Surgical menopause: what happens when ovaries are removed?

What is surgical menopause?

Surgical menopause is menopause that begins when both ovaries are removed in an operation. The medical name for this operation is bilateral oophorectomy. The ovaries are the main source of estrogen. When both are removed, hormone production stops all at once and menopause begins right after the operation (NHS, Hysterectomy).

In natural menopause this drop is spread over years. During the transition called perimenopause, the body adjusts little by little. In surgical menopause there is no such transition. Cleveland Clinic notes that hormone production stops suddenly after the operation, which is why symptoms are often more intense than in natural menopause (Cleveland Clinic, Menopause after hysterectomy).

Sometimes this operation is necessary because of an illness; sometimes it is planned to lower a risk. Whatever the reason, getting used to a body that changes with unexpected speed can take time. Feelings of loss, anger or relief are all understandable.

Does a hysterectomy cause menopause?

This question is very often confused, because two different operations can be called by the same name. The difference is:

• Hysterectomy: Removal of the womb (uterus). The cervix and surrounding tissue may also be removed.
• Oophorectomy: Removal of the ovaries. It can be done in the same operation as a hysterectomy or separately.

If only the womb is removed and the ovaries are kept, menopause does not start right away. Cleveland Clinic writes that women whose ovaries stay in place typically do not go into menopause after a hysterectomy. Even so, two things change:

Your periods stop. According to the NHS, after your womb is removed you will not have periods and cannot get pregnant, whatever your age (NHS, Hysterectomy). This means you cannot tell from your period pattern that menopause is approaching.

Menopause may come a little earlier. The NHS notes that even if one or both ovaries are kept, menopause symptoms may start earlier than expected (NHS, Hysterectomy: risks). A prospective study in the US found that women whose womb was removed but whose ovaries were kept had a higher risk of ovarian failure than women whose womb was still in place. The researchers estimated the difference at about 1.9 years. However, they also noted that it is unclear whether this difference comes from the operation itself or from the condition that led to it (Moorman et al., 2011).

What are the symptoms of surgical menopause?

The symptoms are the same kind as in natural menopause; the difference is in how fast they come and often how severe they are. The NHS writes that when the ovaries are removed, these symptoms usually start soon after the operation: hot flashes, sweating, vaginal dryness and trouble sleeping (NHS, Hysterectomy: risks).

A literature review reports that in women who had not yet reached menopause, the sudden loss of ovarian function through oophorectomy is linked to more serious consequences than natural menopause. Hot flashes, sleep problems and mood changes are similar to those in natural menopause, but the sudden start makes it harder to adjust (Secoșan et al., 2019).

To learn more about hot flashes, see our article on hot flashes. If your symptoms are affecting your sex life, your sleep or your work, talking about this openly with your clinician is the first step to weighing the options that suit you together.

What are the long-term effects of surgical menopause at a young age?

When the ovaries are removed years before the age of natural menopause, the body goes without the protective effect of estrogen for longer. That is why long-term monitoring becomes important.

Bone health: The NHS notes that menopause that starts early, especially before age 40, can increase the risk of osteoporosis (thinning, weakened bones), and that extra measures may be needed to prevent this depending on your age and situation (NHS, Hysterectomy: risks). According to the review, removal of both ovaries before age 45 is considered a risk factor for osteoporosis (Secoșan et al., 2019). The details are in our article on bone health and menopause.

Heart and blood vessel health: The Menopause Society notes that early menopause can increase the risk of heart disease later in life (The Menopause Society, Premature Menopause). The review also reports that the highest heart and blood vessel risk is seen in women whose ovaries were removed at a young age (Secoșan et al., 2019).

This information is not meant to scare you; it is meant to help plan monitoring. It is a good idea to discuss with your clinician how often measures such as bone density scans, blood pressure, cholesterol and blood sugar should be checked. Which options are right for your symptoms and for long-term protection also varies from person to person; you make this decision together with your clinician.

We describe the overall picture of menopause that starts at a young age in our article on early menopause.

Does surgical menopause affect sex and relationships?

It can, and talking about it is nothing to be ashamed of. Vaginal dryness is among the symptoms the NHS lists (NHS, Hysterectomy: risks); this can lead to discomfort or pain during sex. The review reports that in women whose womb was removed but whose ovaries were kept, sexual function declines more slowly than in women who had both ovaries removed (Secoșan et al., 2019).

Losing a part of your body can also make some women feel different about themselves. Sharing openly with your partner what you are feeling is one of the strongest ways to rebuild closeness. Do not hesitate to talk about this with your clinician; there are options for vaginal dryness and low sexual desire too.

What can you keep track of yourself after surgical menopause?

• The date of your operation and when your symptoms first started.
• How often you have hot flashes and night sweats each day.
• Changes in your sleep, mood and sex life.
• If your ovaries were kept, any new symptoms that appear in the years that follow.

This record lets you give a concrete picture at your follow-up appointment instead of a general answer to “how are you?” Seeing how your symptoms developed in the weeks after the operation also makes it easier to decide with your clinician which topic to prioritize.

Does cancer treatment cause menopause?

Apart from surgery, ovarian function can also stop because of treatment. The Menopause Society notes that chemotherapy is among the treatments that can damage the ovaries and lead to menopause (The Menopause Society, Premature Menopause). The NHS also lists radiotherapy (radiation treatment) among the causes of early menopause.

In this case, whether menopause will be permanent depends on your age and the type of treatment. If you are going through cancer treatment, you can discuss your questions about menopause symptoms and fertility with your oncologist before treatment starts.