Living Through Surgical Menopause: Hysterectomy

Last September, I had to have a hysterectomy. I had been living with severe pelvic pain for years, but the pain had started to get worse, traveling down my right leg, sharp stabbing pains in my lower right abdomen, child labor type cramping, and nagging lower back pain. Some months I would have trouble standing up straight the pain was so bad. I was scheduled to have a laparoscopic hysterectomy where the doctor would be removing one ovary, my uterus, and one Fallopian tube. He was hoping to save my other ovary so that I would still have some hormones pumping through my body for a few more years. I was 39, and still had a few years to go until I hit natural menopause.

When my surgeon began the surgery laparoscopically, he found out that I had a very severe case of endometriosis. I had never been diagnosed with endometriosis in all of my years of horrible cramps and irregular periods. I'm not sure why this diagnosis was never made, because all the telltale signs were there, with the exception that I never had any trouble with infertility. Upon opening me up, he discovered I had severe adhesions all over my pelvis, and he had to do a large abdominal incision to be able to clear all of these fibrous tissues out of me. He could not save the other ovary or tube, and my appendix ended up being taken out also. The appendix explained the lower right abdominal pain I had been having for months. My ovary and tube on my right side had become attached to my uterus in a "big ball" was how he described it. The endometriosis had changed the placement of my pelvic organs. Additionally, I had some of the endometriosis on my large bowel. He said in his 25 years as a GYN surgeon, I was in the top ten of worst endometriosis cases he had seen. What a mess I was.

Since I had such a severe case of endometriosis, my doctor decided to not put me on estrogen. I would be put on a dose of progesterone to hopefully kill off the remaining endometrial tissue that he was not able to get through the surgery. Estrogen makes the endometrial tissue grow, so he felt that I would be best off by not having estrogen for three months.

The night after my surgery while I was in the hospital, I had horrible itching all over my body. I had assumed it was from the morphine, but the nurses explained that this was a symptom of estrogen withdrawal. The fun was already beginning.

I recovered really well from the surgery. My doctor came in to check on me in my room the next morning and was surprised to see me looking really healthy and moving around easily. He said people who had put up with as much chronic pain as I had were able to tolerate recuperating from a major surgery easier than most people. He released me that day.

I went home and my life without estrogen had begun. To start with, the first few days after my surgery I was extremely angry. Mostly I was angry that I had a condition that had not been diagnosed that could have been treated years ago so that it wouldn't have gotten to the point it had. My moods were all over the board, alternating between gratitude that the disease had not affected my ability to have my two sons, and anger at my doctors for putting off my hysterectomy for months while I controlled horrible pain anyway that I could.

I didn't sleep well for the first few weeks after my surgery, but that seemed pretty normal because there wasn't really a way to lay down that was comfortable. I seemed to be most comfortable walking around. I did a lot of roaming around at night these first weeks of recovery, and I think it really sped my recuperation. My body healed very fast.

I wish I could say that I adjusted to menopause as easily. The hot flashes during the day were annoying, but the night sweats were becoming unbearable. I had not had one good night's sleep since the surgery. I had no trouble falling asleep, but I would wake up horribly hot and uncomfortable anywhere from five to ten times a night. When I went in for my four week post op visit, I complained to my doctor of headaches, and he noticed that my blood pressure was up. He said both of these were symptoms of having no estrogen. The fact that I wasn't getting good sleep could account for the headaches and the high blood pressure. He said he would be putting me on estrogen in December.

I counted down the days until December. When I finally had my appointment with the doctor in December, he informed me that he would prefer that I hold off on the estrogen until May, or "as long as you can handle it." This was a very disappointing day for me. He felt that my endometriosis was so bad that I shouldn't take any chances with the estrogen at this point. He also said pathology found that my uterus also had something called adenomyosis, which is when the endometrial tissue grows into the muscle wall of the uterus, and then bleeds during the monthly cycle causing pain. In addition to the awful hot flashes, I told my doctor that I had no interest in sex at all. He said that without the hormones, women complained about not having that "spark" in life or spring in your step. That was a very good explanation of how I had been feeling. My blood pressure was still up, but the headaches were starting to go away. I still hadn't had a good night's sleep. I also had noticed that I would occasionally leak a little bit of urine out of the blue. It didn't happen during a sneeze, or while laughing, just randomly without warning. Apparently estrogen deficiency causes the muscles around the ureter to slacken.

By the end of February, I started having some disturbing bleeding. There was nothing left in me to bleed, so I had no idea what this would be from, and I was almost six months post op. I called my gynecologist office, and they got me in first thing the next morning. I was extremely scared, because the only thing that kept running through my head was cancer. Luckily, it was only a routine vaginal infection that could be cured easily with antibiotics. My nurse practitioner asked me if I was doing great after having the hysterectomy. I told her it was great to not be in pain anymore, but the menopause was killing me. As I was telling her this, I burst into tears. I told her I felt depressed and exhausted all of the time. I hadn't slept decently in almost six months time, and I was miserable. I have been on an antidepressant for a few years now already. She had assumed that I was on estrogen, and told me that I needed to call my doctor ASAP and ask to be put on estrogen. I called his nurse that afternoon, and they phoned in a prescription to my pharmacy. The nurse said it may take a couple of weeks to feel the effects of the hormones.

It has been almost three weeks now since I started taking the estrogen replacement, and I am happy to say that I am now sleeping soundly at night. I am rarely having hot flashes during the day anymore. My mood is much better, and I have energy and am getting things done around the house that I have put off for months. It is amazing what can happen to you when you cannot sleep. The annoying urine leakage problem is gone. My sex drive is still pretty nonexistent, but I'm hoping with time that will come back. If it doesn't, I'll be asking for some testosterone at my next appointment in May.

So, I didn't make it until May without estrogen, but I did go for six months without it. During my time without estrogen, the main feeling that I felt was that I was all alone in my suffering. The women I knew that had hysterectomies at my age had all had hormone replacement immediately. They were given estrogen while still in the hospital recovering from surgeries. Women who are in natural menopause get to go through the change gradually. There are hundreds of articles out there about dealing with menopause, but none of them talked about my situation. All of those homeopathic remedies, soy, herbs, what have you, all were to add back some estrogen, and I was supposed to be avoiding the stuff. For those of us, (and for now I'm the only one I know but there must be more out there) who have to go through surgical menopause "cold turkey," I can only say I feel for you. This was the toughest year of my life. From the six months of horrible pain before my surgery, to the six months of life without estrogen, I wouldn't wish this on my worst enemy. Recovery from the surgery was the easy part, ironically. I am hoping that I have not made a mistake by starting on estrogen earlier than my doctor had advised, although I did go as long as I could take it. I pray that the endometriosis does not come back, and I have a pretty good feeling that it will not. I had a very skilled surgeon. For now, I'm relieved to have that little pill each morning that makes a world of difference in my life.