A hysterectomy is the surgical removal of the uterus. While this procedure fundamentally changes reproductive anatomy, its impact on the timing of menopause is not always straightforward. Whether or not a person experiences menopause, and when, depends almost entirely on which other organs, if any, are removed during the procedure.
Partial Hysterectomy and Ovarian Retention
A partial hysterectomy, also called a supracervical or subtotal hysterectomy, involves removing the upper part of the uterus while leaving the cervix in place. The defining factor regarding menopause is whether the ovaries are retained, as their removal is a separate surgical decision. When the ovaries are not removed, the procedure is sometimes referred to as “ovary-sparing.”
The ovaries are the primary source of the reproductive hormones estrogen and progesterone. Since the ovaries remain functional after an ovary-sparing partial hysterectomy, they continue to produce these hormones. This means the patient does not enter immediate surgical menopause. The uterus is a target organ for these hormones but does not produce them.
Retaining the ovaries allows hormonal production to continue, preventing the sudden onset of severe menopausal symptoms. The procedure itself does not trigger an immediate menopausal transition. The continuation of ovarian function means a person with a partial hysterectomy will still experience the natural, age-related decline in hormone production later.
The Timing of Natural Menopause
For individuals who retain their ovaries after a partial hysterectomy, the menopausal transition occurs according to their natural biological timeline. Natural menopause is defined by the gradual decline of ovarian function and the eventual stopping of hormone production. The average age for the onset of natural menopause is around 50 to 51 years.
This process, known as perimenopause, often begins several years before the final menstrual period, marked by hormone fluctuations. In contrast, surgical menopause is the immediate onset of symptoms caused by the bilateral removal of both ovaries (bilateral oophorectomy). The sudden drop in hormone levels during surgical menopause leads to more intense symptoms than the gradual decline seen in natural menopause.
While a partial hysterectomy does not cause surgical menopause, evidence suggests it may slightly accelerate the onset of natural menopause. Some studies indicate the procedure might lead to menopause an average of one to four years earlier than expected. This acceleration is hypothesized to be due to a potential alteration in the blood supply to the ovaries that occurs when the uterus is removed.
Navigating Menopause Without a Uterus
The removal of the uterus eliminates menstruation, meaning a person with a partial hysterectomy will no longer have a monthly period. This loss of menstrual cycles removes the most obvious marker for tracking the onset of perimenopause, which is typically characterized by changes in period frequency and flow. Tracking the transition must therefore rely on non-menstrual symptoms.
Patients should monitor the physical and psychological changes characteristic of declining ovarian function. These symptoms include vasomotor changes like hot flashes and night sweats, shifts in mood, difficulty sleeping, and vaginal dryness. The appearance and increasing frequency of these specific symptoms are the most reliable way to recognize the start of the menopausal transition.
When symptoms become pronounced, or if there is a concern about early onset, clinicians can use specific blood tests to confirm the stage of the transition. Testing for the levels of Follicle-Stimulating Hormone (FSH) and estrogen can provide objective confirmation of menopausal status. As ovarian function declines, the pituitary gland releases higher levels of FSH in an attempt to stimulate the ovaries, offering a measurable marker of the transition in the absence of a menstrual cycle.