What is surgical menopause - and how can I prepare for it?
Surgical menopause happens when both ovaries are removed during surgery — usually through a procedure called a bilateral salpingo-oophorectomy (BSO). Because the ovaries are the main producers of oestrogen, progesterone and testosterone, their removal triggers an abrupt and total drop in these hormones. Unlike natural menopause, which happens gradually as hormone levels decline over time, surgical menopause happens overnight. The physical and emotional effects can be immediate and severe.
What’s the difference between natural, medical and surgical menopause?
Natural menopause is the point when the ovaries stop releasing eggs and hormone production slows down. It usually happens between 45 and 55, with an average age of 51. Perimenopause — the years leading up to it — is a gradual transition.
Surgical menopause, by contrast, is instant. When both ovaries are removed before this natural point, the body is suddenly deprived of key hormones that influence everything from temperature control and sleep to bone density, brain health and mood.
There’s also medical menopause, which is induced temporarily by drugs such as GnRH agonists, chemotherapy, or radiotherapy. This form of menopause is used to suppress ovarian function in conditions like endometriosis or some cancers. It can be reversible if the treatment stops and the ovaries recover.
Why do women have their ovaries removed?
Surgery that leads to menopause may be necessary for a range of reasons. In the UK, around 30,000–40,000 hysterectomies take place each year. Some women have their ovaries removed at the same time, either because of disease or to reduce future cancer risk.
Common reasons include:
Endometriosis, where tissue similar to the womb lining grows elsewhere in the pelvis and can cause severe pain and inflammation. Research shows women with endometriosis are seven times more likely to undergo surgical menopause than those without the condition.
Ovarian cysts or benign tumours, where removal of one or both ovaries may be recommended.
Genetic risk, such as carrying a BRCA1 or BRCA2 mutation, where risk-reducing surgery can cut the chance of ovarian cancer by more than 90%.
Cancer treatment, where the ovaries are removed or shut down to block oestrogen feeding certain cancers.
Although the decision is sometimes lifesaving, it can also have a profound impact on quality of life and long-term health if hormones are not replaced afterwards.
Understanding the impact on your body and mind
When menopause happens suddenly, symptoms can be more intense than in natural menopause. Many women experience severe hot flushes, night sweats, brain fog, anxiety, low mood, loss of libido and joint pain. The sudden loss of oestrogen and testosterone also increases the risk of heart disease, osteoporosis, cognitive decline and sexual dysfunction if left untreated.
A 2024 audit of NHS hospitals found that only 4.8% of premenopausal women received HRT after ovary removal — despite clear national guidance that it should be offered unless clinically unsafe. This lack of care leaves thousands of women vulnerable to avoidable harm.
How is surgical menopause managed?
Treatment and support should begin before surgery. Ideally, there should be a clear post-operative plan that includes hormone replacement therapy (HRT) where appropriate.
HRT is the first-line treatment for surgical menopause, recommended by NICE and the British Menopause Society until the average age of natural menopause (around 51). The type of HRT depends on whether your womb has also been removed:
Oestrogen-only HRT if you’ve had a hysterectomy.
Combined oestrogen and progesterone HRT if your womb is intact, to protect the uterine lining.
Testosterone may also be added to improve energy, mood, cognition and libido.
Transdermal oestrogen (patches, gels or sprays) is often preferred, as it carries a lower risk of blood clots and allows doses to be adjusted easily. Some women, particularly after surgical menopause, need higher or off-licence doses to reach therapeutic hormone levels because absorption varies widely between individuals.
For women who can’t take HRT — for example, after certain hormone-sensitive cancers — non-hormonal medications, vaginal moisturisers, lifestyle support and specialist follow-up are essential.
And finally…
Surgical menopause isn’t “just” menopause — it’s a medical condition that needs proper preparation, management and follow-up care. With the right hormone therapy and support, most women can restore their wellbeing and protect their long-term health. But no one should face the shock of losing their hormones overnight without information, options or aftercare. That’s why awareness, education and reform are urgently needed — so every woman receives the care she deserves.
