You went in for an operation and came out in menopause. Nobody sat you down beforehand to explain that the hot flushes, the broken sleep and the low mood might start within days. You were told how to look after the scar. Nobody mentioned the rest.

Surgical menopause is real, and it can be one of the hardest ways to go through the change.

What surgical menopause is

Surgical menopause happens when both ovaries are removed. The British Menopause Society defines it as the removal of both ovaries before a woman reaches natural menopause. Because the ovaries make most of your estrogen and progesterone, taking them out stops that supply straight away, and menopause starts the same day.

It is not the same as every hysterectomy. A hysterectomy removes the womb. If your ovaries are left in place, your periods stop, but your ovaries can carry on making hormones. Surgical menopause means the ovaries themselves have gone. If you are not sure which operation you had, or are about to have, ask.

Why it can hit harder

Natural menopause usually comes on over years, so the body has time to adjust as hormones drift down. After surgery, there is no drift. The hormones fall in one go.

The symptoms are much the same as a natural menopause: hot flushes (sudden waves of heat), night sweats, mood swings, broken sleep, vaginal dryness. They often arrive suddenly and can be more severe. The BMS says symptoms can be particularly severe because the ovaries' function is lost all at once.

What the guidelines say

NICE NG23 recommends offering support and information about menopause and fertility to anyone likely to go through menopause because of medical or surgical treatment, both before and after the treatment. If nobody had that conversation with you, it is fair to ask for it now.

The BMS says current guidelines advise offering HRT to women under 45 who have a surgical menopause, at least until the average age of natural menopause, unless there is a reason they cannot take it, such as a hormone-dependent cancer. The NHS website says replacing the missing hormones matters before 45, because of a higher chance of problems with the bones and the heart.

Whether HRT fits you, and for how long, is a decision for you and your doctor, weighing your own history.

Looking after yourself afterwards

The most useful approach looks after body and mind together.

Move every week. The NHS suggests adults aim for at least 150 minutes of moderate activity, or 75 minutes of vigorous activity, a week, with muscle-strengthening activity on two or more days. A brisk walk counts. So do bands, bottles of water and your own body weight.

Eat for your bones and heart. Plenty of vegetables, fruit, whole grains, dals and lean protein. Calcium-rich foods such as milk, dahi and leafy greens matter more now. Whether you need a calcium or vitamin D supplement is a question for your doctor, ideally with a blood test.

Protect your bones. A sudden drop in estrogen can speed up bone loss and raise the risk of osteoporosis. Weight-bearing exercise, such as walking and climbing stairs, helps keep bones strong. Ask whether you need a bone density scan.

Watch your heart. The risk of heart disease rises after menopause. Ask for your blood pressure and cholesterol to be checked, and keep an eye on your weight around the middle.

Look after your mind. Losing your ovaries can bring grief, a sense of loss, worry or low mood, sometimes all at once. Counselling or a support group can help you feel less alone. The Pakistan Menopause Society lists support groups and CBT, a talking therapy, for mood symptoms around the menopause.

Keep up with check-ups. Regular check-ups and screening, such as breast checks and mammograms where they are offered, help catch problems early. Our page on health screening explains what to ask for.

Find something that calms you. Yoga, quiet prayer, meditation or slow breathing can help with stress and help you feel more like yourself.

Before your operation, ask

  • Will my ovaries be removed, or only my womb?
  • If my ovaries are removed, when might symptoms start?
  • Will I be offered HRT afterwards, and if not, why not?
  • Who do I contact if the symptoms are hard to cope with?

After your operation, if you are struggling

You are not overreacting. A menopause that arrives overnight is a lot for any body and any mind. Keep a simple record of your hot flushes, sleep and mood for a couple of weeks and take it to your doctor. It makes the conversation shorter and clearer.

Our page on surgical menopause has more, including what the guidelines say about HRT after surgery.