Surgical menopause after ovary removal: symptoms, HRT and bone health

Menopause is the point when the body stops producing eggs and periods stop. NICE explains that it is a life transition that all people who have or have had periods go through, usually between 45 and 55 as part of ageing, but sometimes earlier. One of the routes it names to an earlier menopause is surgery to remove the ovaries, known as oophorectomy, alongside cancer treatment such as chemotherapy or radiotherapy, an inherited condition or an unknown reason.

When both ovaries are removed, menopause is therefore triggered by the operation itself. The NHS adds that early menopause or premature ovarian insufficiency, which means menopause before the age of 45, can be caused by this surgery. Removing the womb (hysterectomy) on its own stops periods, but whether menopause follows depends on whether the ovaries were also taken out.

Because the timing is set by surgery, you may reach menopause at an age earlier than your peers, which can feel isolating. NICE and the NHS both treat it as a recognised cause of menopause with its own treatment options.

The symptoms listed by the NHS for menopause apply here too, though the NHS notes that menopause is different for everyone, with some people having a large impact on daily life and others hardly any symptoms. NICE similarly says symptoms vary from barely noticeable to strongly affecting everyday life and can continue for some time after menopause.

Common features the NHS describes include:

• hot flushes and night sweats, which can bring palpitations, anxiety or dizziness

• sleep problems, which may worsen if you also have night sweats

• mood swings, low mood or depression, memory and concentration problems (brain fog)

• vaginal dryness, burning, irritation or itching, and painful sex

• more urinary tract infections or symptoms that feel like one, and needing to pass urine more often

• weight gain, often around the stomach and upper body

• joint pains and muscle aches, headaches, hair thinning, skin changes and reduced sex drive

• weakening bones (loss of bone density), which can lead to osteoporosis

The NHS tells people with symptoms to talk to a doctor, nurse or pharmacist about HRT and other options. It explains that the type offered depends on whether you still have periods or have had your womb removed.

Oestrogen is the main form of HRT and can be given as tablets, patches, spray or gel; a cream or pessary is sometimes used for vaginal dryness and urinary symptoms. If you have not had a hysterectomy, the NHS says progestogen must be taken as well to protect the womb, available as tablets, as part of a combined patch or as a hormonal coil. Where the womb has been removed, that protective step is not needed, which is why your surgical history changes the prescription. The NHS also says testosterone gel or cream can help low libido for some people and may be prescribed by a menopause specialist.

The NHS adds that HRT can reduce the risk of osteoporosis. NICE says healthcare professionals should discuss all treatment options with you, explaining the benefits and risks so that you can balance treating symptoms with any risks, taking into account your age, medical history, needs and preferences. If you had the ovaries removed because of a cancer, tell the team, because HRT decisions then need individual advice. The British Menopause Society publishes consensus statements on topics including premature ovarian insufficiency, HRT after a breast cancer diagnosis and bioidentical HRT, which clinicians use as references.

The NHS says that if HRT does not work, cannot be taken or is not wanted, other treatments are available. For low mood, depression or anxiety linked to menopause you may be offered antidepressants. For hot flushes and night sweats the NHS lists cognitive behavioural therapy (CBT), and if that does not help a doctor may suggest clonidine or an antidepressant. It also says there is very little evidence about how well herbal remedies such as red clover and black cohosh work or how safe they are, and that some may cause serious side effects alongside other medicines.

Lifestyle measures from the NHS include regular sleep routines, a balanced diet with calcium-rich foods, weight-bearing and resistance exercise, relaxing activities such as yoga or tai chi, not smoking and keeping within alcohol limits. For hot flushes it suggests lightweight clothing, a cool bedroom, a fan, and avoiding triggers such as spicy food, caffeine and hot drinks. Over-the-counter vaginal moisturisers or lubricants are available, and a pharmacist can advise privately; oil-based lubricants can damage condoms.

Starting menopause early means more years with lower hormone levels, which is why bone health features in menopause guidance. The NHS lists weakening bones as a possible effect and recommends weight-bearing exercise, calcium-rich food, sunlight for vitamin D, vitamin D supplements, stopping smoking and cutting down on alcohol, and notes HRT can lower osteoporosis risk. The British Menopause Society also lists consensus statements on prevention and treatment of osteoporosis and on primary prevention of coronary heart disease in women.

Ask your clinician whether a bone density (DEXA) scan is appropriate for you and how often your blood pressure, cholesterol and weight should be checked. These are conversations to have at your post-operative follow-up rather than leaving to chance.

The NHS suggests contacting a GP if you think you have symptoms and want to know your options, or if you notice palpitations. If you have had your ovaries removed but not your womb and notice bleeding, or if you have bleeding after a long time without periods, get it checked: the NHS says any vaginal bleeding after 12 months without a period needs checking because, while not usually serious, it can be a sign of cancer.

Seek urgent help for chest pain, severe breathlessness, one-sided weakness or any other emergency symptoms rather than assuming they relate to hormones.

GPs can prescribe HRT, and many surgical teams discuss it before the operation. NHS menopause clinics and specialist services exist for more complex situations, such as a cancer history or symptoms not controlled by first-line treatment, but access and waits vary by area.

Some people choose a private menopause specialist for longer consultations, testosterone assessment or bone and cardiovascular review. Look for a clinician who is open about evidence and monitoring, and be wary of services promoting unregulated hormone regimens. The NHS lists national charities such as The Menopause Charity and Women's Health Concern for independent information.