Surgical menopause: what happens after ovary removal or hysterectomy

Name: Surgical menopause: what happens after ovary removal or hysterectomy
Creator: MenoWoman

Surgical menopause happens when both ovaries are removed, and it starts suddenly, often with stronger symptoms than a natural menopause. A hysterectomy that leaves the ovaries does not cause menopause on its own, though periods stop.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

Before surgery, ask how it will affect your hormones and what support you will get. Afterwards, see a doctor for severe symptoms, low mood or thoughts of self-harm, or any vaginal bleeding. Call emergency services for chest pain or sudden breathlessness, and get urgent help for a painful, swollen leg.

What surgical menopause is

Surgical menopause is menopause caused by an operation that removes both ovaries, called a bilateral oophorectomy.^1,2 If you have not yet reached menopause, it begins straight away after this surgery.² When both fallopian tubes are removed as well, the operation is called a bilateral salpingo-oophorectomy.²

Common reasons include lowering the risk of breast or ovarian cancer (for example with a BRCA gene change), ovarian cancer, endometriosis, benign ovarian cysts, twisting of an ovary (torsion) and some pelvic infections.² Ovary removal is also one known cause of early menopause and POI.^4,6

Hysterectomy with ovaries kept vs ovaries removed

A hysterectomy removes the womb (uterus). This is where people often get confused:¹

Hysterectomy that leaves the ovaries: periods stop, but the ovaries keep making hormones. Menopause is not expected to start straight away.¹ A few women still get symptoms, because surgery can sometimes reduce blood flow to an ovary.¹
Hysterectomy with both ovaries removed: hormone levels fall within a short time, so menopause starts soon after surgery.¹
Ovaries removed, womb kept: this also causes surgical menopause.

Without periods, it can be hard to tell when a natural menopause arrives later. Symptoms such as hot flashes are often the main clue. Blood tests are not always reliable in midlife, as our guide to at-home menopause tests explains.

Sudden symptoms after ovary removal

In a natural menopause, hormones fall over several years. After ovary removal, they drop within a short time, which can feel like a shock to the body.¹ The symptoms are the same as in natural menopause but can be more severe.¹ They include:

Sexual problems are common. One UK guidance paper reports them in up to 74% of women after risk-reducing ovary removal.³ Many women feel better within one to two years, but symptoms can last much longer.¹

Long-term health after early ovary removal

Symptoms can be harder to manage when they start overnight, and many women say they were not warned. Planning ahead helps. Questions to ask before surgery include:

Will my ovaries be removed, or only my womb?
Will I go into menopause straight away?
Can I start hormone therapy after surgery, and when?
If not, which non-hormonal options can I use?
Who should I contact if symptoms are severe?

Take notes or bring someone with you. If time allows, ask to see a menopause specialist before the operation.

Losing estrogen early raises the risk of bone loss and osteoporosis.¹ Removing the ovaries before natural menopause is also linked to more heart disease. The link is seen mainly in women who do not take hormone therapy.³ The American Heart Association links menopause before 45 with higher coronary heart disease risk.⁵

Some studies also link early ovary removal with dementia and earlier death, again mostly in women not using hormones.³ Most of this evidence comes from observational studies, so it shows links, not proof of cause. See menopause and heart health for checks worth asking about.

Hormone therapy after surgery

When the ovaries are removed young, guidance usually recommends replacing estrogen, especially before 45 and above all before 40. Discuss this with your doctor.¹ UK guidance says treatment should start soon after surgery, if there is no reason not to. It suggests continuing until about 51, the average age of natural menopause.³

If you no longer have a womb, estrogen can usually be given on its own. If you still have a womb, a progestogen is added to protect its lining.^1,3 After surgery for endometriosis, a progestogen is sometimes still used.¹

This is why the type of operation matters for hormone therapy. Ask your surgical team before the operation what your options will be. See estrogen patch vs pill vs gel for the different forms.

BRCA and cancer: when hormone decisions differ

Women with an inherited BRCA1 or BRCA2 gene change are often offered surgery to remove the ovaries and tubes, to lower ovarian cancer risk. UK guidance suggests this from about 35 to 40 for BRCA1, and 40 to 45 for BRCA2.³

BRCA carriers without breast cancer: UK guidance says hormone therapy can be offered after counseling, until about 51. Short-term use has not been shown to raise breast cancer risk in carriers, but the evidence is limited.³ Using it beyond 51 is not routinely advised for women at high breast cancer risk.³

Women who have had breast cancer: hormone therapy is usually not advised, especially for hormone-receptor-positive cancer.^1,3 Non-hormonal options come first. These include CBT, non-hormonal medicines and vaginal moisturizers. They tend to work less well than hormones.³ Low-dose vaginal estrogen may be considered in some cases after specialist advice.³

If you take tamoxifen or another hormone-blocking cancer medicine, ask your cancer team which non-hormonal medicines are suitable. Some antidepressants used for hot flashes, particularly paroxetine and fluoxetine, can block the enzyme that turns tamoxifen into its most active form.⁷ Do not change any cancer medicine without your team.

These decisions depend on your cancer type, genes and wishes. Make them with your cancer team and a menopause specialist. Genetic counseling can also help you weigh the timing of surgery against plans for children.

If hormone therapy is not an option, practical steps still help with night sweats and sleep. Try a cool bedroom and a regular routine. See our sleep routine guide and breathing exercises for hot flashes.

What it is used for: evidence rated

Option	Evidence	What the research shows
Hormone therapy (estrogen alone if no womb)	Strong evidence	Usually advised after early ovary removal, until about the average age of menopause, if there is no reason not to.^1,3
Non-hormonal prescription medicines	Strong evidence	First-line option after breast cancer; they reduce hot flashes but generally less than hormones.³
CBT	Strong evidence	Listed as a non-hormonal option in UK guidance; helps how hot flashes and low mood affect daily life.³
Low-dose vaginal estrogen	Strong evidence	Treats vaginal symptoms; after breast cancer it may be considered only with specialist advice.³
Vaginal moisturizers and lubricants	Some evidence	Hormone-free relief for dryness and painful sex, including after breast cancer.³
Strength training and weight-bearing exercise	Some evidence	General advice for bone and heart health after early estrogen loss rather than a tested treatment; it does not replace estrogen.

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.