Surgical menopause: what to expect after your ovaries are removed

Surgical menopause is menopause caused by removing both ovaries (bilateral oophorectomy) before natural menopause would have occurred. The ovaries make most of a premenopausal woman’s estrogen and much of her testosterone, so the hormonal drop is immediate rather than spread over years. Symptoms can start within days of surgery, and two decades of US cohort data show that women who lose their ovaries young, and do not replace estrogen, carry higher long-term risks to heart, bone and brain. For most women without a contraindication, hormone therapy until at least the average age of menopause is the standard of care.

What the surgery does and does not do

Procedure	Uterus	Ovaries	Effect
Hysterectomy alone	Removed	Kept	Periods stop; hormones continue; natural menopause later
Hysterectomy with bilateral salpingo-oophorectomy	Removed	Both removed	Immediate surgical menopause
Bilateral oophorectomy without hysterectomy	Kept	Both removed	Immediate surgical menopause; progestogen needed with estrogen
Unilateral oophorectomy	Kept	One removed	Usually no menopause; the remaining ovary compensates
Salpingectomy (tubes only)	Kept	Kept	No hormonal effect

Ovaries are removed for several reasons: ovarian cysts or masses, endometriosis, risk reduction in women with BRCA or other high-risk mutations, as part of cancer treatment, or historically as an add-on to hysterectomy to prevent future ovarian cancer. That last practice has declined as the long-term data below became clear.

What to expect in the first weeks

Because estrogen falls within days, hot flashes, night sweats and sleep disruption often begin in the first week or two after surgery, while you are also recovering physically. Vaginal dryness, mood changes and joint aches follow over weeks to months. The NIA notes that women who have both ovaries removed and are not taking hormones may experience menopause symptoms immediately.

If hormone therapy is planned, many surgeons start it in the hospital or at the first postoperative visit, which can prevent the worst of this. Ask before surgery what the plan is, and who will manage it afterward. A surgeon’s job often ends at the six-week check; a menopause clinician’s does not.

Long-term risks: what the US studies found

Nurses’ Health Study. In a prospective study of 29,380 women who had a hysterectomy for benign disease, those who also had both ovaries removed had a higher risk of fatal and nonfatal coronary heart disease (hazard ratio 1.17) over 24 years than women who kept their ovaries, and lower risks of breast and ovarian cancer. For women who had never used estrogen therapy, oophorectomy before age 50 was associated with higher all-cause mortality, heart disease and stroke. The authors estimated roughly one additional death for every nine oophorectomies over a 35-year lifespan, and found no age group in which removing the ovaries improved survival.

The 2013 follow-up, with 28 years of data on 30,117 women, reported that 16.8 percent of women with oophorectomy had died from any cause compared with 13.3 percent with ovarian conservation (hazard ratio 1.13). Ovarian cancer deaths were far fewer after oophorectomy (4 versus 44), but at no age was oophorectomy associated with lower overall mortality. The excess mortality was seen in women under 50 at surgery who never used estrogen, not in past or current estrogen users.

Mayo Clinic Cohort Study of Oophorectomy and Aging. Women in Olmsted County, Minnesota, who had one or both ovaries removed before menopause had a higher risk of cognitive impairment or dementia than matched women who did not (hazard ratio 1.46), and the risk rose the younger they were at surgery. A review from the same group concluded that premature or early loss of ovarian function raises risks of mortality, cardiovascular, neurological and psychiatric disease and osteoporosis, that estrogen treatment prevents some of this, and that it may not prevent all of it.

These are observational studies and cannot prove cause. But they are large, long and consistent, and they are why guidelines treat surgical menopause before 50 as a condition to be treated rather than a convenience to be accepted.

Hormone therapy after surgical menopause

Who. The Menopause Society’s 2022 position statement describes a favorable benefit-risk ratio for women under 60 or within 10 years of menopause onset who have no contraindications. Women with surgical menopause in their 30s and 40s sit squarely in that group. The 2024 international POI guideline covers iatrogenic (treatment-caused) POI and recommends hormone therapy with specific attention to this situation.

What. Without a uterus, estrogen alone is standard; a progestogen is added only when the uterus remains or in special cases such as endometriosis. Transdermal estradiol (patch, gel or spray) avoids first-pass liver metabolism and is often preferred, particularly for women with clot risk factors or migraine. Doses for younger women are commonly higher than typical postmenopausal doses, because the goal is replacement. Some women also notice loss of libido and energy attributed to the drop in ovarian testosterone; testosterone therapy is sometimes used for low desire, and is a reasonable question for a menopause specialist.

How long. At least until the average age of natural menopause, around 51, then reassess as any woman would. The Nurses’ Health Study pattern, excess risk in never-users under 50, is the clearest argument against stopping early.

Evidence strength. Strong for symptom relief and bone protection; observational but consistent for long-term heart and brain outcomes; limited for testosterone.

When estrogen is not an option

After estrogen-sensitive breast cancer, systemic estrogen is usually avoided. The Menopause Society’s 2023 non-hormonal statement supports cognitive behavioral therapy, hypnosis, certain SSRIs and SNRIs, gabapentin and fezolinetant for hot flashes, and low-dose vaginal estrogen or non-hormonal moisturizers for genitourinary symptoms are discussed with the oncologist. Bone density monitoring and heart risk management become more important, not less, when estrogen cannot be replaced.

Red flags after surgery

Call your surgeon or seek urgent care for:

• Fever, worsening abdominal pain, or wound redness and discharge.
• A swollen, painful calf, chest pain or sudden breathlessness, which can signal a blood clot. Surgery and the postoperative period raise clot risk independently of hormones.
• Heavy vaginal bleeding.
• Thoughts of self-harm. Abrupt estrogen loss can affect mood sharply; this is treatable and worth saying out loud.

Planning ahead if surgery is still a choice

If oophorectomy is being proposed alongside a hysterectomy for benign disease and you are under 50, ask whether the ovaries need to come out at all. Removing the fallopian tubes alone (salpingectomy) lowers ovarian cancer risk without causing menopause, and the Nurses’ Health Study found no survival benefit from removing healthy ovaries at any age. If removal is necessary, ask who will manage your hormones afterward, and consider meeting a menopause specialist before the operation. Our directory lists OB-GYNs by city; the MSCP credential indicates specific training in surgical menopause.