Menopause is caused by a decline in ovarian function and hormone production. Because your ovaries are the primary drivers of this change, you can experience symptoms of menopause even if you do not have a uterus.
Menopause is a natural process that occurs in people who have functional ovaries. Healthcare professionals define menopause as a lack of reproductive hormone production in your ovaries for at least
As you age, your ovaries naturally produce less estrogen, progesterone, and testosterone — the hormones associated with reproductive function. Your ovaries also gradually lose ovarian follicles (the sacs that contain eggs).
As these hormonal and functional changes become more significant and eventually stop, you may experience symptoms such as hot flashes, irregular periods, and mood changes.
If you don’t have a uterus but still have one or both ovaries, you can still experience menopause and many of its symptoms.
You don’t need to have a uterus to experience menopause. Although the uterus responds to hormonal changes in menopause, it doesn’t drive the processes behind this shift in reproductive function.
Menopause is
These hormones play various important roles in your body. For example, they influence temperature regulation, metabolism, and the balance of neurotransmitters (chemical messengers) in your brain.
As ovarian hormone levels drop, body-wide symptoms of menopause, such as hot flashes, mood changes, weight gain, and brain fog, can occur.
In people with a uterus, ovarian hormones are also responsible for regulating the thickening and shedding of the uterine lining during the menstrual cycle.
For this reason, irregular uterine bleeding can be a symptom during the menopausal transition if you have a uterus. But if you experience menopause without a uterus, you won’t notice irregular uterine bleeding or other uterine symptoms.
Anyone with one or both functional ovaries can experience menopause, including:
- people who have undergone a hysterectomy
- transgender men
- people born with ovaries but without a uterus (Myer-Rokitansky-Kuster-Hauser [MRKH] syndrome)
People who have had a hysterectomy
A hysterectomy is a surgical procedure to remove your uterus. There are multiple types of hysterectomy:
- Supracervical (partial): The upper uterus is removed, but the cervix is left in place.
- Total: The uterus and cervix are removed.
- Radical: The uterus, the cervix and its tissues, and the upper portion of the vagina are removed.
A hysterectomy, by definition, leaves your ovaries behind. If you still have at least one functional ovary, you can experience menopause. The surgical procedure to remove your ovaries is called a bilateral oophorectomy.
Transgender men
Menopause represents the loss of function in the ovaries. Transgender men can experience menopause after surgery or while receiving hormone therapy.
Removing only your uterus during a gender affirming hysterectomy still leaves functional ovaries if you were born with them, and supplemental testosterone therapy does not stop or prevent the ovarian aging process.
Testosterone therapy to support masculine transitions does not delay menopause, but it naturally suppresses estrogen levels. This suppression can cause menopause-like symptoms, which may even mask the symptoms of true menopause later in life.
But because menopause is a physical state, you can experience it even if hormone therapy reduces or masks the symptoms.
If you undergo gender affirming surgery that removes your uterus and both ovaries, menopause will happen immediately afterward. Healthcare professionals refer to this as surgical menopause.
People with MRKH syndrome
MRKH syndrome, also known as Mullerian agenesis or vaginal agenesis, is a rare medical condition in which the uterus and vagina are underdeveloped at birth despite regular ovarian function and external genitals.
People born with MRKH syndrome or other conditions that affect uterine development but leave ovarian function intact can still experience menopause.
The transition into menopause can affect each person differently, with or without a uterus. It often features a wide array of hormonal, physical, emotional, and mental changes. Symptoms can start during the years leading up to menopause, also known as the perimenopausal period.
These symptoms are related to declining levels of ovarian hormones. Common non-uterine symptoms can include:
- hot flashes
- night sweats
- chills
- sleep disturbances
- brain fog
- mood changes
- anxiety or depression
- body aches and pains
- vaginal dryness
- reduced libido
- bone density loss
- urinary changes
- weight gain
- skin and hair dryness
- elevated blood pressure
- cholesterol changes
- digestive issues
- fatigue
If you do not have a uterus, you will not experience the following symptoms:
- irregular periods
- heavy or prolonged bleeding
- uterine prolapse
- uterine or endometrial atrophy
- uterine cramps
Once you reach clinical menopause and your hormone levels stabilize at lower levels, some of the symptoms you experienced during the menopausal transition may improve as your body adjusts to the new norm.
There are a few things to keep in mind if you don’t have a uterus but will still go through the menopausal transition.
First, many of the symptoms that occur during the menopausal transition are possible with or without a uterus. But if you don’t have a uterus, you won’t experience symptoms related to irregular uterine bleeding, uterine atrophy, or changes in your uterine lining.
If you do experience vaginal bleeding without a uterus, it could be a symptom of a medical condition such as vaginal or cervical infection, trauma, polyps, or cancer.
Next, your individual medical history can affect how soon you experience menopause without a uterus. For example, if you’ve had a hysterectomy, you may be more likely to enter menopause earlier than average. (In the United States, the average age at which menopause occurs is
A hysterectomy may also affect the severity of menopause symptoms. A 2023 study found that women who had undergone a hysterectomy before menopause had more severe menopausal symptoms than those who had not had a hysterectomy.
Finally, if you’re a transgender man, experiencing menopause despite gender affirming medical care may pose unique mental health challenges as you go through a transition that is classically associated with being female. Discussing this with your doctor ahead of time can help you prepare and cope.
To ease menopause symptoms such as hot flashes, sleep issues, and mood shifts, doctors may recommend hormone therapy.
Hormone therapy supplements your body with the hormones that your ovaries aren’t producing enough of. As a result, it can relieve body-wide effects that contribute to changes in your emotions, thinking ability, and physical health.
Hormone therapy does not stop your ovaries from aging, but it helps balance the hormone levels in your body so you don’t feel the effects of menopause as much.
In addition to hormone therapy, your doctor might recommend other medications, such as antidepressants to help manage depression or anxiety or regulate your mood. They might also prescribe nonhormonal medications, such as clonidine or gabapentin, to treat hot flashes.
Additionally, you might benefit from lifestyle strategies that support hormonal regulation, such as regular exercise, a balanced diet, and stress management.
It’s always OK to talk with a mental health professional about your experience of menopause without a uterus. A therapist can help you develop coping strategies and can offer a variety of therapeutic frameworks to help you navigate challenges during this transition.
Many of the signs and symptoms of menopause when you don’t have a uterus are identical to those you would experience if you did have one. However, you will not experience the following symptoms:
- abnormal uterine bleeding
- uterine atrophy
- changes to your uterine lining
Your ovaries drive the changes that occur during menopause. So, if you still have ovaries, you may still notice symptoms such as:
- hot flashes
- sleep disturbances
- weight changes
- brain fog
- vaginal dryness
Hormone therapy can help relieve some menopausal symptoms, but it cannot stop or prevent menopause. Treatment options will vary according to your individual medical needs.