Symptoms of Surgical Menopause

Is it surgical menopause, or something else?

Surgical menopause happens suddenly. When both ovaries are removed, your body loses its main source of oestrogen, progesterone and testosterone overnight, and this abrupt hormone crash triggers an intense and immediate reaction in both our body and brain. As this happens, we can start experience symptoms within hours and the days that follow.

Unlike natural menopause, which unfolds gradually over years, surgical menopause can feel like a sudden storm due to the hormonal deficency we experience. Symptoms often feel extreme, especially without hormone replacement therapy (HRT), and can take us by surprise if we don’t anticipate them.

We typically know the stereotypical ‘brain fog and hot flushes’ that are commonly associated with menopause. But there are many more that are less discussed, and as a result we can question whether they are related to surgical menopause – or whether we need think again. You may experience a handful of these symptoms, or find yourself nodding at many of them as you read through. It’s important to remember that we all experience surgical menopause differently and our symptoms will differ from woman to woman.

Physical symptoms

Hot flushes and night sweats

Sudden waves of heat that can leave you drenched, dizzy and disoriented. They often come day and night, disrupting sleep and confidence in public and have a pesky habit of arriving at the most inconvenient moments.

• Flushing across the face, chest and neck

• Dripping sweats, often occuring during the night as you sleep

• Dizziness or nausea during an episode

• Cold flushes and chills

Insomnia and disrupted sleep

Falling asleep becomes difficult; staying asleep feels impossible. Hormonal withdrawal alters your sleep rhythm, while night sweats wake you repeatedly.

• Frequent waking in the early hours

• Getting up to pee during the night and unable to get back to sleep easily

• Racing thoughts and restlessness

• Daytime exhaustion or “wired-but-tired” feeling

• Vivid dreams, nightmares and night terrors

Changes to smell and taste

Hormonal shifts can alter our sensory perception including changes to our sense of smell and taste. Some women also experience phantom smells that can be disconcerting. This can also be caused by dry mouth, or dental issues caused by loss of oestrogen.

• Foods tasting metallic, bitter or “off”

• Stronger or reduced sense of smell and taste

• Smelling unusual or ‘phantom’ smells - cigarettes, mouldy food, rubbish

• Change in the way you perceive your partner’s natural scent, perhaps negatively

• Change to your body odour, and the way it smells to you

Changes to digestion and your gut health

Loss of oestrogen affects our gut motility and the microbiome, so its loss can alter digestion. This can result in discomfort, bloating, and issues going to the loo. It’s worth speaking to a doctor if any of these symptoms persist.

• Bloating, cramping or trapped wind

• Increased flatulence and pungent gas

• Constipation, diarrhoea or swinging between the two

• Discomfort and slow gut motility

• New food sensitivities or IBS-like symptoms

• Feeling of incomplete emptying when passing stools

Breast changes

Oestrogen loss can leads to a reduction in breast tissue density and elasticity, changing the size and shape of your breasts.

• Soreness or tenderness around the time of patch changes

• Noticeable sagging or loss of fullness in the breast and breast tissue

• Skin thinning or puckering (always get this checked out)

• Changes to colour or size of nipple

• Lumpy breasts – often harmless cysts or fibrocystic changes, but always seek medical advice for any new lump, unusual pain, or discharge from the nipple.

Fatigue and low energy

We’re not talking about needing an early night or two - this is deep “in-your-bones” exhaustion that doesn’t lift with rest. Oestrogen helps regulate energy metabolism, so its loss can make every task feel harder and like you are wading through mud.

• Feeling heavy-limbed or sluggish

• Needing naps through the day, but still feeling drained

• Loss of energy and stamina for work or exercise

• A feeling of ‘meh’ about things you usually find enjoyable.

Joint and muscle pain

Many of us feel a bit creaky as we get older, but for women in surgical menopause the aching, stiffness and inflammation are common and often more difficult to manage. Affecting the hips, back and knees in particular. Many women describe feeling as if they’ve aged overnight and find that they feel the joint and muscle pain mostly in the morning.

• Chronic bone ache

• Localised joint inflammation – often affecting knees, toes, fingers and wrists.

• “Shattered shins” sensation, or deep muscular soreness

• Jaw pain and tension in the face and neck

• Clicking or locking in joints - shoulder, jaw, elbow, knees etc.

Vaginal dryness and pain

As oestrogen levels drop, the delicate membranes in our vagina and vulva can thin and become drier. This can cause itching, soreness and pain during sex. This is part of genitourinary syndrome of menopause (GSM).

• Burning or stinging sensations

• Tearing or bleeding when wiping or clothes (pants) brush against your vulva

• Clitoral or labial atrophy or shrinkage

• Recurrent irritation or discharge – particularly watery, clear discharge that can indicate the vagina is working overtime to lubricate.

• Pain, discomfort and/or bleeding during or after sex

Bladder and pelvic changes

Oestrogen supports the bladder and pelvic floor. Without it, you may notice increased urgency, frequency, leaks, or recurrent urinary tract infections.

• Sudden urge to pee, often with little warning and causing you to dash for the loo

• Leaking wee when coughing, sneezing, running or jumping

• Burning, stinging or pressure after urination

• Waking up to pee in the night

• Recurrent urinary tract infections (UTIs) or bouts of cystitis that don’t seem to respond to medications

Headaches and migraines

Sudden hormonal changes can trigger or worsen migraines and tension headaches.

• Sharp one-sided pain or visual aura

• Pressure behind the eyes

• “Hormone headaches” that flare before patch change or at night

Heart palpitations

A racing, fluttering heartbeat (sometimes mistaken for panic or anxiety) can be one of the first symptoms women notice after surgery.

• Skipping or pounding heartbeat

• Chest tightness or fluttering in the throat

• Sudden surges of adrenaline or panic

Skin, hair and dental changes

Dryness, thinning hair, brittle nails and a sudden loss of elasticity in the skin are all linked to low oestrogen and collagen decline. If you feel like you’ve aged in a matter of weeks, you aren’t alone.

• Flaky or dry skin

• Increased hair shedding

• Fine lines appearing rapidly

• Appearance of grey hairs (and pubes!)

• Chin hairs and moustache

• Adult acne and ‘backne’

• Brittle nails that break or tear easily

• Hives or itchy skin including in your ears

• ‘Creepy crawly skin’ like bugs are under your skin

• Gum problems, loose or broken teeth

• Burning mouth and tongue

• Electric shock sensations or buzzing or ‘zinging’ sensations under the skin

Tinnitus (ringing in the ears)

Falling oestrogen levels can affect circulation and auditory nerve function, causing persistent ringing or humming that can drive you bonkers, especially when you are trying to sleep.

• Constant or intermittent noise in one or both ears

• Humming, buzzing, ringing or hissing sounds

• Sensitivity to sound

• Dizziness or balance issue

New or worsening allergies

Oestrogen supports our immune balance; its loss can trigger hypersensitivity in our body and increased histamine reactions, even to food, drink or products that we’ve previously tolerated well.

• Heightened response to dust, pollen, food or alcohol

• Skin rashes, itchy skin and hives

• Itchy ears, tongue or mouth

• Increased histamine reactions or “menopause allergies”

Changes in weight and body shape

Fat tends to shift towards the abdomen, even without changes in diet or exercise, as metabolism and insulin sensitivity change after ovary removal. Insulin resistance is common for women in surgical menopause and should be monitored.

• Bloated or puffy midsection

• Muscle loss from thighs and arms

• Difficulty maintaining previous weight

Cognitive symptoms

Brain fog

One of the most commonly associated symptoms of menopause gets an upgrade in surgical menopause. The feeling of “losing your words”, struggling to remember names (“thingy-me-bob, you know him”), or walking into a room and forgetting why. Many women describe it as feeling detached from their own thoughts.

• Short-term memory lapses

• Stuttering while speaking

• Feeling like your brain ‘spasms’ while talking

• Losing track mid-sentence and forgetting what you were doing

• Difficulty following conversations or reading

Poor concentration and focus

Oestrogen supports neurotransmitters involved in attention and memory. Its loss can make multitasking or staying organised much harder.

• Forgetting appointments or tasks

• Slower processing and reaction time

• Feeling easily distracted or overwhelmed

• Losing focus at work, or struggling to concentrate

Sensory changes

Some women notice increased light sensitivity, dizziness, or visual changes, which can be part of the brain’s reaction to hormonal shock.

• Blurred or flickering vision

• Heightened sensitivity to sound or light

• Motion sickness or imbalance

• A sense of ‘seeing’ things out of the corner of your eye (and there’s nothing there)

• Vertigo

Emotional and psychological symptoms

Anxiety and panic attacks

Sudden, intense surges of panic or fear can happen out of nowhere. This is a biological response to hormonal imbalance, not a character flaw or overreaction.

• Chest tightness and racing heart

• Shaking or feeling detached from reality

• A sense of dread or worry with no clear cause

• Anxious dreams or waking in panic during the night

• Anxiety when driving

Low mood and depression

Many women experience emotional flatness or sadness. The drop in oestrogen, progesterone and testosterone alters brain chemistry, affecting serotonin and dopamine and can leave us feeling low and depressed.

• Loss of joy or interest in usual activities

• Tearfulness or emotional numbness

• Social withdrawal or loss of motivation

• A sense of doom and feeling of hopelessness

• Suicidal ideation: please seek help if you have thoughts of harming yourself by calling 999 or seeking support from A&E.

Irritability and mood swings

Mood swings are very common - you might feel fine one minute and furious or tearful the next, or feeling sudden peaks of rage over minor events. These mood shifts can be exhausting and confusing, including for those around you.

• Feeling snappy or over-reactive

• Crying easily or feeling out of control

• Sudden peaks of anger or rage

• Happy one minute, angry or sad in the next

• Guilt or frustration afterwards

Loss of confidence or self-identity

As your hormones and body change, It’s common to feel not like yourself. Surgical menopause can affect the way you view yourself, and your sense of femininity. Some women report feeling disconnected, unsure, or even alien to your own personality.

• Reduced self-esteem

• Fear of returning to work or social situations

• Sense of detachment from who you used to be

• Anxiety or paranoia about how people percieve you

• Feeling ‘alien’ in your own body

• Not recognising yourself in the mirror or photos

• Not wanting people to take photos of you

• Feeling self-conscious, including during intimacy with your partner

• Avoiding challenging yourself or new situations

• Wanting to stay at home more than usual

Sexual changes

Loss of libido

Testosterone plays a key role in sexual desire, and its sudden loss after surgery can switch off your interest in sex and intimacy almost overnight.

• Lack of spontaneous desire or fantasy

• Feeling indifferent or anxious about sex even with your regular partner

• Emotional disconnection from your partner

• Deliberately avoiding moments of intimacy

Reduced arousal

Even when you want to be close, your body may not respond in the same way. Reduced blood flow and nerve sensitivity can make arousal slower, and vaginal dryness can cause discomfort or pain. It’s important to remember that intimacy doesn’t always mean sex.

• Difficulty becoming physically aroused or a feeling like you can’t quite get ‘there’

• Longer time to reach pleasure, including during masturbation

• Decreased genital sensitivity when being touched or masturbating

• Not feeling ‘wet’ or ready for sex

• Loss of enjoyment during foreplay or a feeling of being less turned on

Changes in orgasm

Many women notice that their orgasms feel different after surgery — less intense, muted, or harder to reach. This can be related to your surgery, especially if your uterus was removed (hysterectomy), or you have scarring build up over time. Some women who have had their cervix removed feel that the sensation of orgasm changes.

• Loss of uterine or deep pelvic contractions

• Duller or more distant sensation

• Difficulty reaching climax or needing more stimulation

• Feeling ‘different’ or emotional after orgasm

• A sensation of your orgasm ‘travelling’ differently around your body

• Inability to achieve orgasm when self-pleasuring

Painful intercourse (dyspareunia)

Thinning and dryness of your vaginal and vulvar tissue can make vaginal penetration painful, and leave soreness or stinging afterwards. Over time, this can make you anxious about penetrative sex.

• Sharp pain on entry or a feeling of ‘tearing’.

• Burning feeling after sex, or stinging when peeing after penetration.

• Bleeding when wiping after intercourse or digital penetration.

• Pain ‘deep’ inside during thrusting

• Aching inside after penetration

• A throbbing sensation deep inside that lasts for hours after sex

• Avoidance of intimacy due to fear of pain

Why symptoms can feel so extreme

In natural menopause, the body adjusts gradually as hormones decline. In surgical menopause, hormone levels plummet in a matter of hours, leaving no time for adaptation. This sudden deprivation affects the brain, skin, heart, and every organ system — which is why the impact can feel total. It’s important to keep monitoring your symptoms using apps, notes or our symptom tracker.