Most women experience fluctuations in hormone levels with a gradual decline from 35-40 years onward. At times the decline can gain momentum but a convoluted, drawn out back and forth is most common over several years, causing many symptoms to mirror this pattern.

For a variety of reasons, women undergo hysterectomy. This could be full removal of the uterus and ovaries (Total hysterectomy), fallopian tubes and/or cervix or removal of the uterus only. There are some implications and differences in what women might experience as a result of these procedures but sudden symptom presentation is likely in all instances.

Roughly 55,000 hysterectomies are performed in the UK every year. Between 30,000 and 40,000 of these take place in the NHS. Globally, 1.2 million women can expect to undergo this form of surgery for reasons that range from heavy periods, fibroids, endometriosis, prolapse, cancer, and postpartum haemorrhage.

If your ovaries are removed during a hysterectomy, you will experience immediate menopause, irrespective of your age. This condition is referred to as surgical menopause. Conversely, if your ovaries are preserved during the hysterectomy, there is up to a 50% likelihood that they may cease functioning within five years, potentially due to the disruption of blood supply to the uterus. Additionally, radiation therapy following a hysterectomy for cancer may lead to premature ovarian failure.

Ovaries will still produce hormones after uterine removal and these can be an important supply of hormones in this event in the prevention of chronic disease such as osteoporosis. Libido can also be retained when ovarian hormones are left to produce hormones (including testosterone) without removal.

Having one ovary removed may mean that you experience menopause sooner than you would have.

During coaching sessions, many women share with me the lack of direction, explanation or guidelines for what they may encounter after surgery. And hormone replacement therapy (HRT) is not always offered as standard procedure. HRT can help alleviate some of the menopausal symptoms they may experience such as flushing, night sweats, sleep disturbance and joint pain, urinary tract and vaginal support as well as prevention of some chronic diseases. Of course, for some women, HRT is not an option and other interventions are discussed in session.

Natural remedies can also play a role in supporting symptoms of menopause after hysterectomy providing they do not conflict with other medications you may or may not take. Phytoestrogen compounds are documented with significant positive outcomes for us in easing the symptoms of menopause, whilst omega 3 fatty acids, vitamins and minerals as well as supplemental bacteria all have their place in overall health during menopause and in support of its symptom management.

A focus needs to be given to mental health support post hysterectomy however as women having undergone this procedure are more likely to suffer depression. Ovarian removal particularly, impacts neurotransmitters such as dopamine and serotonin which can impact mood in general as well as sleep and emotional regulation.

Again natural remedies can support in a number of ways in reducing anxiety, depression and low mood and these natural approaches are definitely gaining momentum. Anti-depressant medication is widely prescribed to the population at large and in some instances is helpful and needed.

Lifestyle interventions

Having a support network bodes well in most life stages and post hysterectomy, acceptance within yourself, your family unit, romantic relationships and even with co-workers depends on this. Women gain confidence, improved self esteem & body image and better health outcomes as a result of community support & understanding. (1,2). With the surge in app based technology support forums, in person and online, many group networks exist, providing we look and find them. Sometimes suggestions and sign posting is all we really to do in order to support a woman through this experience. Women need to feel confident to make informed decisions, in their own time.

Building bone mineral density (BMD) and muscle mass becomes crucial after hysterectomy as the drop in oestrogen with ovarian removal can reduce both. Longer term risks of low bone mineral density include osteopenia, osteoporosis and bone fractures.

Whilst lower muscle mass in linked to increased fat deposition, lower physical function and poorer quality of life. (3,4) Resistance training helps support both muscle mass and BMD.

Greater muscle mass is associated with improved insulin activity, which can lower the risk of developing type 2 diabetes. Engaging in resistance training is one effective way to increase muscle mass. It not only builds stronger muscles but also improves the body’s ability to utilize glucose effectively.

Dietary factors to embrace

1. Polyunsaturated fatty acids (especially omega 3 and 6) may effectively mitigate low-muscle-mass risk. (5) Supplement with Omega 3 if you don’t eat much oily fish each week and aim for 500mg to 1g of EPA specifically.

2. Quality protein is key to increase satiety and prevent sugar cravings, eat enough so that your overall ratio of protein matches carbohydrate intake or more.

3. Reduced sugars and starch in your diet will support hormone balance in general as well as gut bacteria and immunity, reducing the chances of the dreaded meno belly. Watch out for those bread, pasta and rice dishes as well as the obvious added sugars, juices and sweet treats.

4. Antioxidant nutrients work towards reducing oxidative stress on the body as a whole but play a crucial role in brain health & aging Eat the rainbow of vegetables and investigate some specialist antioxidant supplements in the initial stages post recovery and then as a top up every couple of months.

5. High fibre intakes (30g or more each day) is well established in supporting metabolism, gut health, longer term health, blood sugar balance and more. Eat as many greens as you can as well as pulses and legumes for both soluble and insoluble types of fibre.

References

1. Pinar G, Okdem S, Dogan N, Buyukgonenc L, Ayhan A. The effects of hysterectomy on body image, self-esteem, and marital adjustment in Turkish women with gynecologic cancer. Clin J Oncol Nurs. 2012;16(3):E99–104. doi: 10.1188/12.CJON.E99-E104. 

   
   

2. Wu SM, Lee HL, Yeh MY, Che HL. Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective. J Clin Nurs. 2014;23(23–24):3366–3377. doi: 10.1111/jocn.12580. [

    

3. Prado CM, Purcell SA, Alish C, Pereira SL, Deutz NE, Heyland DK, Goodpaster BH, Tappenden KA, Heymsfield SB. Implications of low muscle mass across the continuum of care: a narrative review. Ann Med. 2018 Dec;50(8):675-693. doi: 10.1080/07853890.2018.1511918. Epub 2018 Sep 12. PMID: 30169116; PMCID: PMC6370503.

   
   

4. Camargo Pereira C, Pagotto V, de Oliveira C, Silveira EA. Low muscle mass and mortality risk later in life: A 10-year follow-up study. PLoS One. 2022 Jul 28;17(7):e0271579. doi: 10.1371/journal.pone.0271579. PMID: 35901119; PMCID: PMC9333286.

   
   

5. Zou H, Zheng L, Zeng C. Polyunsaturated Fatty Acids and Reduced Risk of Low Muscle Mass in Adults. Nutrients. 2025 Feb 28;17(5):858. doi: 10.3390/nu17050858.