Surgical Menopause: What No One Tells You Before Your Ovaries Are Removed
Somewhere in a fifteen-minute appointment, you may have heard the word "oophorectomy". Maybe it was wrapped up in a bigger conversation about a hysterectomy. Maybe it came with a leaflet. Maybe it came with a date already booked in.
And maybe you nodded, because that's what you do in appointments, and then you got in the car and thought: wait, what does that actually mean for me?
If that's you right now, you are not being difficult by wanting more than a leaflet. In one qualitative study of women who'd had their ovaries removed to manage a hereditary cancer risk, many said they would have liked more information about the physical and emotional after-effects of oophorectomy, both before and after their surgery (Hallowell, 2000). A separate qualitative study of women deciding about oophorectomy alongside hysterectomy found a similar pattern: women were uneasy about the idea of a sudden menopause, and many felt inadequately informed about their options and about longer-term outcomes such as bone and heart health (Bhavnani and Clarke, 2003). These are smaller, older studies rather than a single definitive verdict on current UK practice - but they're consistent with why NICE guidance now specifically recommends that anyone likely to experience menopause through medical or surgical treatment is offered the chance to discuss it, before and after, with someone who knows menopause (NICE, 2024).
So if you've come here feeling like nobody quite finished the sentence - this is that sentence.
What Surgical Menopause Actually Is (And How It's Different)
Natural menopause usually involves hormonal changes that develop over a period of years. Surgical menopause is different because the loss of ovarian hormone production can happen abruptly. When both ovaries are removed - whether for endometriosis, ovarian cysts, a hereditary cancer risk (such as a BRCA gene variant), or as part of treatment for gynaecological cancer, with or without a hysterectomy at the same time - ovarian hormone production doesn't taper off; it stops within days. If this happens before the age of 40, it's classed as premature ovarian insufficiency (POI); between 40 and 45, it's early menopause. Either way, your body is having to adjust to a hormonal cliff-edge rather than a slope, and that matters for how you feel and for your longer-term health.
This isn't a small distinction. It's the reason menopause guidance treats surgical menopause under 45 as its own category, with its own recommendations - not simply an earlier version of "normal" menopause. If you want to understand more about why the sudden hormonal change can feel so intense, I've explained the biology in more detail in my guide to why surgical menopause can feel so severe.
The Health Evidence: What Removing Your Ovaries Can Mean for Your Long-Term Health
This is the part that can be easy to miss in a pre-op conversation, and it's the part I think you deserve to have in full. None of it is designed to frighten you - it's designed to make sure you're making a genuinely informed decision, and that you know what to ask for afterwards.
Most of what follows comes from cohort studies and systematic reviews rather than randomised trials - this is how this kind of long-term health evidence in women's health is generally gathered, but it's worth knowing that "associated with" is more accurate than "causes" for everything below.
Heart health
Your ovaries don't just manage your cycle - cohort research points to a protective role for oestrogen in cardiovascular health. A large, long-running cohort study found that bilateral oophorectomy performed before age 45 was associated with increased cardiovascular mortality, particularly cardiac mortality - and that this excess risk appeared concentrated among women who did not use oestrogen therapy afterwards, while women who did were not shown to have the same increased risk (Rocca et al., 2008). That's an important finding, and it supports having a proper conversation about hormone therapy - but it isn't proof that HRT eliminates cardiovascular risk for every individual; it's one well-designed study showing a strong association at group level.
Brain health
Some observational research also points to a role for oestrogen in brain health. Several large studies - including work from the Mayo Clinic's long-running cohort - have found that both unilateral and bilateral oophorectomy performed before the onset of natural menopause are associated with an increased long-term risk of cognitive impairment or dementia, with the association appearing stronger the younger the age at surgery (Rocca et al., 2007). A 2019 systematic review and meta-analysis confirmed this association across the available studies, while also noting that hormone therapy appeared to reduce it in some of the pooled data (Georgakis et al., 2019). A 2021 Mayo Clinic follow-up looking specifically at mild cognitive impairment reached broadly similar conclusions (Rocca et al., 2021). Some studies in this body of research suggest that starting hormone therapy soon after surgery, rather than years later, may be more protective than delayed treatment - though this isn't settled with the same certainty as the association itself.
Bone health
Oestrogen also plays a role in bone health, and a 2017 systematic review and meta-analysis found that hysterectomy and bilateral oophorectomy were associated with an increased risk of fractures, osteoporosis and reduced bone mineral density compared with women who hadn't had this surgery (Fakkert et al., 2017). A more recent systematic review and meta-analysis reached a similar conclusion specifically for bilateral oophorectomy and fracture risk (European Journal of Endocrinology, 2025). At the individual-study level, the WHAM study - a prospective, controlled study following women for two years after premenopausal risk-reducing ovary removal — found substantial loss of bone density and bone strength in the surgery group, and found that postoperative hormone therapy alleviated, though didn't fully prevent, this bone loss (Jiang et al., 2021).
Emotional and mental health - the more nuanced picture
This is the area where the evidence is genuinely mixed, and I want to be straight with you about that rather than flatten it into a single scary headline.
The clearest data here comes from the WHAM study, which followed women having risk-reducing ovary removal (most with a BRCA1/2 gene variant) against a comparison group who kept their ovaries. It found the proportion with clinically significant depressive symptoms rose from 14.5% before surgery to 27.1% at three months, and clinically significant anxiety symptoms rose from 6.1% to 17.7% over the same period (Hickey et al., 2021) - a real, measured pattern, not something anyone imagined. This happened even though some participants were already using hormone therapy, though the study wasn't designed to test whether HRT/MHT prevents or treats mood symptoms specifically.
The more reassuring part of the same research programme: by the two-year mark, depressive and anxiety symptoms were, on average, no longer elevated at a group level compared with the comparison group - though women who were still experiencing significant symptoms at twelve months were highly likely to still be experiencing them at twenty-four months (Hickey et al., 2025).
The honest summary: for many women, the first months after surgery are genuinely harder, emotionally, than they expected - and that's backed by real data, not just anecdote. For most, that intensity eases at a population level. For some, it doesn't ease on its own, and that's worth proper support rather than "give it time and see."
Surgical menopause can affect much more than the specific areas covered here. If you're trying to understand the wider range of changes that can happen through menopause, you can explore my guide to menopause symptoms.
Why Hormone Support Deserves a Conversation Before Surgery
You'll notice a pattern running through several of the sections above: hormone therapy can change the risk-benefit picture, which is why it's worth discussing before surgery.
This is reflected directly in UK clinical guidance. NICE recommends offering sex steroid replacement - either HRT/MHT or a combined hormonal contraceptive - to people with premature ovarian insufficiency, unless it's contraindicated, and continuing it until at least the age of natural menopause (NICE, 2024). For women having surgery between 40 and 44, NICE frames the balance of benefits and risks as sitting between the position for POI and the position for people at the usual age of menopause - in other words, still worth a proper, individualised conversation about hormone replacement, not a blanket "wait and see" (NICE, 2024).
It's also worth being precise about what HRT/MHT is and isn't being recommended for here. NICE guidance is careful on this point: HRT isn't recommended solely for primary prevention of chronic disease in menopause at the usual age - that's a different, more general population than the one this article is about. Surgical menopause under 45 is treated differently in the guidance, because in this situation hormone therapy isn't only about prevention in a healthy-ageing population, it's about replacing hormones your body would ordinarily still be making for another decade or more.
This is why the conversation before surgery matters so much - so you can understand the likely benefits, the trade-offs, and the role of hormone therapy in advance, rather than working it out afterwards. Whether HRT is right for you, and in what form, is a decision for you and your clinical team, based on your own history and any contraindications.
If you do go on to start HRT and still don't feel as you expected, you may find it useful to understand why you may still have symptoms after starting HRT.
Questions Worth Taking Into Your Appointment
Behaviour change starts with feeling equipped, not overwhelmed. If you've got a pre-op appointment coming up, or you're still weighing up the decision, these are worth writing down:
What will removing both of my ovaries mean for me personally, now and in the years ahead?
What do I need to know about surgical menopause before I make this decision?
What is the plan for supporting me after surgery, including who I contact if I'm struggling?
You're Allowed to Ask for More Time and More Information
If you take one thing from this article, let it be this: wanting more than fifteen minutes and a leaflet before a decision this significant is not you being difficult. Some of the research into women's experience of this exact decision backs you up on that, and current NICE guidance explicitly recognises the need for this conversation to happen properly, before and after treatment.
As a health coach, I can't tell you whether to have this surgery, and I can't tell you what HRT dose or type is right for you — that conversation belongs with your surgical team, your gynaecologist, and your GP. What I can do is help you walk into that conversation informed, ask the questions that get you real answers, and support you through whatever comes next — whether that's preparing well beforehand or rebuilding afterwards.
And if you've already had the surgery and are struggling with how much life has changed, you may also want to read “Surgical Menopause Ruined My Life”: What If You Feel This Way?.
Take a conversation guide into your appointment
If you're facing surgical menopause, you don't have to remember all of this when you walk into your appointment. I've created a free conversation guide you can take with you, with questions about hormone replacement, recovery, emotional support and longer-term health.
Get the free Before Your Ovaries Are Removed Conversation Guide
Frequently Asked Questions
Is surgical menopause worse than natural menopause?
Surgical menopause can feel more sudden and intense because ovarian hormone production stops abruptly. How symptoms develop and settle varies between women, and hormone treatment may be appropriate for some but not others.
Do I have to take HRT after my ovaries are removed?
It isn't automatic or right for everyone, but NICE guidance recommends offering sex steroid replacement to everyone with premature ovarian insufficiency, unless contraindicated, and continuing it until at least the natural age of menopause. This is a decision to make with your clinical team based on your own health history.
Will surgical menopause affect my sex life?
It can, particularly through vaginal dryness and changes in desire, though this varies a lot between women and can often be improved with appropriate treatment and support. Vaginal oestrogen is one option that may be discussed with a GP or menopause specialist.
What is considered premature or early menopause after ovary removal?
Surgery before 40 is classed as premature ovarian insufficiency; between 40 and 44 is classed as early menopause; 45 and over isn't classified as early. The younger group is managed differently to menopause at the average age of 51, with a stronger emphasis on hormone replacement.
Can lifestyle changes help with surgical menopause symptoms?
Lifestyle approaches can support your wellbeing alongside appropriate medical care. Regular movement, strength training, nutritious food, sleep and stress management can all form part of looking after yourself through surgical menopause. Coaching can help you turn those broad recommendations into realistic routines that fit your life.
References
Bhavnani, V. and Clarke, A. (2003) 'Women awaiting hysterectomy: a qualitative study of issues involved in decisions about oophorectomy', BJOG: An International Journal of Obstetrics and Gynaecology, 110(2), pp. 168–174. doi: 10.1046/j.1471-0528.2003.01372.x. PMID: 12618161
British Menopause Society (2025) NICE Menopause: identification and management - from guideline to practice. Available at: https://thebms.org.uk (Accessed: 27 August 2026).
European Journal of Endocrinology (2025) 'Hysterectomy, oophorectomy, and bone health: a systematic review and meta-analysis', European Journal of Endocrinology, 193(3), p. S15. PMID: 40845177
Fakkert, I.E., Teixeira, N., Abma, E.M., Slart, R., Mourits, M. and de Bock, G.H. (2017) 'Bone mineral density and fractures after surgical menopause: systematic review and meta-analysis', BJOG, 124(10), pp. 1525–1535. PMID: 28436196.
Georgakis, M.K., Beskou-Kontou, T., Theodoridis, I., Skalkidou, A. and Petridou, E.T. (2019) 'Surgical menopause in association with cognitive function and risk of dementia: a systematic review and meta-analysis', Psychoneuroendocrinology, 106, pp. 9–19. PMID: 30928686.
Hallowell, N. (2000) 'A qualitative study of the information needs of high-risk women undergoing prophylactic oophorectomy', Psycho-Oncology, 9(6), pp. 486–495. doi: 10.1002/1099-1611(200011/12)9:6<486::aid-pon478>3.0.co;2-y. PMID: 11180583
Hickey, M., Moss, K.M., Brand, A., Wrede, C.D., Domchek, S.M., Meiser, B., Mishra, G.D. and Joffe, H. (2021) 'What happens after menopause? (WHAM): a prospective controlled study of depression and anxiety up to 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy', Gynecologic Oncology, 161(2), pp. 527–534. doi: 10.1016/j.ygyno.2021.02.001. PMID: 33583580
Hickey, M., Nguyen, T.L., Krejany, E.O., Domchek, S.M., Brand, A., Hopper, J.L. and Joffe, H. (2025) 'What happens after menopause? (WHAM): impact of risk-reducing salpingo-oophorectomy on depressive and anxiety symptoms at 24 months', Gynecologic Oncology, 192, pp. 1–7. doi: 10.1016/j.ygyno.2024.10.031.
Jiang, H., Robinson, D.L., Lee, P.V.S., Krejany, E.O., Yates, C.J., Hickey, M. and Wark, J.D. (2021) 'Loss of bone density and bone strength following premenopausal risk-reducing bilateral salpingo-oophorectomy: a prospective controlled study (WHAM Study)', Osteoporosis International, 32(1), pp. 101–112. doi: 10.1007/s00198-020-05608-5. PMID: 32856124.
National Institute for Health and Care Excellence (2024) Menopause: identification and management (NG23). Available at: https://www.nice.org.uk/guidance/ng23 (Accessed: 27 August 2026).
Rocca, W.A., Grossardt, B.R., Miller, V.M., Shuster, L.T. and Melton, L.J. 3rd (2008) 'Increased cardiovascular mortality after early bilateral oophorectomy', Menopause, 15(6), pp. 1050–1059. PMID: 19034050.
Rocca, W.A., Bower, J.H., Maraganore, D.M., Ahlskog, J.E., Grossardt, B.R., de Andrade, M. and Melton, L.J. 3rd (2007) 'Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause', Neurology, 69(11), pp. 1074–1083. PMID: 17761551.
Rocca, W.A., Lohse, C.M., Smith, C.Y., Fields, J.A., Machulda, M.M. and Mielke, M.M. (2021) 'Association of premenopausal bilateral oophorectomy with cognitive performance and risk of mild cognitive impairment', JAMA Network Open, 4(11), e2131448. PMID: 34762113.
