Surgical menopause

The British Menopause Society defines surgical menopause as the removal of both ovaries, a bilateral oophorectomy, before a woman reaches menopause naturally. It is often done at the same time as a hysterectomy.

If one ovary is kept, it is not a surgical menopause. The NHS website says that when one or both ovaries are left in place at a hysterectomy, menopause may still come sooner than it otherwise would. Menopause brought on by chemotherapy or radiotherapy is related but different: see chemo-induced menopause.

Why the ovaries are removed

The BMS lists the reasons. Some are cancers, or a high inherited risk of them: women who carry a BRCA1 or BRCA2 gene change may choose risk-reducing surgery. Others are not cancer at all: heavy bleeding, fibroids, endometriosis, long-term pelvic pain and repeated ovarian cysts.

The Menopause Society recommends keeping the ovaries when the womb is removed for a reason other than cancer, in women who have not reached menopause and have an average risk of ovarian cancer. The Asia-Pacific Menopause Federation says the same.

If your ovaries are removed, the NHS website says you will usually have severe menopausal symptoms after the operation, such as hot flushes, anxiety and sweating.

The BMS lists what can follow: hot flushes and night sweats, the loss of fertility, low libido, vaginal dryness, repeated urine infections, and changes in mood and memory, including a higher risk of depression and anxiety. It says the loss of libido can be more marked than after a natural menopause.

All of this can land while you are still healing from major surgery.

The BMS describes natural menopause as the ovaries winding down, which lowers estrogen and progesterone over years. Surgery removes them in a single operation, and the BMS says it is this sudden loss of ovarian function that can make symptoms particularly severe.

There may be a second reason. The BMS notes that some studies suggest the ovaries go on making androgens, hormones such as testosterone, after menopause, which may be why surgery can affect libido more than a natural menopause does.

Longer-term health

The BMS says surgical menopause brings a higher risk of heart disease and of osteoporosis, and that women who have it before their natural menopause may face higher rates of heart disease, stroke, memory problems and thinning bones. It adds that good large-scale data is limited. The NHS website says women whose ovaries have been removed are at greater risk of osteoporosis.

Support before and after

The BMS says every woman having a surgical menopause should be counselled and given information about the hormonal effects of surgery and the role of HRT, both before the operation and before she leaves hospital, with clear communication to her GP or family doctor.

The BMS says HRT plays a significant role in managing surgical menopause, especially before 45, and that current guidelines advise offering it at least until the average age of natural menopause unless there is a reason not to. After that, it says, carrying on should be an informed decision based on your symptoms.

The type depends on your womb. The BMS says estrogen-only HRT can be used if you have had a hysterectomy, while a woman who keeps her womb needs combined estrogen and progestogen. It also lists vaginal estrogen, vaginal DHEA, testosterone, tibolone, and non-hormonal medicines including SSRIs, clonidine, gabapentin and fezolinetant. The NHS website notes that women who have had certain types of cancer, such as some breast cancers, may not be able to have hormone treatments. See non-hormonal treatments.

If surgery is planned, ask beforehand what will happen to your hormones and what support you will get. NICE NG23 says that information should come both before and after treatment.

Afterwards, see your doctor if symptoms are hard to live with, or if your mood drops. The NHS website says early or premature menopause can affect mental health as well as physical health, and that help is available.

If children are still part of your plans, raise it before the operation, not after. NICE NG23 names fertility as part of the information women should get before surgical treatment.

At home, a sudden menopause can be hard to explain, because it does not look like the slow change an older relative went through. The Pakistan Menopause Society's recommendations say a husband's and family's support plays an important role in managing menopause symptoms.