Quick answers to the most common questions about surgical menopause. Click any question to expand the answer — and follow the links for more detail.
| On this page: Understanding surgical menopause Hysterectomy & menopause Symptoms Treatment Long-term health 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?
In natural menopause hormone levels decline gradually. In surgical menopause they drop overnight, which is why symptoms are often more sudden and severe.
Why are ovaries removed during surgery?
Common reasons include ovarian cancer, endometriosis, BRCA gene mutations, ovarian cysts, and severe pelvic conditions. Sometimes removal happens unexpectedly during surgery planned for another reason. Read more: Causes.
Hysterectomy & menopause
What is a hysterectomy?
A hysterectomy removes the uterus. It does not automatically mean your ovaries will be removed — always ask your surgeon specifically what is planned. Read more: Surgery 101
Do I still need smear tests after a hysterectomy?
It depends on whether your cervix was removed and your history of abnormal smears. Ask your GP — cervical screening may still be recommended in some cases.
Will I enter menopause if I keep my ovaries during a hysterectomy?
Not immediately, but some women enter menopause 2-3 years earlier than expected even when ovaries are retained, possibly due to changes in blood supply.
Symptoms
What symptoms should I expect?
Symptoms vary widely and can include hot flushes, night sweats, brain fog, mood changes, sleep disruption, joint pain, vaginal dryness, and reduced libido. Some begin within days of surgery, others emerge later. Everyone’s journey is different. Read more: Symptoms
Are symptoms worse than natural menopause?
They can be more intense and sudden, especially in younger women, because there is no gradual transition. Read more: Symptoms
Will symptoms get better over time?
With the right treatment most symptoms improve. Some women continue to experience effects for years without adequate support — individualised care and regular follow-up make a real difference.
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
What is hormone replacement therapy (HRT) and do I need it?
HRT replaces the hormones your ovaries no longer produce. It is strongly recommended for most women with surgical menopause to manage symptoms and protect long-term health. The choice is always yours. Read more: HRT
What if I can’t take HRT?
Non-hormonal options are available including certain medications, supplements, and complementary therapies. Read more: Complementary & Non-Hormonal Treatments
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?
Testosterone is lost at surgery along with estrogen. It can help with energy, libido, and cognitive function but is not routinely offered in New Zealand. Ask your clinical team specifically about this. Read more: HRT
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 should I stop HRT?
There’s no set time to stop HRT after surgical menopause and many women will opt to continue indefinitely. Current guidelines recommend continuing until at least the average age of natural menopause — around 51. Many women continue beyond this with ongoing benefit. Always discuss with your clinical team. 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.
Long-term health
What are the long-term health risks?
Without adequate hormone replacement, risks increase for osteoporosis, cardiovascular disease, cognitive decline, and genitourinary symptoms. Most of these risks can be significantly reduced with appropriate treatment and lifestyle measures. Read more: Long-Term Health
Can diet and exercise make a difference?
Yes — weight-bearing exercise, a calcium and vitamin D rich diet, avoiding smoking, and limiting alcohol all support bone and heart health. They are an important complement to medical treatment, not a replacement for it.
Mental & emotional health
Is it normal to feel depressed or anxious after surgery?
Yes. Hormonal changes directly affect mood and emotional regulation. Combined with the psychological impact of surgery, low mood and anxiety are very common and very treatable. Read more: Emotional Impact
Can surgical menopause trigger past trauma or grief?
Yes, for some women it can bring up past experiences or feelings of loss. You are not alone and support is available. Read more: Emotional Impact
Before surgery
What questions should I ask before agreeing to ovary removal?
Ask about the reasons, risks, alternatives, long-term consequences, and what the plan is for managing menopause afterwards. You have the right to take time to decide. Read more: Informed Consent
Can I request a second opinion?
Yes, always. You have every right to seek a second opinion or ask about alternative approaches. Read more: Self-Advocacy
After surgery
What does recovery look like?
Recovery involves both physical healing from surgery and hormonal adjustment. Physical healing typically takes several weeks, but hormonal adjustment can take longer. Be patient with yourself. Read more: Post-surgery · What to expect after surgery
What if my GP doesn’t know much about surgical menopause?
You can ask for a referral to a specialist or seek a second opinion. Bringing our free booklet to your appointment can help frame the conversation. Read more: Self-advocacy · Healthcare directory
How can I find a good menopause-informed healthcare provider?
Check our Healthcare directory for providers in Aotearoa with experience in surgical menopause and menopause care. Read more: Healthcare directory
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[Updated: April 2026]
Surgical Menopause New Zealand Trust 