Surgical menopause: definitions

For those of us in surgical menopause, the most striking difference between us and any other woman is that we no longer have ovaries. Ovaries are glands that fulfill two functions in the body. They produce the eggs that allow us to have children, and they produce three hormones (estrogen, progesterone and testosterone) that have wide-ranging effects throughout our bodies.

While many of us experience grief at the loss of our ability to produce children, we have to remember that a hyst is a TANSTAAFL situation where in order to have a higher level of health in our life (or life at all), we had to give that capability up. We may not necessarily be too pleased about it, but the fact is: we can live without the further capability of reproducing.

The loss of our hormones is another story, and that's the big one we're grappling with here. Because there is a lot of confusion as to the difference between our situation and that of any woman as she ages, we're going to clarify the difference before we go on to look more closely at what our ovarian hormones in particular do for us.

Menopause is when a woman stops ovulating and menstruating due to a state of lowered ovarian hormone output. In most cases, this happens naturally to women as they age, and thus is distinguished from surgical menopause by being called “natural menopause.” In surgical menopause, not to belabor the obvious, it's the surgical procedure of removing the ovaries that causes the hormone output to plummet. The two states are different in that in natural menopause the ovaries continue to put out low levels of hormones whereas in surgical menopause, there isn't a shred of ovary left to put out any hormones.

The ovaries are not the only producers of ovarian hormones (by which we mean estrogen, progesterone and testosterone) in the body—only the most prolific and efficient producers. You can also obtain the ovarian hormones by other routes, both endogenous (inside the body) and exogenous (outside the body). Let's look at some of these, since they are important to understanding our new bodies.

Endogenous hormone sources

There are four major mechanisms by which we produce estrogen, progesterone and testosterone in our bodies.
  1. The primary endogenous ovarian hormone source is, as we've said, the ovaries.
  2. There is a fatty layer over the belly that is made up of a special kind of fat, and it's called the omentum. One of the roles of the omentum is to produce a weaker variety of estrogen called estrone. This is the primary source, in addition to lowered but continued ovarian output, of estrogens in the naturally menopaused woman. How much estrone the omentum puts out is a matter of individual variation, but clearly the larger the fat belly, the more material there is to work with. This is not a call to chub up, but it is one reason why one woman's needs are different from another and why high-body-fat women may need fewer exogenous hormones than smaller skinny ones. The body's innate reliance on this mechanism is also part of the reason why post-menopausal women have those little apple pot bellies—their bodies are maximizing their remaining hormone production.
  3. The third level of hormone production is mediated by the adrenal glands and utilizes cholesterol as its most basic building block. When the hypothalamus (a part of the brain) senses a deficiency of ovarian hormones, it sends out a panic signal that puts the adrenals into overdrive making up for that deficiency by a lot of chemical juggling and sleight of hand that turns cholesterol into the needed ovarian hormones. Unfortunately, it can't match the ovaries' level of output, and while it's trying, the competition between all the other systems that rely on adrenal capacity can get ugly. If it goes on too long, the whole systemic balance of the body starts to crumble, like the proverbial row of dominoes. Like what? Well, adrenal hormones affect your day/night cycle (including sleep), your stress response capability (stress that goes on too long can rob your bones of strength), your metabolism (hot/cold, fatigue, glucose metabolism), your psychological equilibrium, and your immune system. This is not trivial stuff.
  4. Increasing evidence shows that other parts of the body (some nervous system cells, for instance) manufacture small amounts of hormones. While they are not enough to get by on alone, they may produce enough that the sum package explains why one woman's needs are not another's.

Exogenous hormone sources

In addition to endogenous hormone sources, there are many exogenous sources of hormones—that is, things that we take into our bodies that exert hormonal actions. Although the biggie we think of immediately is hormone replacement therapy (variously referred to throughout this site as HRT or hrt, since we're not absolutely reliable about the caps thing), that's not the only way to take in hormones.

Another significant source of hormones that is attracting increasing attention from health care providers and agencies is what are called xenoestrogens. These are estrogens or estrogenic compounds that are found in the environment in the form of pesticides and industrial chemicals, in packaging materials, in our toiletries/cosmetics, and in our foods as naturally-occurring phytoestrogens (as in soy foods, for example) or perhaps the foods themselves (such as red meats) or the hormones given to the animals we eat. You can read more about xenoestrogens from Tulane University and Cornell. The bottom line on xenoestrogens, however, is that we may have a significant hormonal intake without ever being aware of it.

This isn't just quibbling. If we think about it, we can all identify some woman we know who never took a hormone in her life and lived to a ripe old postmenopausal age with nary a sign of hormonal deficiency. Since hormonal actions in our bodies can only be carried out by hormones, how do we explain this paradox? Are the need for ovarian hormones and the menopausal symptoms that need creates something that we get over? If we just grit our teeth and persevere, will we “get through” menopause and come out the other side fine?

Not at all. The fact that women in natural menopause seem to “get over” menopausal symptoms only demonstrates that their bodies are capable of scraping together enough endogenous and exogenous estrogens to get by and that they adjust to the changes sub-optimal hormone levels cause in their bodies. Some do fairly well at it, others die or are horribly crippled by their failure to maintain adequate levels—even though those deaths or diseases may not be attributed to an underlying hormonal deficiency.

Similarly, in surgical menopause, there are a few—very few—women who, without using HRT, take in and make enough hormones that they do not experience the more obvious results of hormonal deficiency. But the stresses that this adaptation causes can in turn create other health problems.

There is an unfortunate mystique among women today that insists that a strong woman is able to rise above menopausal discomforts, that to replace hormones is at best giving in to a medical/pharmaceutical plot and at worst a sure road to cancer. This political kind of reasoning suggests that it is somehow better to struggle along in marginal health than to replace, in reasonable functional quantities, the chemicals we've lost. Don't get us wrong: we're not buying into that “eternal youth” stuff. But we have a lot of years ahead of us, and we're just not willing to live it in an ever-deteriorating condition. No one thinks to tell diabetics that using insulin (a hormone) is morally weak or that a hypothyroid person (one lacking adequate thyroid hormone) is better off putting up with the symptoms of their imbalance, even though both of those hormone-deficiency states can be “natural” parts of aging too. While there are valid physiological reasons why some women should not take hormones, wishful thinking or moral righteousness may not be enough to keep you healthy.

For a woman in surgical menopause, there is no way to fulfill the vital functions hormones played in her body other than with hormones. She can replace them by taking pharmaceutical hormones, she can manufacture some herself, or she can get them from food sources or environmental contaminants. But without hormones from one source or another, she will exist in a deficiency state with all that deficiency implies for her health and wellbeing. Although study results vary according to exactly what is being tested, several research studies have shown that women who took HRT are living up to about 10 years longer than those who didn't. We find that fairly impressive.