You Are Not Broken – Episode 322: Surgical Menopause - A Personal Narrative

Host: Dr. Kelly Casperson, MD
Guest: Dr. Juliana Hauser
Date: June 15, 2025

Episode Overview

In this deeply personal episode, Dr. Kelly Casperson welcomes Dr. Juliana Hauser, a sex therapist and midlife expert, to share her journey through surgical menopause following a hysterectomy. With candor and humor, the conversation explores the decision-making process, the emotional landscape, the medical nuances, and the under-acknowledged importance of rituals, support, and sexual health following surgery. The episode aims to dispel misconceptions, normalize open dialogue, and provide validation for anyone facing or navigating surgical menopause.

Key Discussion Points & Insights

The Decision to Pursue Surgery

• Dr. Hauser’s mother and sister both had hysterectomies early, leading to a personal and familial pressure to consider surgery herself ([02:06]).
• Quote: “You're a ticking time bomb. You're a ticking time bomb.” – Dr. Hauser citing her mother ([02:08]).
• Dr. Hauser waited until she developed severe symptoms (heavy and frequent periods, visible fibroid) to pursue the procedure, prioritizing her quality of life and sexual health in the decision ([02:40]).

Navigating the Medical System: Informed, Yet Overwhelmed

• Despite her professional background, Dr. Hauser felt overwhelmed by the many decisions required (uterus, ovaries, cervix, surgical techniques) ([05:34]).
• Quote: “I was floored. How many decisions I had to keep making.” – Dr. Hauser ([05:27]).
• Struggled to find personal stories about surgical menopause; silence among peers and limited resources contributed to isolation ([06:48]).
• Turned to online support (e.g., HysterSisters) and started openly sharing her journey to fill the visibility gap ([07:13]).

Loss of Control & Emotional Impact

• Dr. Casperson affirms the unsettling feeling of surgery’s “controlled lack of control” and validates patients’ anxieties ([07:36]).
• Clarifies the difference between hysterectomy types; removal of only the uterus doesn’t always mean loss of hormones—ovaries are key, but their function may decline after surgery ([08:50]).
• Many women are unclear about exactly what organs were removed during surgery, underscoring the need for clarity in medical communication ([09:57]).

Terminology & Sexual Health Considerations

• “Partial hysterectomy” is a confusing term; patients and even some doctors use different definitions ([11:26]).
• Decision to keep or remove the cervix involves tradeoffs: reduced cancer risk vs. potential changes in sexual sensation and vaginal length ([12:24]).
• Quote: “What were the options that I had to make sure… sexual pleasure was going to be something that was prioritized?” – Dr. Hauser ([13:33]).
• Following surgery, Dr. Hauser found her sexual function and pleasure intact—her first orgasm post-op was “fantastic” and very emotional ([14:23]).

Processing the Transition: Rituals and Grief

• Dr. Hauser’s surgery date came quickly; she craved time to process and ritualize the end of menstruation ([15:16]).
• Noted lack of societal or medical space for grieving the loss of fertility/uterus, even as feeling physically better was celebrated ([15:42]).
• Created her own goodbye ritual (a backyard bonfire burning menstrual products) and hired a menopause doula for emotional support ([18:17]).

The Role of a Menopause Doula

• Menopause doulas provide emotional, logistical, and informational support through the transition—not just for surgical menopause ([18:54]).
• Dr. Hauser and her doula co-created their approach and later discovered there’s a certification for menopause doulas ([19:12]).
• Quote: “I feel as passionate about menopause doulas as I do about pelvic floor therapists… I think it should be for everybody.” – Dr. Hauser ([19:46]).

Hormone Journey & Medical Follow-Up

• Post-op hormone therapy required trial and error; Dr. Hauser’s skin didn’t absorb topical treatments, leading to further adjustments ([24:10]).
• Normalized the wide range of absorption and individual response to hormone replacement ([25:13]).
• Quote: “Once I got that dosage right, I felt like myself again.” – Dr. Hauser ([26:21]).
• Ultimately found success with hormone pellets, challenging stigma and shame around less “preferred” therapies ([26:32]).
• Reflected on gratitude for options available today compared to prior generations ([27:37]).

Intergenerational Perspectives & Individual Differences

• Dr. Hauser’s family had different attitudes about surgery and hormones; conversation revealed generational divides ([28:48]).
• Explored emotional fallout: grief, fear of “less womanness,” and the importance of validating all ways people respond to these changes ([29:37]).
• Surgery recovery was smoother than expected due to good preparation, physical strength, and positive mindset ([30:56]).

Impact on Dr. Hauser's Clinical Practice

• Now asks more nuanced follow-up questions with clients about surgical and menopausal experiences ([32:04]).
• Notes high levels of emotional impact: “not feeling like myself” is reported by around 60% of respondents in her surveys ([32:34]).
• Openly discusses and normalizes mental health challenges—anxiety, depression—and models transparency with her own daughter and clients ([33:23], [34:19]).

Sexual Confidence Advice: “What Are You Good at in Bed?”

• Dr. Casperson highlights Dr. Hauser’s sex communication tip from a prior event: ask your partner what you’re good at in bed ([36:04]).
• Quote: “Everybody loves knowing what they’re good at…that is the pro move.” – Dr. Casperson ([36:12]).
• Dr. Hauser shares a client story about translating sexual strengths (“risk taking”) into career moves, demonstrating the broader value of self-awareness in intimacy ([37:12]).

Notable Quotes & Memorable Moments

• On decision-making overload:
  “I was floored. How many decisions I had to keep making.” – Dr. Hauser ([05:27])

• On discussing sexual health with your doctor:
  “I had this weird feeling of, like, it was hard for me to start talking about my sex life. And I know better, and I teach that.” – Dr. Hauser ([02:56])

• On confusion about terms:
  “I'm embarrassed to tell you, I don't know if I have my ovaries or not.” – Dr. Hauser ([09:58])

• On support and ritual:
  “I wish there was a party. I wish there was a ritual for this.” – Dr. Hauser ([17:31])
  “We took the rest of products and burned them. And we did a goodbye to the period bonfire.” – Dr. Hauser ([18:17])

• On sexual health post-op:
  “The first orgasm my head after surgery when I was allowed to have it was fantastic. And I remember crying. I actually cried. It's like, oh, thank goodness I'm okay.” – Dr. Hauser ([14:30])

• On shame and hormone therapy:
  “I felt like something was wrong. I was doing menopause wrong because I wasn't able to do the preferred route of all the medications.” – Dr. Hauser ([26:35])

• Dr. Casperson’s favorite communication tip:
  “Ask your partner what you're good at in bed. Everybody loves knowing what they’re good at…that is the pro move.” ([36:04])

Important Timestamps

• 00:46 – 02:40: The origin of Dr. Hauser’s surgical menopause decision
• 05:27: Decision fatigue — medical choices and agency
• 07:36: Emotions and loss of control surrounding surgery
• 08:50: Hysterectomy, ovary removal, and menopause — clarifications
• 12:24 – 14:23: Cervix decisions, sexual pleasure, and personal fears
• 15:16 – 18:17: Processing grief, ritualizing the transition, and hiring a menopause doula
• 24:10 – 26:32: Hormone therapy trials and normalization
• 28:48 – 31:10: Generational views, recovery experience, and the importance of mindset
• 32:04 – 34:19: Impacts on therapy practice and addressing mental health
• 36:04 – 38:23: Asking “what are you good at in bed?”—practical sex advice

Resources & Final Notes

• Dr. Juliana Hauser’s upcoming book:
  A New Position on Sex: A Guide to Greater Sexual Confidence, Authenticity and Pleasure (Release: September 19)
• Menopause Doula Institute ([20:38])
• Dr. Casperson’s Adult Sex Education Masterclass: kellycaspersonmd.com

Episode in a Sentence:
A refreshingly honest, multi-layered exploration of surgical menopause, blending medical insight, emotional truth, and affirming advice—validating, educating, and empowering listeners at every step.