Decisions, decisions? Everything you need to know to help you decide on surgery
Choosing to remove your ovaries (oophorectomy) or womb (hysterectomy) is one of the most significant health decisions many women will ever face. It’s a choice that can carry lifelong consequences — for your hormones, fertility, sexual health, and emotional wellbeing. Yet too often, women find themselves making it with incomplete information or under immense pressure.
At SURGE Menopause, we believe in informed, empowered decision-making. This guide isn’t here to tell you what to do — that’s a conversation between you and your consultant — but to help you ask the right questions, understand the potential impacts, and plan ahead so that you can move into surgery feeling prepared, not blindsided.
Which surgery are you having?
A hysterectomy removes the uterus, meaning you’ll no longer have periods or be able to become pregnant.
A total hysterectomy removes the uterus and cervix.
A subtotal (or partial) hysterectomy leaves the cervix in place.
A radical hysterectomy removes the uterus, cervix, surrounding tissues, and sometimes part of the vagina, often used in cancer treatment.
An oophorectomy removes one or both ovaries. When both are removed — a procedure called bilateral salpingo-oophorectomy (BSO) — it causes an immediate and total loss of ovarian hormones. This is what’s known as surgical menopause.
If the surgery is performed before the natural age of menopause (around 51 in the UK), this sudden hormonal drop can cause intense symptoms and increase long-term health risks including cardiovascular disease, bone loss, and cognitive decline.
Why the decision is so complex
The reasons for surgery vary — endometriosis, adenomyosis, fibroids, heavy bleeding, or cancer risk — and each case is unique. For some, surgery brings immense relief from pain and bleeding. For others, it creates new challenges, especially when the hormonal changes are not anticipated or managed.
New research shows that women with endometriosis are seven times more likely to experience surgical menopause, and at a younger age than those without the condition. Meanwhile, data from the BMJ confirm that removing both ovaries before age 50 increases the risk of all-cause mortality and non-cancer-related death. These are sobering statistics — and they highlight why thoughtful, individualised care is essential.
Questions to ask before surgery
You might feel under pressure to make a decision quickly – especially as waitlists are long and consultation time is limited. But before consenting, you should feel confident that you understand:
Why your consultant recommends the procedure, and whether there are alternatives such as medical management options that you’d be open to considering.
Exactly what will be removed — uterus, ovaries, fallopian tubes, cervix?
What happens hormonally after surgery. Will this cause surgical menopause?
What is the plan for HRT (Hormone Replacement Therapy). You should also know when HRT will start (ie, immediately and before you leave hospital, or if there is a delay during your recovery phase) and what the factors are for the timeliness of HRT starting.
How will my health be protected? From short term crash menopause symptoms to long term health concerns ie bone, heart and cognitive function?
What are the emotional and sexual impacts I should prepare for? Should I expect my mood to dip, or will I experience anxiety? Will my ability to orgasm be affected, or how could this impact on my relationship and own sense of sexuality?
Who will manage my care afterwards — what follow ups with the hospital team will I have, and when will I be discharged into GP care. Will I automatically be referred to a menopause specialist, and what is the timeframe for the referral currently?
If your surgeon can’t answer these questions clearly, ask for a follow-up consultation or a referral to a menopause specialist before making a final decision. You’re entitled to understand the full implications and to make an informed decision for your care.
Planning for surgical menopause
If both ovaries are being removed, you’ll experience a sudden loss of oestrogen, progesterone, and testosterone. Symptoms often appear within days, not months, and can include hot flushes, anxiety, insomnia, mood swings, and brain fog. These are not just “a few hot flushes” — they are the result of acute hormonal deprivation.
Evidence from the Mayo Clinic and Royal College of Obstetricians and Gynaecologists shows that hormone therapy can offset many of the health risks associated with early menopause when prescribed promptly and continued until the natural age of menopause.
However, a recent UK audit found that just 4.8% of premenopausal women received HRT at discharge after BSO – which indicates a shocking gap in care. This underlines the importance of having your post-operative hormone plan agreed before surgery, not after.
Considering your individual risk
For women with endometriosis or hormone-sensitive cancers, the discussion is more complex. Deep infiltrating endometriosis (DIE) may reactivate with oestrogen-only HRT. If your endometriosis is superficial and can be excised by a specialist, then you will likely be advised to commence combined HRT (continuous oestrogen and progesterone). Certain cancers limit HRT options altogether. In these cases, multidisciplinary input from your gynaecologist, oncologist, and menopause specialist is vital.
If you carry a genetic mutation such as BRCA1 or BRCA2, risk-reducing salpingo-oophorectomy is a lifesaving procedure, but one that requires careful management of surgical menopause afterwards.
The RCOG recommends offering HRT until at least age 51 to protect bone, heart, and cognitive health, unless contraindicated.
Preparing emotionally and practically
The physical and emotional toll of surgical menopause can be significant. Many women describe feelings of loss, grief, or identity change after surgery — particularly if their fertility journey has been long and painful.
Planning ahead can help:
Build a support network of friends, family or peers who understand.
Seek counselling before or after surgery if you need space to process it.
Prepare your home and recovery space, including rest, nutrition, and gentle movement plans.
Stay informed: track your symptoms and progress once you begin recovery.
Your decision, your body
Whether to have an oophorectomy or hysterectomy is a personal decision, and no one should feel rushed, coerced, or dismissed. Ask every question you need to, seek a second opinion if something doesn’t feel right, and remember that it’s okay to take your time.
You deserve care that sees the whole of you — not just your organs — and a treatment plan that supports your long-term health, hormones, and happiness.
