Surgical Menopause Explained
Article written by Dr Mari Walling, British Menopause Society Registered Specialist, GP, Co-founder of Lemala Health, December 2025
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
In this article, we discuss surgical menopause, including what it is, why it happens, the symptoms you might experience, potential risks and how surgical menopause can be managed using hormone replacement therapy (HRT) and lifestyle support.
Surgical Menopause: What You Need to Know
Symptoms, HRT, and Long-Term Health
Surgical menopause occurs when both ovaries are removed, a procedure known as a bilateral oophorectomy. In many cases, this is done alongside removal of the womb and fallopian tubes, but it is the removal of the ovaries that causes menopause.
The ovaries produce oestrogen, progesterone, and testosterone. When they are removed, levels of these hormones fall sharply, leading to an immediate menopausal state. Periods stop permanently, fertility ends, and menopausal symptoms can begin very quickly.
Surgical menopause is permanent and is a form of medically induced menopause.
Why Surgical Menopause Happens
Common reasons for surgical menopause include:
Bilateral oophorectomy: Removing both ovaries to treat or prevent conditions such as ovarian cancer, severe endometriosis, or ovarian cysts.
Hysterectomy with bilateral salpingo-oophorectomy (BSO): Removal of the uterus, ovaries, and fallopian tubes.
Risk-reducing surgery: Women with genetic predispositions such as BRCA1 or BRCA2 mutations may have their ovaries and fallopian tubes removed to lower future cancer risk.
What Happens in Surgical Menopause
Surgical menopause often feels very different from natural menopause because hormone levels fall suddenly rather than over several years.
Some women experience menopausal symptoms very soon after surgery, while for others they appear more gradually. Starting hormone replacement therapy early can help reduce the severity of symptoms for many women.
Common symptoms include:
Hot flushes and night sweats
Mood changes, anxiety, or depression
Sleep problems and fatigue
Palpitations, weight changes, hair thinning, and dry skin
Joint or muscle aches
Vaginal or vulval dryness and discomfort
Bladder symptoms
Loss of libido and changes in sexual function
The ovaries also contribute around half of the body’s testosterone production. Their removal leads to a significant reduction in testosterone levels, which can affect sexual desire and wellbeing for some women.
In women under the age of 45, surgical menopause without adequate hormone replacement has been associated with increased long-term health risks. These include osteoporosis, cardiovascular disease, cognitive changes and increased overall mortality compared with women who experience menopause at the usual age.
How Long Does Surgical Menopause Last?
Surgical menopause is permanent. This means the low-hormone state does not reverse over time. However, symptoms often improve, particularly when appropriate treatment and support are in place.
What If Only One Ovary Is Removed?
Removal of one ovary, known as a unilateral oophorectomy, does not usually cause surgical menopause. Most women will still go through a natural menopausal transition.
However, if the remaining ovary is damaged during surgery or its blood supply is affected, menopausal symptoms may occur earlier or more suddenly than expected.
Managing Surgical Menopause
Hormone Replacement Therapy (HRT)
HRT is the main treatment for surgical menopause. It helps relieve symptoms and reduces the long-term health risks associated with early loss of oestrogen.
Women who experience surgical menopause before the age of 45 are usually advised to take HRT until at least the average age of natural menopause, unless there is a medical reason not to do so.
There are no fixed age or time limits for HRT use. Decisions should be individualised and reviewed regularly, and HRT can be continued long term or lifelong if the benefits outweigh any risks.
The type and dose depend on whether the uterus (womb) is present and individual health factors. HRT is often started soon after surgery, with transdermal forms such as patches, gels, or sprays preferred to reduce the risk of blood clots.
Women with a history of endometriosis can usually take oestrogen as part of HRT, although a progestogen may still be recommended to reduce the risk of stimulating any remaining endometriosis tissue.
Vaginal and Sexual Health
Low oestrogen levels can affect the vagina, vulva, bladder, and urethra, leading to dryness, discomfort, recurrent infections, and pain with sex.
Vaginal oestrogen or prasterone can be very effective and is safe for long-term use for most women.
Some women benefit from psychosexual counselling or women’s health physiotherapy, particularly if intimacy has been affected.
Testosterone
Testosterone replacement may be discussed following surgical menopause because of the significant drop in levels after ovary removal. Current guidelines recommend considering testosterone only for women with persistent low libido that has not improved despite optimised oestrogen therapy and addressing other contributing factors.
Some women report improvements in sexual desire, energy, concentration, mood, and general wellbeing, although not everyone experiences benefit. A trial of testosterone is usually reviewed after three to six months.
Lifestyle Strategies
All women in surgical menopause should receive advice on protecting bone, heart, and brain health, particularly those who experience menopause at a younger age or who cannot take HRT.
Lifestyle measures can support wellbeing during surgical menopause:
Eating a balanced diet and maintaining a healthy weight
Ensuring adequate calcium and vitamin D intake
Engaging in regular weight-bearing and strength-based exercise
Reducing caffeine and alcohol
Avoiding smoking
Seeking psychological support, including CBT for menopause-related stress
Bone density scans are usually recommended for women who experience early menopause, including surgical menopause before the age of 45.
Getting Support
Surgical menopause can be a major life change, both physically and emotionally. With the right information and support, many women feel significantly better and regain a strong sense of wellbeing.
At Lemala Health, our menopause specialists, offer personalised care to support women before and after surgical menopause.