Technically speaking, these latter individuals will experience natural menopause. Of course, it's a little more difficult for them to tell when their last real cycle is because they won't have periods to mark them, but when they begin to experience the symptoms of perimenopause, they'll be the same classic ones most of the population sees.
The only real difference that is likely to be obvious will be that anyone who has had a hysterectomy, even if they retained their ovaries, may go into menopause earlier than they might otherwise have done. When they do, especially if it comes particularly early, they may also find that their post-fertile ovaries don't really provide the same level of hormonal support as they might have done had they never been subjected to the disruptions of surgery.
We're not saying this to worry you if you're not there yet. But it's a possibility—by no means a certainty—to be aware of. While the ideal of natural menopause is that our aging ovaries continue to obligingly pump out enough hormones to meet our post-fertile needs, anyone who has had a hyst should be prepared to revisit that issue if it turns out that they arrive at menopause only to find they're not actually feeling so great about their coverage. Those of us who thought they might get away without having to deal with the whole concept of hrt may end up needing to revise that plan.
In general, the same strategies the vast majority employs to ease ourselves through the upheavals of perimenopause will pertain to this variety of natural menopause as well. Those of us with mild ovarian impairment may find that the over-the-counter nutraceuticals or soy estrogens in popular use may provide all the helpful boost they need to make up the gap between what their own ovaries make and what they need to maintain health and wellness. Others, though, may find, once perimenopause has settled down, that they still aren't meeting their needs well enough and they may want to go on to work with hrts to supplement themselves back up to a comfortable level of hormonal support.
Does not having a uterus change how I should use hrt?
Instead, for these individuals in natural menopause without a uterus, any progestogen needs only to be supplemented to a level that meets their actual, demonstrated needs for it. We don't need it just on spec—our ovaries and adrenals take good care of providing for most of our needs and if we're meeting our estrogen needs well, we should have plenty of progesterone available to meet our post-fertile needs for it without supplementation. Additionally, more recent study data about the risks of progestogen exposure make unnecessary use of progestogens much more questionable than it was even a decade ago. But if some needs remain after we have adjusted our estrogen as well as we can, then we have the information we require to go on to work on meeting our progestogen needs more fully with supplementation.
Are there any other special situations that will guide my choices of hrt?
The obvious one is endometriosis, which often requires a progestogen-heavy hormone imbalance for best suppression of endo growth. Other health needs that might guide hrt use and choices would include cancer risk or blood clotting disorders.
And there may be others. The point is, we need to remember that we don't use hrt in a vaccuum: it does have to fit with the rest of our life and health. But aside from not needing a progestogen to protect a uterus, whose of us experiencing this variety of natural menopause have all of the choices—and risks—of any other person in natural menopause.
