Will I still go through menopause after hysterectomy? Exploring sex and menopause symptoms after hysterectomy
If you or someone close to you has undergone a hysterectomy, you may have questions about sex and menopause. Life after hysterectomy can be a difficult and confusing time. For others, it might have provided the relief you've longed for. Whatever your experience, we've put together some common FAQ's to help you navigate sex and menopause after hysterectomy.
What is a hysterectomy, and why is it performed?
Hysterectomy is the removal of the uterus (womb). It might surprise you to learn that hysterectomy is one of the most common surgical procedures in women globally , with 600,000 performed in the US each year . For premenopausal women (women who have not been through menopause yet), the ovaries are usually kept intact , but this is not always the case. Some hysterectomies include the removal of the ovaries, which is known as an oophorectomy.
The decision to remove the ovaries depends on the reason behind the hysterectomy and your general health. If you have already gone through menopause, or are close to menopause, then you may be advised to remove your ovaries, to protect against ovarian cancer in the future.
Hysterectomies are performed for many reasons, including conditions such as:
- uterine fibroids
- heavy menstrual bleeding
- pelvic pain
- prolapse of the uterus
- cancer 
What is menopause?
All women will go through menopause at some point in their lives. Menopause is confirmed when you no longer have periods and is diagnosed when you've gone without a menstrual period for 12 consecutive months. Most women start this transition (often called perimenopause) in their 40s.
The average age of reaching menopause is 51 , but surgical menopause, or menopause brought on by medical intervention, can be sudden and severe. You may skip the perimenopause stage and go straight into menopause, giving you little time to prepare. You might also experience a range of physical and emotional symptoms related to menopause, explained later on.
Menopause after hysterectomy with ovaries intact
Whether or not you will go through menopause after your hysterectomy depends on the type of surgery you have.
If your ovaries are removed during the hysterectomy, you will go through menopause immediately after the operation. This is known as surgical menopause.
But, if you keep one or both of your ovaries, you won't enter surgical menopause, but there's a chance you'll experience menopause within 5 years of the operation. You may also experience menopause symptoms, such as hot flashes for a short time, immediately after your surgery. These symptoms should improve as you heal from your surgery.
Menopause symptoms after hysterectomy
While there are many as 48 symptoms of menopause , your personal experience will be unique. There is no rulebook for what you will experience and for how long.
After a hysterectomy, you may experience some of the following menopause symptoms:
- Vaginal dryness (vaginal and vulva dryness is common in as many as 90% of post-menopausal women) 
- Hot flashes
- Night sweats and/or cold flashes
- Urinary urgency and UTIs
- Difficulty sleeping (insomnia)
- Emotional changes (irritability, mood swings, anxiety, brain fog, or mild depression)
- Breast tenderness
- Worsening of premenstrual syndrome (PMS)
- Hair loss
- Acne and skin changes
- Decreased fertility
- Weight gain
- Joint pain and muscle tension
- Changes in sex drive
Emotional effects of hysterectomy menopause
After a hysterectomy, you may experience some emotional disturbances or mental health symptoms related to menopause. These are common and treatable, so there's no need to suffer in silence.
Symptoms may include:
- Brain fog
- Confidence and self-esteem decline
Irritability and mood swings 
Speak to your doctor, therapist, or healthcare provider if you have any mental health concerns.
Do you still have a menstrual period after a hysterectomy?
No, after a hysterectomy, you will no longer have period, regardless of your age.
If you do not have your ovaries removed as part of the hysterectomy, you will continue to produce hormones and have hormonal menstrual cycles, but without bleeding.
Do you have to take hormones after a hysterectomy?
You may be offered hormones after your hysterectomy, but whether you take them is entirely your decision.
If you have your ovaries removed, you may choose to take Hormone Replacement Therapy (HRT) to replace some of the hormones your ovaries used to produce. This can help to relieve many of the menopausal symptoms you might experience as a result. HRT is also known as Hormone Therapy or Estrogen Replacement Therapy, and it works by replacing hormones that are low including the use of replacement estrogen.
Sex after total hysterectomy
Hysterectomy is a major surgery, and it is common to experience some side effects that might initially affect sex . After recovery, many women can enjoy sex as they previously did. You'll need to avoid putting anything in your vagina for at least 6 weeks after hysterectomy, but it's always best to get your doctor's advice.
While there may be emotional and physical symptoms to work through after a hysterectomy, it does not fundamentally affect a woman's ability to enjoy sex . If you experience vaginal dryness (itching, irritation, burning, or pain in the vagina), consider trying a vaginal moisturizer or hydrating water-based lubricant. These can ease dryness and the associated discomfort and hydrate vaginal tissues naturally.
Some women may experience sexual problems after hysterectomy. These can include:
- Loss of sex drive
- Vaginal dryness
- Pelvic floor weakness
- Change in sexual sensation
During menopause, your estrogen levels decrease, causing the walls of the vagina to thin. Thinning tissue may cause pain during sex. Shifting hormone levels may also affect libido. Speak to your doctor if you find sex difficult or painful after a hysterectomy.
 NHS Inform