Insight into surgical menopause

Surgical menopause occurs when both ovaries are removed before the natural age of menopause (around 51 years). This surgery is called a bilateral oophorectomy and may be performed to treat conditions such as endometriosis or persistent pelvic pain, to manage certain gynaecological cancers or to reduce cancer risk in women who carry genetic mutations like the BRCA gene or Lynch Syndrome.

 Unlike natural menopause which happens gradually over several years, surgical menopause causes a sudden and complete loss of ovarian hormones, mainly oestrogen and testosterone. This abrupt change can trigger symptoms quickly and sometimes more intensely than those experienced during natural menopause.

Reasons why surgery may be considered

For women with an inherited increased risk of ovarian or breast cancer, removing the ovaries can significantly reduce that risk. It can also bring relief to women with severe endometriosis or premenstrual dysphoric disorder (PMDD) that hasn’t responded to other treatments.

However if you don’t have a medical or genetic reason for surgery it’s generally not recommended to remove healthy ovaries before natural menopause. Doing so can increase long-term health risks including heart disease, bone loss, cognitive dysfunction and mood changes.

How surgical menopause affects the body

When the ovaries are removed, hormone levels fall rapidly which can lead to:

• Sudden and intense hot flushes and night sweats

• Vaginal dryness or discomfort known as genitourinary syndrome of menopause (GSM)

• Reduced bone density increasing the risk of osteoporosis and fractures

• Higher risk of heart disease due to the loss of oestrogen’s protective effects

• Mood changes including anxiety or low mood

• Cognitive changes such as difficulty concentrating or memory lapses

• Reduced libido and sexual discomfort due to low testosterone and oestrogen

• Loss of fertility

These changes can affect physical, mental and emotional wellbeing so preparation and support are key before and after surgery.

Menopausal Hormone Therapy (MHT) is usually recommended for most women who experience surgical menopause before the age of 50 provided there are no medical reasons not to use it. MHT helps replace lost hormones, easing symptoms and protecting bone, heart and brain health.

Treatment is usually started soon after surgery and continued until the average age of natural menopause. Younger women may need higher doses of oestrogen (preferably oestradiol) to match natural levels. If the uterus is still present, a progestogen (preferably progesterone) is added to protect the uterine lining.

Dietary and lifestyle choices can also make a big difference. Eating a diet rich in fruits and vegetables that includes some healthy fats and lean protein ensures a good variety of vitamins, minerals and other important nutrients. Regular exercise, maintaining a healthy weight, not smoking, moderating alcohol and getting good quality sleep all help to reduce long-term health risks.

Emotional and sexual wellbeing

Adjusting to surgical menopause can be challenging not only physically but also mentally and emotionally. Feelings of grief, loss of fertility or changes in body image are common. Counselling, joining a menopause support network or talking to your health professional can help you feel understood and empowered. For sexual health, vaginal oestrogen, DHEA or Sea buckthorn oil treatments can improve comfort while testosterone therapy may be considered if low sexual desire persists despite MHT. Bulgarian tribulus may also be an option here.

Living well after surgery

While surgical menopause can bring challenges, many women regain their balance and vitality with the right care. A personalised approach including options of hormone therapy, fine-tuning dietary and lifestyle choices, complementary medicines, emotional support and regular health reviews can help you protect your long-term wellbeing and feel confident about your next chapter.

References available upon request