Menopause & Midlife
Surgical Menopause: What to Expect After Your Ovaries Are Removed
Surgical menopause happens when both ovaries are removed (a bilateral oophorectomy) before natural menopause. Because estrogen drops suddenly, hot flashes, night sweats and sleep problems often start within days and can feel more intense than natural menopause. For most people under the typical age of menopause, hormone therapy is recommended unless there's a medical reason to avoid it.
A hysterectomy alone, which removes the uterus but leaves the ovaries, does not cause surgical menopause. That's one of the most common mix-ups, so let's start there.
Which surgery causes menopause?
| Surgery | What's removed | Periods? | Menopause? |
|---|---|---|---|
| Hysterectomy (ovaries kept) | Uterus, often cervix and fallopian tubes | Stop | No; ovaries keep making hormones |
| Bilateral oophorectomy | Both ovaries | Stop if uterus also removed | Yes, immediately |
| Bilateral salpingo-oophorectomy (BSO) | Both ovaries and fallopian tubes | Stop if uterus also removed | Yes, immediately |
| Unilateral oophorectomy | One ovary | Continue | Usually no |
| Salpingectomy | Fallopian tubes only | Continue | No |
After a hysterectomy with ovaries kept, you won't have periods, so it's harder to tell when natural menopause arrives. Hot flashes and other symptoms become the main clue.
If you're not sure exactly what was removed, ask for your operative report. Many people are told "they took everything" and later learn one ovary is still there, or the reverse.
Why ovaries are removed
- Cancer risk reduction in people with BRCA1/BRCA2 variants or Lynch syndrome
- Ovarian or other gynecologic cancer
- Severe endometriosis
- Ovarian cysts or masses
- Treatment of some hormone-sensitive breast cancers
ACOG advises that for people at average risk of ovarian cancer having a hysterectomy for benign reasons, keeping healthy ovaries should be strongly considered for premenopausal patients, because removing them early is linked to long-term health risks. Removing the fallopian tubes (salpingectomy) while keeping the ovaries may be offered as a way to lower ovarian cancer risk.
Before surgery: questions to ask your surgeon
- Is removing both ovaries necessary, or can one or both be kept?
- Should my fallopian tubes be removed?
- Will I start hormone therapy, and when? Who will prescribe it?
- What symptoms should I expect in the first weeks?
- When should I have a bone density test?
Asking "who will manage my menopause afterward?" is worth doing before the operation. Surgeons, especially cancer surgeons, focus on the surgery and the follow-up for the condition that led to it. Menopause care can fall through the cracks unless someone owns it.
What it feels like: the first weeks
Symptoms are similar to natural menopause but often arrive all at once, layered on top of surgical recovery:
- Hot flashes and night sweats, sometimes severe, starting within days
- Trouble sleeping, which makes surgical fatigue worse
- Mood changes, anxiety or low mood
- Brain fog
- Joint aches
Many people describe it as going from zero to full menopause in a week. That's not in your head, and you don't have to tough it out. If you're starting hormone therapy, ask exactly when your first dose should be. Bring up menopause symptoms at your post-op visit, not only the incision.
The first months
As you recover from surgery, other changes may show up:
- Vaginal dryness and painful sex
- Lower sex drive (the ovaries also make testosterone)
- Ongoing sleep or mood issues
Once your surgeon clears you for sex, lubricants, vaginal moisturizers and low-dose vaginal estrogen can help with dryness and pain. Our guide to genitourinary syndrome of menopause covers the options. If low desire is distressing, talk to your clinician; there are several causes and treatments to explore.
The long view: bones, heart and brain
Losing ovarian hormones before natural menopause is linked to higher long-term risk of:
- Osteoporosis and fractures. See osteoporosis screening and bone density tests.
- Heart disease.
- Possibly cognitive decline and mood disorders, especially when ovaries are removed at a younger age and hormone therapy isn't used.
These risks are a major reason hormone therapy is recommended for many people after early surgical menopause.
Hormone therapy after surgical menopause
According to The Menopause Society and ACOG:
- People who have surgical menopause before the average age of natural menopause generally benefit from hormone therapy, unless there's a contraindication, at least until around age 50 to 52.
- If your uterus was removed, you can usually take estrogen alone. Estrogen-only therapy did not increase breast cancer risk in the Women's Health Initiative.
- If your uterus is still present, you need a progestogen too.
- Some people start hormone therapy right after surgery. Your surgeon and gynecologist will plan timing with you.
More in menopause hormone therapy benefits and risks.
Special situations
- BRCA carriers without breast cancer: hormone therapy until around the average age of natural menopause is often considered after risk-reducing surgery. Decide with your gynecologist and cancer genetics team.
- After hormone-sensitive breast cancer: systemic hormone therapy is usually avoided. Non-hormonal options can treat hot flashes.
- After endometriosis surgery: hormone therapy may still be used; your clinician may add a progestogen in some cases to lower the chance of remaining endometriosis being stimulated.
- After ovarian or endometrial cancer: depends on cancer type and stage; your gynecologic oncologist will advise.
What about testosterone?
The ovaries make some testosterone. The Menopause Society notes that testosterone therapy may help some postmenopausal women with low sexual desire that causes distress (hypoactive sexual desire disorder), but there's no FDA-approved testosterone product for women in the US. Ask your clinician about the pros and cons.
When to see a doctor
Contact your clinician if:
- Hot flashes, sleep problems or mood changes after surgery are hard to manage
- You had your ovaries removed before 45 and aren't on hormone therapy
- You have vaginal dryness or painful sex
- You feel depressed or hopeless (call or text 988 for immediate support)
Finding care in New York
Gynecologists and gynecologic oncologists across New York City, Long Island and the Hudson Valley manage surgical menopause. A common, workable setup: keep seeing your surgeon for cancer or endometriosis follow-up, and see a gynecologist or nurse practitioner for menopause, bones and heart health. If your surgery was at a big Manhattan center and you live in Suffolk or Orange County, it's reasonable to find a menopause clinician closer to home. Search the directory to find one near you.
Frequently asked questions
Does a hysterectomy cause menopause?
A hysterectomy alone (removing the uterus) stops periods but does not cause menopause if the ovaries are left in place. Removing both ovaries (bilateral oophorectomy) causes immediate menopause.
How soon do symptoms start after ovaries are removed?
Symptoms like hot flashes can begin within days of surgery, because estrogen levels drop suddenly rather than gradually.
Is surgical menopause worse than natural menopause?
Symptoms are often more sudden and intense than with natural menopause, because there is no gradual transition. Experiences vary.
Do I need progesterone after surgical menopause?
If your uterus was also removed, estrogen alone is usually used. If you still have your uterus, you need a progestogen with estrogen to protect the lining.
Can I take hormone therapy if I had my ovaries removed because of BRCA?
For BRCA carriers without a personal history of breast cancer, hormone therapy until around the average age of natural menopause is often considered. Discuss with your gynecologist and cancer genetics team.
Sources
- ACOG — Elective and Risk-Reducing Salpingo-oophorectomy (Practice Bulletin 89)
- ACOG — Hereditary Breast and Ovarian Cancer Syndrome (Practice Bulletin 182)
- The Menopause Society — 2022 Hormone Therapy Position Statement
- MedlinePlus — Hysterectomy; Ovary Removal
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.