| On this page: Understanding Surgical Menopause Hysterectomy & Menopause Symptoms & Health Treatment & Support Long-Term Considerations Mental & Emotional Health Before Surgery After Surgery |
Frequently Asked Questions (FAQs)
Understanding Surgical Menopause
What is surgical menopause?
Surgical menopause happens when both ovaries are removed (a procedure called bilateral oophorectomy), leading to an immediate drop in hormone levels. This brings on menopause suddenly, regardless of age or menstrual status.
How is it different from natural menopause?
Natural menopause occurs gradually, while surgical menopause is immediate. Symptoms can be more intense because the body has no time to adjust. Surgical menopause also affects younger women who wouldn’t otherwise be in menopause.
Why are ovaries removed during surgery?
Reasons include ovarian cancer or tumours, high genetic cancer risk (BRCA1/BRCA2, Lynch syndrome), severe endometriosis or PMS/PMDD, ovarian cysts, PCOS (rarely), or as part of gender-affirming surgery for trans men. In some cases, ovaries may be removed as a precaution – but this decision should always involve a clear, informed conversation about risks, benefits, and alternatives.
What are the benefits of a bilateral oophorectomy?
A bilateral oophorectomy is often necessary to treat or prevent medical conditions such as ovarian cancer, endometriosis, or severe pelvic pain. The primary benefit is the elimination or reduction of these health issues, which can significantly improve quality of life. For some, it offers relief from chronic pain, excessive bleeding, or other debilitating symptoms associated with their condition.
Hysterectomy & Menopause
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus. A bilateral oophorectomy is sometimes performed alongside a hysterectomy. There are three types of hysterectomy:
- Subtotal or Partial Hysterectomy: The body of the uterus is removed, but the cervix is left in place.
- Total or Simple Hysterectomy: The entire uterus and cervix are removed.
- Radical Hysterectomy: The uterus, cervix, fallopian tubes, ovaries, possibly the upper part of the vagina, associated pelvic ligaments, and lymph nodes are removed.
Do I still need smear tests after a hysterectomy?
If your cervix was removed and you have no history of abnormal smears, you may no longer need screening. But if your cervix remains or you have a history of abnormal cells, regular cervical screening may still be needed. Ask your GP.
What is the average age of menopause after a hysterectomy (keeping ovaries)?
Even if the ovaries are retained during a hysterectomy, women may experience menopause 2-3 years earlier than they would have naturally. This is possibly due to reduced blood flow to the ovaries, but it varies for each individual.
Symptoms & Health
What symptoms should I expect?
Symptoms vary, but common ones include:
- Hot flushes and night sweats
- Mood swings, anxiety, or low mood
- Brain fog and memory issues
- Sleep problems and fatigue
- Vaginal dryness and low libido
- Joint pain or stiffness
- Weight changes
Some symptoms may start quickly; others may appear months later. Everyone’s journey is different.
How soon do symptoms start?
Often within days to weeks after surgery, especially if the treatment isn’t adequate.
Are the symptoms worse than natural menopause?
They can be more intense and sudden, especially in younger women. There is no gradual transition, which can make the experience more overwhelming.
Will symptoms get better over time?
The duration of symptoms varies. With the right treatment, many symptoms improve. But some women continue to experience effects for years, especially without adequate support. Individualised care is essential. Regular follow-ups can help manage and adjust treatment as needed.
What happens to your body after surgical menopause?
The immediate and significant drop in hormone levels can trigger various symptoms and also affects long-term health, increasing the risk of bone thinning (osteoporosis), cardiovascular issues, and changes in skin elasticity. These changes can be managed through hormone replacement therapy (HRT) or other treatments, depending on individual health needs.
Do you age faster after surgical menopause?
Surgical menopause can accelerate some aspects of ageing because estrogen plays a vital role in maintaining bone density, skin health, and cardiovascular function. Without estrogen, the body may show signs of ageing earlier, such as wrinkles, joint pain, and a higher risk of osteoporosis. However, the impact varies for each individual, and interventions like hormone replacement therapy (HRT), lifestyle changes, and proper medical care can help mitigate these effects and promote healthy ageing.
Can surgical menopause affect my mental health?
Yes. The sudden drop in hormones can lead to mood swings, anxiety, depression, and cognitive difficulties such as brain fog. These changes can feel overwhelming, especially without support. Women with a history of hormone sensitivity, PMS/PMDD, or mental health conditions may be more vulnerable to new or worsening symptoms. It’s important to reach out for support – you’re not alone, and help is available.
What happens when both ovaries are removed after menopause or in perimenopause??
Even after menopause, the ovaries continue to produce small amounts of hormones – especially testosterone and estrogen – that support bone, heart, brain, and skin health. When both ovaries are removed, residual hormone production stops completely. This can lead to:
- A sudden drop in hormone levels
- New or worsened menopausal symptoms
- Increased risk of osteoporosis, cardiovascular disease, and skin or muscle changes
These effects can be managed with HRT or other treatments, depending on your individual health needs and risk factors. It’s important to talk with your doctor about the best approach for you.
Treatment & Support
What is hormone replacement therapy (HRT)?
It’s a treatment used to replace the hormones – mainly estrogen (and sometimes progesterone and/or testosterone) – that your body no longer produces after menopause. In the case of surgical menopause, where both ovaries are removed, HRT is often used to:
- Reduce symptoms like hot flushes, night sweats, mood swings, brain fog, and vaginal dryness
- Protect long-term health – especially bone, heart, and brain health
- Support quality of life and emotional wellbeing
There are different types and forms of HRT, including patches, gels, pills, and vaginal treatments, and the choice depends on your needs, preferences, and medical history. For many women under 45, HRT is considered the first-line treatment unless there’s a reason it isn’t suitable.
Do I have to take hormones?
HRT is the recommended treatment for surgical menopause, unless there are medical reasons not to. However, the choice is always yours.
What if I can’t take estrogen?
Non-hormonal options are available to manage some symptoms. Your doctor can help you explore alternatives.
What are the differences between gels, patches, tablets, and implants?
Gels and patches are absorbed through the skin and can offer steady hormone levels. Tablets are taken orally and can be contraindicated with some conditions. Implants release hormones slowly over time but are not easily available in New Zealand. Some methods suit certain women better than others.
What about testosterone – do I need it?
Testosterone is only prescribed for low libido, but it can also help some women with energy, and mental clarity. Not everyone benefit from it. Talk to your doctor about whether it might be appropriate for you.
Are lab tests useful for monitoring hormone replacement therapy (HRT) effectiveness?
While not commonly performed, lab tests can be indicated when symptoms persist or to ensure testosterone levels stay within the female range. Common lab tests include:
- Estradiol (E2): Measures the primary form of estrogen.
- Testosterone: Helps manage symptoms related to libido and energy.
- Sex Hormone-Binding Globulin (SHBG): Indicates how well hormones are being processed.
- Free Androgen Index (FAI): Assesses testosterone levels in relation to SHBG.
When do I need to stop hormone replacement therapy (HRT)?
There’s no set time to stop hormone replacement therapy (HRT) after surgical menopause and many women will opt to continue indefinitely. The current guidelines recommend continuing until at least the natural menopause age (51), but the decision should be made with your healthcare provider, based on your specific needs (risks/benefits). For those who wish to discontinue HRT, it’s often recommended to taper off gradually under medical supervision to help the body adjust. HRT may be resumed if symptoms persist re-occur or there are ongoing health concerns.
What are the alternatives to hormone replacement therapy (HRT), and are they as effective?
There are non-hormonal options that can help manage some symptoms of surgical menopause. These include:
- Prescription medications such as certain antidepressants, which can reduce hot flushes and help with mood.
- Vaginal moisturisers and lubricants to ease vaginal dryness and discomfort (not as efficient as local vaginal estrogen or DHEA).
- Supplements like calcium and vitamin D for bone health (though they don’t treat other symptoms).
- Complementary therapies such as cognitive behavioural therapy (CBT) and hypnotherapy.
- Lifestyle changes like regular exercise, balanced nutrition, and stress reduction.
Some women also explore options like acupuncture or herbal supplements, though evidence for these is mixed. While non-hormonal options can help with specific symptoms, they generally aren’t as effective as HRT for protecting long-term health (e.g. bone, heart, and brain) after surgical menopause.
What vitamins can I take to support my health?
After surgical menopause, ensuring adequate nutrition is essential to support your body’s changing needs. A good diet should be sufficient to provide what your body needs. Important vitamins and supplements to include in your diet are:
- Calcium and Vitamin D: These are crucial for maintaining bone health, as surgical menopause increases the risk of osteoporosis.
- Vitamin B12: This vitamin supports nerve function and energy levels, which can sometimes be affected by menopause.
- Magnesium: Magnesium is important for bone health, muscle function, and sleep regulation.
- Omega-3 Fatty Acids: These support heart health, which is particularly important after menopause.
- Vitamin E: It may help reduce symptoms like hot flushes and night sweats.
It’s important to consult with a healthcare provider before starting any supplements to ensure they are right for your needs.
Long-Term Considerations
What are the long-term health risks (e.g. bones, heart, brain)?
Without hormones, risks increase for osteoporosis, heart disease, cognitive decline, and urogenital symptoms. These risks can often be reduced with HRT, other interventions and lifestyle changes.
Can diet, exercise, or lifestyle make a difference?
Yes, staying active, maintaining a healthy diet rich in calcium and vitamin D, avoiding smoking, and limiting alcohol can help manage symptoms and reduce the risks of osteoporosis and heart disease. Stress management and sleep hygiene can also support your wellbeing in menopause.
Mental & Emotional Health
Is it normal to feel depressed or anxious after surgery?
Yes. Hormonal changes, combined with the emotional impact of surgery, can lead to low mood, anxiety, or grief.
What supports are available for emotional health?
Talking therapies, peer support, mindfulness, and sometimes medication can help. Don’t hesitate to reach out for support.
Can surgical menopause trigger past trauma or grief?
Yes. For some, it can bring up past experiences or feelings of loss. You’re not alone, and support is available.
How can I talk to my partner or whānau about what I’m going through?
Be honest and open. It may help to share resources or bring your partner to a medical appointment. Clear communication makes a big difference.
Before Surgery
What questions should I ask before agreeing to ovary removal?
Ask about the reasons, risks, alternatives, long-term impacts, and what support you’ll need after surgery. It’s okay to ask for time to decide.
What does informed consent really mean in this context?
It means you understand what the surgery involves, the risks and benefits, and that you agree freely. You have the right to ask questions and to decline any part of the treatment.
Can I request a second opinion or different approach?
Yes. You have every right to seek a second opinion or ask about other options, including less invasive treatments.
Is it okay to delay or decline surgery?
Yes, unless it’s an emergency. Your decision should be based on full information and your own values.
How can I prepare for surgical menopause?
Discuss hormone replacement therapy (HRT) options, lifestyle changes, and potential risks with your doctor. It’s also helpful to have a support system in place, as the emotional and physical changes can be challenging.
After Surgery
What does recovery look like?
Recovery varies. You may feel tired or emotional. Physical healing can take many weeks to many months, and hormonal adjustment may take time too.
Who will support me after I leave the hospital?
Follow-up care may involve your GP, specialist, and ideally, a menopause-informed provider. Peer support can also make a big difference.
What kind of follow-up care do I need after surgery?
You may need regular bone density scans, cardiovascular health assessments, and check-ins to manage symptoms and adjust treatments as needed. It’s essential to work closely with your healthcare team to monitor your health over time.
What if I don’t feel “like myself” after surgery?
Many women feel this way. It’s okay to grieve, to question, and to seek support. Your feelings are valid.
What if my GP doesn’t know much about surgical menopause?
You can ask for a referral or seek a second opinion. Bringing resources to your appointment may help too.
How do I advocate for myself in the health system?
Know your rights, prepare for appointments, and speak up about your needs. You deserve informed, respectful care.
How can I find a good menopause doctor?
Check the directories from the Australasian Menopause Society (AMS), The Menopause Society (formerly NAMS), or our own NZ register.
What other organisations or services can help?
Check our Online Resources page for links to local and international support organisations.
[Updated: 12 July 2025]
Surgical Menopause New Zealand Trust 