What science tells
us about surgical menopause

What the research shows us

Surgical menopause isn’t just an abrupt end to periods – it’s an abrupt change in our biology. When our ovaries are removed, the loss of oestrogen, progesterone and testosterone affects almost every system in our body. For decades, research has shown that this sudden deprivation can have a long term impact on our health, but also that replacing those hormones dramatically reduces the risks and can also help to manage the short term symptoms that many of us will experience rapidly, and severely, in the hours, days and weeks after surgery.

Key Facts

• Surgical menopause before 45 is linked with increased mortality, heart disease, and cognitive decline.

• These risks are preventable with timely hormone replacement.

• Fewer than 1 in 20 UK women receive HRT after surgery despite clear guidance.

• Body-identical HRT (17β-estradiol and micronised progesterone) offers the safest and most effective replacement.

• The science overwhelmingly supports individualised, hormone-based aftercare for every woman who undergoes ovary removal.

Before you dive in

The research we’ve summarised here is powerful – but like all science, it needs context. Most studies on surgical menopause are observational, meaning they show strong links rather than absolute cause and effect. Many also draw on data from midlife, white, Western women, so findings may not reflect every lived experience. There is a significant gap in data and need for further research for surgical menopause and the impact of hormone therapy on our short and long term health.

Where possible, we’ve included the most recent research in the list below. However, it’s worth remembering that much of the early research assessed older, synthetic hormone therapies; not the body-identical, transdermal HRT now recommended by NICE and the British Menopause Society and commonly used by women. Today’s treatments are safer, more precise, and far better understood.

We share this research to help inform, not alarm – and to help women, clinicians, and policymakers see just how much difference the right care can make.

Key Research Studies

Below, we’ve summarised the most influential studies shaping current understanding of surgical menopause and hormone therapy.

Long-term health consequences of premature or early menopause
Faubion SS, Kuhle CL, Shuster LT, Rocca WA (2015) Climacteric, 18(4):483-491. DOI: 10.3109/13697137.2015.1020484

This landmark Mayo Clinic review examined how the early loss of ovarian hormones affects long-term health and lifespan. It concluded that early menopause – surgical or natural – increases cardiovascular, bone, cognitive, and mental health risks, and that oestrogen replacement until at least the average menopause age restores protection.

Key findings:

• Women who lose ovarian function before natural menopause face higher risks of cardiovascular disease, osteoporosis, depression, and cognitive decline.

• Early oestrogen replacement until at least age 51 reduces those risks and restores life expectancy to normal levels.

• Authors advocate proactive, individualised hormone therapy for women with surgical menopause.

Treatment of women after bilateral salpingo-oophorectomy prior to natural menopause
Kaunitz AM, Kapoor E, Faubion SS (2021) –JAMA, 326(14):1429-1430. DOI: 10.1001/jama.2021.3305

Published in JAMA, this paper provided practical recommendations for caring for women after ovary removal. It concluded that oestrogen therapy should start immediately after surgery where there are no contraindications to its use, and continue to around age 51 to reduce the risk of heart disease, dementia, and early death.

Key findings:

• Immediate HRT after surgery is vital, even without symptoms.

• Transdermal oestrogen is the preferred route for safety and efficacy although it advised that women’s choices should be taken into consideration when discussing HRT regimen

• Continuing therapy until the natural menopause age significantly reduces heart, cognitive and mortality risks.

Association between bilateral salpingo-oophorectomy and all-cause and cause-specific mortality
Cusimano MC, Simpson AN, Han A, et al. (2021)BMJ, 375:e067528. DOI: 10.1136/bmj-2021-067528

This large Canadian cohort study followed more than 200,000 women to explore how age at ovary removal impacts mortality. It found that women who had surgery before 45 had a 31% higher risk of death, but that risk disappeared after 50 – confirming that both age and hormone replacement are crucial.

Key findings:

• Study of over 200,000 Canadian women.

• Ovary removal before age 45 increased overall mortality by 31%.

• No increased risk after age 50 – highlighting age and hormone status as critical factors.

Audit of hormone replacement therapy use following bilateral oophorectomy in premenopausal women
Cashell C, Newson L, Glynne S, et al. (2024)

A five-year NHS audit measuring how often women received HRT after surgery. It revealed that only 4.8% of eligible premenopausal women were prescribed HRT, exposing a major care gap and underscoring the need for better clinical training and consistent post-operative guidance (and something SURGE Menopause advocates for, too)

Key findings:

• Five-year NHS audit across three hospitals.

• Only 4.8 % of eligible premenopausal women received HRT after ovary removal.

• Authors call for national training and patient education to close this critical care gap.

Risk-reducing salpingo-oophorectomy and the use of HRT below the age of natural menopause
Manchanda R, Gaba F, Talaulikar V, et al. (2021) BJOG, 128(13):2143-2153. DOI: 10.1111/1471-0528.16896

This Royal College of Obstetricians and Gynaecologists-backed review examined HRT use after preventative ovary removal in women with BRCA or Lynch gene mutations. It concluded that HRT is safe for women under 51 without prior breast cancer and should begin immediately post-surgery.

Key findings:

• Guidance for BRCA and Lynch gene carriers undergoing risk-reducing surgery.

• HRT is safe for women under 51 without prior breast cancer.

• Hormones should start immediately post-surgery and continue until at least the average menopause age.

The range and variation in serum estradiol levels achieved by licensed transdermal estradiol preparations Glynne, S. J., Cashell, C., Newson, L. R., Pearce, E., Bailey, L., & Samuel, M. (2025) Menopause, 32(2), 000–000. DOI:10.1097/GME.0000000000002312

A UK study assessing how effectively different forms of transdermal oestrogen are absorbed across the skin. It found that even at the highest licensed doses, up to one in four women had low oestradiol levels, highlighting why individualised, off-label dosing is often necessary to achieve symptom relief and health protection.

Key findings:

• Significant variation in oestrogen absorption across the skin.

• Up to 1 in 4 women had sub-therapeutic levels despite highest licensed doses (100 µg patch / 4 pumps gel).

• Supports personalised dosing and use of off-label regimens when clinically indicated.

Long-term health consequences after ovarian removal at benign hysterectomy
Gottschau M, et al. (2023) –Annals of Internal Medicine, 178(4). DOI: 10.7326/M22-1628

This Danish population study followed over 30,000 women who had their ovaries removed during non-cancer hysterectomy. It concluded that ovary removal is linked to higher long-term rates of cardiovascular and metabolic disease, confirming that the ovaries continue to protect health well beyond fertility.

Key findings:

• Nationwide Danish cohort of > 30,000 women.

• Oophorectomy increased later cardiovascular and metabolic disease risk.

• Confirms ovaries have ongoing protective value beyond fertility.

Rethinking menopausal hormone therapy: for whom, when and how?
Cho L. (2023)Circulation, 147(16):1272-1284. DOI: 10.1161/CIRCULATIONAHA.122.061559

A major cardiology review evaluating how HRT timing and formulation affect women’s heart health. It concluded that early, body-identical hormone therapy reduces cardiovascular disease risk and should be integrated into routine prevention strategies for women.

Key findings:

• Emphasises the cardiovascular benefits of early, individualised HRT.

• Challenges outdated caution around oestrogen therapy.

• Urges integration of menopause care into women’s heart-health strategies.

Effect of bilateral oophorectomy on women’s long-term health: a review
Parker WH. (2009) Women’s Health (NY), 5(1):39-48. DOI: 10.2217/WHE.09.42

One of the earliest reviews to consolidate the evidence linking ovary removal with later disease. It showed that oophorectomy before natural menopause increases the risk of heart disease, osteoporosis, dementia, and early death — and that these risks can be mitigated with oestrogen therapy.

Key findings:

• Removing ovaries before natural menopause increases risks of heart disease, osteoporosis, dementia, and early death.

• Advocates HRT as protective therapy for women without contraindications.

Premature or early menopause: long-term health consequences
Shuster L T, Rhodes D J, Gostout B S, Grossardt B R, Rocca W A. (2010). Cleveland Clinic Journal of Medicine, 77(8), 501-513. PubMed 19733988

This cross-disciplinary review examined how early loss of ovarian hormones affects ageing across the cardiovascular, skeletal, and neurological systems. It concluded that hormone therapy is essential to maintain health and quality of life in women who experience premature or surgical menopause.

Key findings:

• Summarises global evidence on premature and surgical menopause.

• Early hormone loss accelerates cardiovascular, skeletal, and neurological ageing.

• Highlights importance of prompt diagnosis and hormone replacement.

Excess morbidity and mortality associated with under-use of oestrogen therapy after oophorectomy
Ferris, J. S., Jackson, R., Tyndale-Biscoe, S., Kelsey, T. W., & Anderson, R. A. (2024). American Journal of Obstetrics and Gynecology, 230(3), 275.e1–275.e11.

A population-based study exploring outcomes for women who were not prescribed HRT after ovary removal. It found that lack of oestrogen therapy significantly increased chronic disease rates and mortality — a preventable gap in care.

Key findings:

• Under-use of oestrogen therapy after oophorectomy increases chronic disease and mortality.

• Reinforces the need for standardised HRT counselling and prescribing.

• Concludes that oestrogen therapy saves lives.

Clinical Effects of Early or Surgical Menopause (2020) Obstetrics & Gynecology, 135(4):853-868. ResearchGate link

A broad review drawing together evidence on both the physical and emotional effects of surgical menopause, showing how prompt HRT and lifestyle care improve quality of life.

Key findings:

• Review of physiological and psychological outcomes of surgical menopause.

• Confirms HRT mitigates most long-term risks when initiated promptly.

• Supports combined lifestyle and hormonal care for optimal outcomes.

Hysterectomy and oophorectomy and long-term outcomes: a UK Biobank cohort study
Xu Z, et al. (2022) Human Reproduction, 37(9):2175-2185. DOI: 10.1093/humrep/deac142

A UK Biobank analysis of more than 140,000 women examining how surgical menopause affects cardiovascular and metabolic health. It found that oophorectomy increased the risk of heart and metabolic disorders — but that HRT use reduced these risks significantly.

Key findings:

• Large UK Biobank analysis of > 140,000 participants.

• Surgical menopause linked with increased cardiovascular and metabolic disorders.

• Adds to evidence that early HRT prevents long-term disease progression.

White Paper on Lifestyle Medicine in Menopausal Health
International Menopause Society (2025)

A global consensus statement exploring the role of lifestyle interventions in menopause care. It concluded that combining movement, nutrition, sleep, and stress management with HRT creates the most powerful long-term protection against chronic disease.

Key findings:

• Global consensus statement calling for integration of lifestyle medicine into menopause care.

• Movement, nutrition, sleep, and stress management work synergistically with HRT.

• Urges policymakers to adopt holistic prevention strategies for chronic disease in women.

What the evidence tells us

Across decades of research, the conclusion is clear:
Removing the ovaries before natural menopause — without replacing the hormones they produce — has measurable, long-term consequences.

• Women who lose ovarian hormones early face higher risks of heart disease, bone loss, cognitive decline and premature death.

• These effects are not inevitable — they result from hormone deprivation and are largely preventable.

• Adequate, body-identical HRT restores normal health outcomes and life expectancy.

• Absorption varies, so treatment must be personalised rather than standardised.

• Hormones work best alongside lifestyle medicine, creating true long-term protection.

With the right therapy and support, women can recover balance, vitality and the long, healthy future their bodies were designed for.