecology.

"Bilateral oophorectomy at the time of hysterectomy for benign disease is commonly practiced to prevent subsequent development of ovarian cancer," write William H. Parker, MD, from the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, and colleagues. "Oophorectomy before menopause leads to an abrupt reduction in endogenous estrogen and androgen production....Later age of menopause has been associated with a reduced risk of death from coronary heart disease and stroke, and studies show that preserving ovarian function is associated with a lower risk of coronary heart disease."

So, my advice for what it's worth is: if you can just deal with the endometriosis without removing parts, especially the ovaries, that would be best. But only you and your doctor know your actual situation and what the best decision is in that case.

Not sure if you mentioned how old you are. I had a 3-month dose of Lupron given to me one month before my hyst. w/ ovaries out... due to severe endometriosis. By the time I was given Lupron, I was having severe episodes of right-sided and abdominal pain. I am very thankful that I no longer have any of that (at almost 2 years post hyst.), but I do kind of grieve the loss of my ovaries. I do not miss the pain they gave me, or the up and down surges of estrogen that I had (I was one month shy of 47 when I had the surgery). But I do miss the lubrication that they provided (among other things).

I am not sure if it was due to the Lupron effect or the LSH/BSO, but I had bad depression about 2 1/2 months out from my surgery, even though I was put on .05 Vivelle Dot the day after. Was it the Lupron or just regular surgical menopause, I do not know. But it was not pretty! The good news is that about 6 months out I suddenly realized that I was feeling really great!

I've been doing well until a couple of months ago when I started having breast tenderness issues, and I've been trying to reduce the patch, but it's been a rough go. We'll see...

Anyway, I'd agree with the other poster that surgical menopause is quite rough! Once your ovaries get taken out, they can never be put back. That's why doctors often try to just do Lupron for awhile and see if they can get the patients to make it to natural menopause when endometriosis usually subsides on its own. I think I'd try for that first, except that (in my case) I had a goretex patch from a previous myomectomy that was adhered to my bowel and almost perforated it, plus the endo had started to mess with my ureter. I am really thankful that I had the skilled surgeon that I had and that he took care of the big wadded mess I had inside of me (due to severe adhesions and endo).

If you decide to get the hysterectomy, I'd get a surgeon that I really trusted and have them decide while inside, viewing your ovaries, if they really need to come out or not. That is what my surgeon did, and he decided that they needed to come out.

I have had 3 surgeries: a myomectomy (which actually had a rougher recovery time except for the surgical menopause aspect of the hyst.), a laparoscopy due to an endometrioma that was found, and then the LSH/BSO. About 8 or 9 years passed between the first and the last surgery, which I now view as valuable time in which I was able to keep my ovaries.

Best wishes to you, and God bless as you and your doctor determine what is the best course of action for you!

Brenda

Thank you for this question. I feel like you read my mind and thoughts. I am scheduled for surgery on June 3rd and they will decided when "in there" if one or both overies go.I have been thinking some of the same thoughts becuase I am on lupron right now and have terrible endo. Thanks again for asking and I have enjoyed reading the posts. Kris

Thanks for the posts people, it is reassuring ad helpful. We've been talking at home and I think a hysterectomy and cleaning up of the endo as much as they can is something we both feel will be of immense help.

I'm leaning towards asking them to view the ovaries when in there. I have constant right sided pain, feels like I've either got a severe stitch from running badly when mild and, at worst, makes me feel light headed enough that I wonder if I'm going to pass out. This makes us wonder if there's something not right with that ovary.

Both sides seem to be very polarised about ovaries. It's either a strong feeling that they should be left in due to terrible expereinces post removal or feedback that they went and it's not been a problem. No grey areas. It's been interesting to see the number of women though that seem to need their ovaries removed within five years of haivng a hysterectomy, whether that be due to fibroids, cysts or endo.

Repeat surgeries is something we need to try and avoid.

I asked my dh about it last night, and he said he is really glad I had the ovaries out. And I do have to say that s*x has been much, much better for us ever since about 6 months out from the surgery, as I no longer have had pain or uncomfortableness during int*rcourse! It's just that I often need an extra lube job from K-Y, etc.

I did lots and lots of research prior to my surgery, too, and I noticed that women who kept their ovaries when they had a hyst. and endo, very often had to have an additional surgery to get the ovaries removed. Also, they had to deal with wild surges and drops of estrogen. I love the fact that I can have a consistant measured dose of estrogen now, instead of those wild and crazy swings.

Did you have an ultrasound done? Mine had shown the surgeon that my ovaries had shriveled up some and were obviously not where they were supposed to be (due to adhesions). I was having pretty significant right-sided pain by where my right ovary was, too, prior to the surgery.

Another consideration is that I have heard it is much more difficult to remove endo in a procedure done after you've already had a hyst, so that could be something else to consider as well. However, please remember that I am no expert whatsoever... so just be sure you have a surgeon you can trust and let him take care of you!! The surgeon I had was actually referred to in a big, huge book on endo by Mary Baldwn (I think???), and he has taught many other doctors about how to use the laparscopic method for doing hysterectomies, so I knew I was in good hands! Also, I had lots and lots of people praying for me, and I know that God was ultimately the one who oversaw the whole operation and guided the surgeon's hand. My bottom-line trust has been in Him (no better place to be)! In fact, I remember that Ps. 103:1-3 was a great help to me right before my surgery... "Praise the Lord, O my soul; ALL MY INMOST BEING, praise his holy name. Praise the Lord, O my soul, and forget not all his benefits- who forgives all your sins and heals all your diseases..."

Brenda