What is surgical menopause?
Surgical menopause refers to the sudden onset of menopause after removal of the ovaries (oophorectomy).
The ovaries are responsible for producing hormones, including oestrogen and progesterone, which play a crucial role in the menstrual cycle and overall reproductive health. With the ovaries gone, the levels of these hormones drop drastically. As a result, your periods will stop, and you can no longer get pregnant. This sharp change also produces a range of physical and mental symptoms that can be challenging to navigate.
Knowing what to expect from surgical menopause and understanding what treatments are available to help deal with the symptoms can make this transition a little easier to deal with.
Causes of surgical menopause
The removal of the ovaries, and thus, the onset of surgical menopause, can occur for a range of circumstances:
Bilateral oophorectomy
A bilateral oophorectomy is the surgical removal of both ovaries. This procedure is often performed to treat or prevent conditions like ovarian cancer, severe endometriosis, or ovarian cysts.
Hysterectomy with bilateral salpingo-oophorectomy (BSO)
In some cases, a hysterectomy (removal of the uterus) is paired with a bilateral salpingo-oophorectomy, which removes both the ovaries and fallopian tubes. While a hysterectomy alone does not lead to menopause, the removal of the ovaries and fallopian tubes causes an immediate onset of surgical menopause.
Cancer treatment
Certain cancer treatments, like chemotherapy or radiation, can damage the ovaries, causing them to stop functioning and leading to early menopause.
In other cases, ovarian removal may be part of cancer treatment, especially if the cancer is hormone-sensitive.
Risk reduction surgery
Women at high risk for certain cancers, particularly those with a genetic predisposition (such as BRCA1 or BRCA2 mutations), may choose to undergo risk-reducing surgery that removes the ovaries and fallopian tubes.
How long does surgical menopause last?
Removal of the ovaries is permanent meaning that you will enter menopause followed by postmenopause and will remain in this stage for the rest of your life. However, menopause symptoms typically improve over time, especially with hormone replacement therapy (HRT) treatment.
What are the symptoms of surgical menopause?
The effects of surgical menopause are like those of natural menopause, although they tend to be more severe. This is because the drop in oestrogen and progesterone happens very suddenly rather than over several years. Symptoms of surgical menopause include:
Hot flushes
Lasting from 30 seconds up to an hour, hot flushes are a rapid sensation of heat spreading across the face and body. They can cause reddened skin, sweating and chilliness after they pass.
Night sweats
These are hot flushes that occur at night. They often cause women to wake up drenched in sweat, with their night clothes and bedding wet through.
Vaginal dryness and discomfort
Menopause causes vaginal tissues to become drier, thinner and less elastic. This can cause irritation and itching, and lead to painful sex.
Loss of libido
Surgical menopause can result in a more prominent loss of libido compared to women experiencing natural menopause.
Bladder symptoms
Decreased oestrogen levels alter the urogenital microbiome, lower vaginal pH, and cause thinning and drying of genital tissue, increasing the risk of infections like UTIs and bladder infections. Lower oestrogen also makes the bladder more sensitive, leading to irritation and more frequent, urgent urges to urinate, even when the bladder isn't full.
Mood and emotional changes
It’s common for hormone changes to result in mood swings. You may experience irritability, poor concentration, loss of self-esteem, and forgetfulness.
Surgical postmenopausal women can also be more likely to experience anxiety and depression compared to natural postmenopausal women.
Palpitations
Lower oestrogen levels affect the pathways that electrical impulses use to travel through the heat. Consequently, you may feel like your heart is racing or fluttering.
Fatigue
Fatigue is a common symptom, fuelled by hormone changes and sleep problems during menopause.
Weight gain
An oophorectomy leads to more rapid weight gain than both natural menopause and a hysterectomy only.
Other bodily changes
Surgical menopause can also cause a range of other symptoms including hair loss, brittle nails, dry skin, and aches and pains.
Risks of surgical menopause
Women who undergo surgical menopause have a slightly increased overall mortality rate than those who go through natural menopause. They also have an increased risk of:
- Osteoporosis
- Cardiovascular disease
- Stroke
- Cognitive impairment
- Parkinson’s disease
- Colorectal cancer
- Sexual dysfunction
Are there any benefits to surgical menopause?
In most instances, the ovaries are removed to treat another condition. So, although surgical menopause can be a difficult thing to experience, it can result in underlying conditions going into remission, rectifying entirely or symptoms of the condition improving. For example, if done for severe endometriosis, women may see drastic improvement in pelvic pain.
In addition, removal of the ovaries can reduce the risk of ovarian and breast cancer.
How to treat the symptoms of surgical menopause
Hormone replacement therapy (HRT) is often recommended and plays a significant role for women undergoing surgical menopause to manage symptoms and reduce the risk of long-term health issues associated with oestrogen deficiency, such as osteoporosis. This is particularly the case for women under the age of 45, provided there is no personal history of medical contraindications.
However, the decision to use HRT should be made on an individual basis, considering factors such as your overall health, medical history, and any potential risks or contraindications.
There are also several lifestyle interventions that can help manage symptoms including:
- Maintaining a healthy diet
- Reducing caffeine and alcohol
- Stopping smoking
- Exercising regularly
- Psychological support, including CBT for menopause
Whether you know you will be undergoing ovarian removal surgery, or you have already had an oophorectomy, knowing which doctor to consult for menopause after surgery can make a big difference in helping you navigate this significant life transition.
At Menopause Care, we have a team of experienced menopause doctors, nurses, coaches, dieticians and CBT specialists who can offer tailored guidance and treatment to help you manage the physical and emotional impact of surgical menopause. To get started, book a consultation.
Surgical menopause | Target Ovarian Cancer Target Ovarian Cancer (January 2022)
Surgical menopause: a toolkit for healthcare professionals British Menopause Society (September 2024)
Surgically Induced Menopause—A Practical Review of Literature - PMC Secoșan et al. (August 2019)