Surgical Menopause: What to Expect Before and After Surgery

Surgical menopause happens when both ovaries are removed before natural menopause. Estrogen, progesterone and much of your testosterone drop suddenly, so symptoms can begin within days and may be more intense than a natural transition. A hysterectomy that keeps the ovaries does not cause surgical menopause, although menopause may come earlier. Hormone therapy is often recommended afterward.

What is surgical menopause?

The NHS explains that if both ovaries are removed during a total or radical hysterectomy, you experience menopause immediately after the operation, regardless of your age. This is known as surgical menopause, sometimes called induced menopause.

It can happen with or without removal of the womb:

• Bilateral oophorectomy: removal of both ovaries
• Bilateral salpingo-oophorectomy (BSO): removal of both ovaries and fallopian tubes
• Total hysterectomy with BSO: removal of the womb, cervix, tubes and ovaries

If you have already been through natural menopause, removing the ovaries does not cause a sudden change in symptoms. However, the NHS notes that the ovaries continue producing testosterone for up to 20 years after menopause, and small amounts of estrogen.

Does a hysterectomy cause menopause?

Not by itself. If your ovaries are kept, they continue making hormones and you go through menopause naturally later. You won’t have periods, though, so it can be harder to tell when it happens. See how to know when menopause has started.

The NHS notes there is a chance of reaching menopause sooner than you otherwise would, even with one or both ovaries kept. This may be because surgery affects the blood supply to the ovaries.

Why are ovaries removed?

Common reasons include:

• Cancer treatment: ovarian, endometrial (womb lining) or fallopian tube cancer
• Reducing cancer risk: in people with an inherited high risk, such as BRCA1 or BRCA2 gene variants
• Severe endometriosis or other conditions that haven’t responded to treatment
• Serious infection or abscess involving the ovaries and tubes

Sometimes surgeons recommend removing healthy ovaries during a hysterectomy after menopause, to protect against ovarian cancer. The NHS notes that some surgeons prefer to leave healthy ovaries in place when cancer risk is low, because they help protect against problems such as osteoporosis and play a part in sexual desire. If you would prefer to keep your ovaries, make this clear to your surgeon before the operation.

What symptoms can you expect?

Because hormones drop suddenly rather than gradually, symptoms can start within days and may feel more intense than natural menopause. Common symptoms include:

• Hot flashes (called hot flushes in the UK) and night sweats
• Sleep problems
• Mood changes, anxiety and difficulty concentrating
• Vaginal dryness and discomfort during sex
• Lower sex drive, partly because testosterone from the ovaries falls
• Headaches and joint aches

These come on top of normal recovery from surgery, which can make the first weeks especially tiring. Emotional reactions are common too, particularly if surgery was for cancer or ended plans for pregnancy.

What are the long-term health effects?

When ovaries are removed before natural menopause, you spend more years without ovarian hormones. Research links this with:

• Heart and circulation: increased risk of cardiovascular disease
• Bones: increased risk of osteoporosis and fractures
• Brain: increased risk of cognitive impairment and dementia, especially when ovaries are removed before 45
• Mood: higher rates of depression
• Sexual function: changes linked to the sudden loss of ovarian androgens

The 2024 international guideline on premature ovarian insufficiency recommends that these risks be discussed when planning removal of both ovaries under 45, especially for people at average risk of ovarian cancer. Research on hysterectomy in Sweden notes that ovaries should only be removed before menopause if strictly necessary, followed by estrogen until the age of natural menopause.

What treatment options are there?

Hormone therapy

For many people, hormone therapy relieves symptoms and helps protect long-term health.

• Estrogen-only therapy. If your womb has been removed, you usually don’t need a progestogen, because its role is to protect the womb lining.
• Combined therapy after endometriosis. If you had endometriosis, combined estrogen and progestogen may be recommended even after hysterectomy, to reduce the risk of it returning.
• Duration. If surgery happens before natural menopause, and especially before 45, guidance recommends hormone therapy until at least the usual age of menopause, unless there is a reason not to.
• Dose. Estrogen needs can be higher after surgical menopause than after a gradual natural menopause, because symptoms are often more intense.
• Timing. Planning ahead means hormone therapy can often be started soon after surgery, if suitable.

If you have BRCA gene variants

For people with BRCA1 or BRCA2 variants who have not had breast cancer, the 2024 international POI guideline states that hormone therapy is an option after risk-reducing removal of the ovaries and tubes. The Menopause Society notes that short-term hormone therapy appears safe in this group when surgery happens before the average age of menopause.

If you have had breast cancer or another hormone-sensitive cancer

Hormone therapy is generally not recommended after breast cancer. Non-hormonal options are available, and a newer medicine, elinzanetant, has been studied in women with a history of breast cancer. Your oncology team can advise on what is suitable.

Testosterone

Loss of ovarian testosterone can affect sex drive. The 2024 guideline recommends that testosterone be considered for low sexual desire in women whose POI was caused by medical treatment, including removal of the ovaries before 40, once other causes have been addressed. Testosterone for women is not licensed in every country, so availability varies.

Vaginal estrogen and non-hormonal options

Vaginal estrogen treats dryness and urinary symptoms and can be used alongside other treatment. Non-hormonal medicines and cognitive behavioral therapy (CBT) can help hot flashes and sleep. See what menopause is for an overview of treatments.

What to ask before surgery

If surgery is planned, a conversation beforehand can make a big difference:

1. Do both of my ovaries need to be removed, and why?
2. What are the benefits and risks of keeping one or both ovaries in my situation?
3. What symptoms should I expect, and how soon?
4. Is hormone therapy suitable for me, and can it start soon after surgery?
5. Will I need estrogen only, or combined therapy?
6. How will my bone and heart health be monitored?
7. Should fertility preservation be considered before surgery?
8. What happens if the surgeon finds something unexpected during the operation?

The NHS notes you may be asked to consent in advance to removal of your ovaries if an abnormality is found during surgery. Think about this carefully and discuss any concerns with your surgeon.

Recovering after surgery

• Expect symptoms early, and don’t hesitate to contact your care team if they are severe.
• Keep a record of symptoms, sleep and mood to review at follow-up.
• Plan follow-up for hormone therapy, bone health and heart health checks.
• Ask for support if you’re struggling emotionally, especially after cancer surgery or the loss of fertility.

Seek urgent medical help after surgery if you have:

• Heavy bleeding, fever, severe or worsening pain, or wound problems
• Leg swelling or pain, chest pain or sudden breathlessness, which can signal a blood clot

If low mood includes thoughts of harming yourself, contact emergency services or a crisis line in your country straight away.

For questions to ask at later appointments, see your first menopause appointment.

Frequently asked questions

Will I go into menopause if I have a hysterectomy?

Only if both ovaries are removed. If they are kept, you’ll go through menopause naturally later, although possibly a little earlier than otherwise.

How soon do symptoms start after ovaries are removed?

Often within days of surgery, because hormone levels drop suddenly.

Do I need progesterone if I’ve had a hysterectomy?

Usually not, because a progestogen is mainly needed to protect the womb lining. One exception is a history of endometriosis, where combined therapy may still be recommended.

Is surgical menopause worse than natural menopause?

Symptoms are often more sudden and may be more intense, but experiences vary. Treatment can be planned in advance to help.

Is it safe to take HRT after ovary removal for BRCA?

For people with BRCA variants who have not had breast cancer, international guidance describes hormone therapy as an option after risk-reducing surgery. Discuss your own situation with your specialist team.

References

1. NHS: Hysterectomy: considerations
2. East Sussex Healthcare NHS Trust: The choice of conserving or removing the ovaries (patient information)
3. Oxford University Hospitals NHS: The menopause and hysterectomy (patient information)
4. ESHRE/ASRM/IMS: Evidence-based guideline on premature ovarian insufficiency, 2024
5. The American Journal of Medicine: Bilateral oophorectomy and premature menopause
6. Cleveland Clinic: Do you go through menopause after a hysterectomy?
7. Long-term follow-up of sexual function after perimenopausal hysterectomy with or without oophorectomy
8. Changes in hormone levels after bilateral oophorectomy: meta-analysis
9. Guideline Central: NAMS 2022 hormone therapy position statement summary (BRCA)
10. The 2022 hormone therapy position statement of The North American Menopause Society
11. Living Beyond Breast Cancer: FDA approves elinzanetant
12. FSRH Contraception Choices: Perimenopause and menopause (progestogen and womb protection)

Editorial status: evidence-based educational article. Last evidence check: September 10, 2026.