Everything you need to ask before and after surgery

Facing surgery that could bring on menopause is daunting enough without the added uncertainty of what comes next. Whether your operation is for endometriosis, fibroids, risk-reducing reasons, or another gynaecological condition, being informed and prepared is one of the most empowering steps you can take.

The questions you ask before and after your surgery can make a huge difference to your recovery, your symptoms, and your long-term health. Here’s what we wish we had known before having surgery, and what we think will help you as you approach your hysterectomy or BSO.

Before surgery questions for your surgeon or specialist

1. What exactly will be removed?
Ask whether your surgeon plans to remove your womb (hysterectomy), one or both ovaries (oophorectomy), and/or fallopian tubes (salpingectomy). Each combination carries different hormonal and recovery implications. For example, if both ovaries are removed, you’ll enter surgical menopause immediately.

2. How will this affect my hormones?
If your ovaries are removed, your body will experience a sudden loss of oestrogen, progesterone and testosterone. This abrupt hormone deprivation can trigger severe menopausal symptoms, and increase longer-term risks for heart, bone and brain health if untreated. Even removing the womb alone can cause your ovaries to fail earlier than expected, so discuss how your hormonal health will be monitored post-surgery.

3. Will I need HRT and when will it start?
According to NICE and the British Menopause Society, women who go through early or surgical menopause should usually be offered hormone replacement therapy (HRT) until the average age of natural menopause (around 51), unless there’s a medical reason not to. Ask what your options are, whether you’ll receive an initial prescription before leaving hospital, and what to do if you experience side effects.

4. Will I need progesterone as well as oestrogen?
Even if your womb is removed, progesterone can still be prescribed to help stabilise mood, protect breast tissue, and support endometriosis management. It’s worth asking whether your surgeon recommends continuing with combined therapy or oestrogen alone.

5. What are the long-term health risks of surgical menopause if untreated?
Research shows that premature loss of ovarian hormones increases the risk of cardiovascular disease, osteoporosis, cognitive decline, and mood disorders. Your surgeon should explain these risks and how they plan to mitigate them through early hormone replacement and follow-up care.

6. How will pain and scarring be managed?
If you live with endometriosis or have had multiple pelvic surgeries, ask about the likelihood of scar tissue (adhesions) reforming, and what can be done to reduce inflammation and pain in recovery.

7. Who will handle my post-operative care?
Confirm who you’ll be handed over to after surgery. Will your surgeon liaise directly with your GP about HRT and follow-up care? Many women report falling through the cracks at this stage, so make sure there’s a clear plan for ongoing support.

After surgery questions for your surgical team or GP

1. When should I start HRT?
For most women without contraindications, HRT should be started as soon as possible after surgery. If you were told to wait, ask why and for how long. The abrupt hormone loss can severely impact your physical and emotional wellbeing within days.

2. How will we monitor whether my HRT is working?
Symptoms, not blood tests, are usually the best guide. However, if you don’t feel well after a few weeks or suspect poor absorption from your patch or gel, ask for a blood test to check your oestrogen levels. Some women need higher or off-label doses to reach therapeutic levels.

3. Can I add testosterone?
Testosterone plays a key role in energy, mood, libido, and cognition. Although not yet licensed for women in the UK, NICE and BMS guidance support its use for low sexual desire after menopause. You can ask your GP or specialist about this, but note that not all NHS GPs currently prescribe it.

4. What lifestyle measures will support my recovery?
Movement, protein-rich food, and calcium and vitamin D all help maintain bone and heart health. Sleep and stress management are equally vital while your hormones stabilise. If your hospital hasn’t provided guidance, ask your GP or menopause specialist for a plan that suits you.

5. What follow-up care should I expect?
You should be reviewed around six weeks post-op and again after starting HRT to adjust the dose or formulation as needed. Ask who to contact if your symptoms worsen or you need faster support.

Why These Questions Matter

Recent studies show that fewer than 5% of women receive HRT after surgical menopause, despite strong national guidance. In a 2024 Menopause Support survey of more than 500 women, nearly 75% said they were not warned about surgical menopause before their operation, and 83% felt their GP lacked sufficient knowledge to support them afterwards. Women deserve better.