Are there long term risks for women in surgical menopause?
When both ovaries are removed before the natural age of menopause (around 51), it triggers what’s known as surgical menopause. The sudden loss of oestrogen, progesterone, and testosterone doesn’t just cause the well-known symptoms like hot flushes and insomnia — it has a profound effect on long-term health too.
Many women are never warned of these risks before surgery, yet the research is clear: early oestrogen deprivation impacts almost every system in the body. Here’s what the evidence tells us.
Heart and Blood Vessel Health
Oestrogen has a powerful protective effect on the cardiovascular system. It helps to keep arteries flexible, supports healthy cholesterol levels, and reduces inflammation. When oestrogen levels fall abruptly after surgery, that protection disappears overnight.
Studies from the Mayo Clinic and BMJ have shown that women who undergo bilateral oophorectomy (the removal of both ovaries) before the age of 45 face a significantly higher risk of heart disease, stroke, and early death compared with those who keep their ovaries.
These risks are largely preventable when women receive appropriate hormone therapy. Replacing oestrogen to at least the age of natural menopause can restore much of that protection — yet too many are discharged without it.
Bone Health and Osteoporosis
Oestrogen plays a vital role in maintaining bone strength. Without it, bone density drops quickly, especially in the first few years after surgery. Research has found that bone loss can occur at more than twice the rate of natural menopause.
Without HRT, this can lead to early osteoporosis and a higher risk of fractures later in life. Weight-bearing exercise, vitamin D, calcium, and oestrogen replacement are all key to protecting bone health.
Brain and Cognitive Function
The loss of oestrogen affects the brain as well as the body. Data from the Mayo Clinic Cohort Study of Oophorectomy and Aging show that women who have their ovaries removed before menopause have nearly twice the risk of cognitive decline or dementia later in life.
These neurological effects appear to be mitigated when oestrogen therapy is started soon after surgery — highlighting just how critical timely HRT can be.
Mental Health and Emotional Wellbeing
The hormonal crash of surgical menopause can trigger severe anxiety, depression, and mood swings. The Mayo Clinic’s long-term studies also report higher rates of new-onset depression and anxiety following oophorectomy, particularly in younger women.
Psychological support, peer connection, and hormone therapy all play important roles in recovery. Yet, as the Menopause Support 2024 survey revealed, over 60% of women weren’t even told about HRT before surgery, and many were left to navigate the emotional fallout alone.
Bone, Brain, Heart — and Beyond
Oestrogen loss accelerates ageing across multiple systems: the cardiovascular system, the skeleton, and even the eyes and skin. There is evidence linking early surgical menopause with higher rates of parkinsonism, glaucoma, and macular degeneration — all associated with premature ageing of the nervous system.
In short, removing the ovaries before natural menopause creates an immediate and lifelong hormone deficiency that impacts far more than reproduction. This is not just about hot flushes — it’s about whole-body health.
Why HRT Matters
Guidelines from the British Menopause Society, NICE, and the Royal College of Obstetricians and Gynaecologists all recommend that women who experience surgical menopause before the natural age should receive hormone replacement therapy, unless contraindicated (for example, due to certain cancers).
HRT can reduce the long-term risks of heart disease, osteoporosis, and cognitive decline, while improving mood, sleep, and sexual function. It’s not a luxury — it’s a standard of care.
The Bottom Line
Surgical menopause is not simply an early menopause. It is an abrupt, medically induced hormone deficiency with serious implications for long-term health. Every woman deserves to understand these risks before surgery — and to be offered the treatment and support that can protect her future.
