Surgical menopause: after removal of the ovaries or hysterectomy

A hysterectomy removes the womb and ends periods, but menopause occurs only if the ovaries are removed or stop working. Removal of both ovaries, bilateral salpingo-oophorectomy, produces immediate menopause. Removal of one ovary typically does not. Removal of the ovaries is done for reasons such as cancer treatment, risk reduction in people with BRCA variants, severe endometriosis or other conditions.

In natural menopause, oestrogen falls gradually over years, giving the body time to adapt. After surgical removal, levels drop within days. Hot flushes, night sweats, mood changes, sleep disturbance, vaginal dryness and loss of sexual desire can begin quickly and may be marked. Testosterone from the ovaries also falls, which can affect desire and energy.

• Oestrogen-only HRT is usually used after hysterectomy, with a progestogen added if there is a history of endometriosis or remnants of the womb lining.

• For women under the usual age of menopause, HRT is generally advised until at least that age unless there is a contraindication.

• Testosterone may be considered if low sexual desire persists despite oestrogen.

• For women with hormone-sensitive cancers, individual specialist advice is needed.

• Women with BRCA variants who have risk-reducing surgery should be offered HRT discussion with a specialist.

Early loss of oestrogen increases the risk of osteoporosis and possibly cardiovascular disease. HRT reduces bone loss. Weight-bearing exercise, calcium and vitamin D, avoiding smoking and moderate alcohol also matter. Clinicians may recommend a bone density scan, depending on age and risk.

If you have a choice, discuss with your surgeon whether the ovaries need to be removed, what the implications are and what hormone plan will follow. Ask whether HRT can start straight after surgery, whether a prescription will be arranged and who will review you. Having a menopause specialist involved before surgery is increasingly encouraged.

Surgery that ends fertility or changes the body can bring grief and relief in various measures. Support from a counsellor, peer groups or your clinical team can help. If you feel persistently low or hopeless, speak to your GP or call NHS 111. Samaritans can be reached on 116 123 at any time.

Review should cover symptom control, HRT dose and route, blood pressure, bone health and wellbeing. If symptoms continue despite treatment, ask for referral to a menopause specialist.

Before an operation, ask whether removing the ovaries is essential, what difference it makes to your long-term risk and what the alternatives are. Ask who will prescribe HRT and when you will start, what dose they plan, whether testosterone is an option and when your first review will take place. If surgery is urgent, ask for these questions to be revisited as soon as you are recovering. Write the answers down, because information is easy to forget around an operation.