Understanding and Managing Long-Term Health Risks
Surgical menopause involves the removal of both ovaries, leading to a sudden drop in hormone levels-especially estrogen and testosterone. This transition can bring significant symptoms and long-term health risks, particularly for women under 45. However, with the right approach, many of these effects can be managed or even prevented. This guide explores the potential health impacts of surgical menopause and how to protect your well-being now and in the future.
Hormonal Deficiency and Health Risks
When hormone levels drop suddenly, the effects can be widespread-impacting joints, muscles, mood, memory, skin, sleep, digestion, sexual health, and more. These symptoms are often more severe and long-lasting for women who experience menopause before 45. In addition to these symptoms, hormone deficiency also poses well-documented long-term health risks, including:
- Accelerated biological ageing
- Increased risk of mortality
- Chronic conditions such as osteoporosis, heart disease, dementia, depression, diabetes, hypertension, and some cancers
While this sounds concerning, there are effective ways to manage these risks and support long-term health.
Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) is the gold standard treatment for supporting bone, brain, and heart health and reducing long-term disease risks after surgical menopause. HRT works by supplementing lost hormone levels. The decision to use HRT should be made in consultation with a healthcare provider, taking into account your medical history and personal health factors.
The Menopause Society (formerly NAMS) highlights that early initiation of HRT can reduce:
- Hot flushes and night sweats (vasomotor symptoms or VMS)
- Genitourinary symptoms
- The risk of osteoporosis and fractures
- Likely cardiovascular disease and overall mortality
For more details on treatment options, visit the Treatments section.
Alternatives to HRT
For those who have been advised against HRT or prefer to explore alternative approaches, there are still effective options to manage symptoms and protect long-term health. These include:
- Non-hormonal treatments: Certain antidepressants, gabapentin, or herbal supplements, can relieve symptoms like hot flushes and mood swings.
- Complementary approaches: Herbal therapy and therapies like cognitive-behavioural therapy (CBT) or hypnotherapy may offer additional support.
For more information on treatment options, visit the Treatments section.
Holistic Health Approaches
Beyond medical treatments like HRT or alternatives, adopting a holistic approach to health is crucial. Regular exercise, a balanced diet, stress management, sleep hygiene, and self-care can significantly enhance long-term well-being and quality of life. Taking proactive steps in these areas can help navigate surgical menopause and support a healthy future.
Key Health Risks After Surgical Menopause
Bone, Muscle and Joint Health
Estrogen is vital for maintaining bone density, muscle strength, and joint function. When estrogen levels drop suddenly, women may experience:
- Joint pain, stiffness, and inflammation
- Muscle loss (sarcopenia) and weakness
- Decreased bone mineral density
- Increased risk of falls and fractures
These symptoms are collectively referred to as the musculoskeletal syndrome of menopause, which affects over 70% of women during the menopause transition, with around 25% experiencing disabling effects.
HRT can help reduce these effects by slowing the rate of bone and muscle loss. Other options include Selective Estrogen Receptor Modulators (SERMs) and bisphosphonates, which help preserve bone density.
Supplements for Bone Health
Certain supplements support bone health, particularly when used alongside HRT or other treatments:
- Vitamin D3: 1000 IU/day may improve bone density and reduce the risk of falls.
- Magnesium: 500 mg/day supports vitamin D metabolism.
- Vitamin K2: May slow bone loss in some people.
- Protein and resistance training: Crucial for maintaining muscle mass and reducing fracture risk.
Osteoporosis Risk
Osteoporosis is a well-known risk associated with surgical menopause. It’s characterised by weakened bones that are more susceptible to fractures. The sudden drop in estrogen accelerates bone loss, leading to a reduction in bone mineral density. This increased bone loss can make the bones fragile and more likely to break, especially in the hips, spine, and wrists. Osteoporosis can significantly impact quality of life and fractures can lead to pain, loss of mobility, and even long-term disability.
Importance of DEXA Scans
A Dual-Energy X-ray Absorptiometry scan (or DEXA scan), is a specialised imaging test used to measure bone mineral density (BMD). It is the most common and reliable method for diagnosing osteoporosis.
The DXA scan is quick and non-invasive, focusing on key areas prone to fracture like spine, hips, and sometimes the forearm. The scan uses two X-ray beams at different energy levels to assess bone density, with lower bone density indicating a higher risk of fractures.
For women in surgical menopause, regular DEXA scans are an important tool to:
- Monitor treatment effectiveness
- Assess current bone density
- Guide preventive treatment (e.g. calcium, vitamin D, HRT)
For more information on osteoporosis, visit: Osteoporosis New Zealand.
Cardiovascular Health
Estrogen helps keep cholesterol levels in balance and supports healthy blood vessel function. After surgery:
- LDL (“bad”) cholesterol may rise
- HDL (“good”) cholesterol may fall
- Risk of plaque buildup in arteries increases
- Risk of heart disease, stroke, and high blood pressure rises
To reduce cardiovascular risk:
- Adopt heart-healthy habits (e.g. fruit, vegetables, whole grains, healthy fats).
- Stay physically active
- Monitor blood pressure and cholesterol levels
- Maintain a healthy weight
In some cases, your doctor may recommend medications to manage cholesterol or blood pressure.
For more information, visit Heart Foundation New Zealand.
Brain and Cognitive Health
Estrogen has neuroprotective properties and supports memory, attention, and cognitive function. Its sudden loss may increase the risk of:
- Memory issues and brain fog
- Difficulty concentrating
- Dementia, particularly when ovaries are removed before age 45
To support brain health:
- Engage in mentally stimulating activities
- Eat a diet rich in antioxidants
- Stay physically active
- Prioritise sleep and manage stress
For more information, visit Dementia New Zealand, Alzheimers New Zealand, and Parkinson’s New Zealand.
Metabolic Health
Estrogen plays a vital role in regulating metabolism, including how the body processes glucose and fat. Surgical menopause increases:
- Insulin resistance and risk of type 2 diabetes
- Abdominal (central) fat gain
- Risk of cardiovascular disease and metabolic syndrome
- Fatty liver disease (particularly non-alcoholic fatty liver disease)
To reduce risk:
- Prioritise sleep and limit alcohol
- Maintain a balanced diet
- Stay active
- Monitor blood glucose and cholesterol
For more information on diabetes, visit Diabetes New Zealand.
Sexual Health
After surgery, many women experience changes in sexual function due to the sudden decline in hormone levels, particularly estrogen and testosterone. These hormonal shifts can lead to symptoms such as:
- Genitourinary syndrome of the menopause (GSM), which can include vulvovaginal dryness, urogenital atrophy, recurrent urinary tract infection and incontinence.
- Pain during intercourse (vulvodynia, vaginismus).
- Lower libido as ovaries produce half of testosterone reserve.
The psychological impact of surgery and hormonal changes may contribute to feelings of anxiety, depression, or body image issues, further affecting sexual well-being.
Support options include:
- Hormone replacement therapy (HRT)
- Vaginal estrogen cream or DHEA
- Moisturisers and/or lubricants
- Pelvic floor therapy
- Counselling or sex therapy
- Mindfulness and stress reduction techniques
Open conversations with your healthcare provider can help tailor the right approach for your needs.
Mental Health
The hormonal shifts, physical symptoms, and life changes after surgical menopause can affect mental health. Women may experience:
- Anxiety and depression
- Mood swings
- Low motivation or self-esteem
- Emotional overwhelm
Helpful strategies include:
- Seeking medical treatment when needed
- Seeing a therapist or counsellor (e.g. CBT or mindfulness-based therapy)
- Engaging in physical activity
- Practising relaxation (e.g. meditation or yoga)
- Connecting with others through peer support
Prioritising your mental health is just as important as physical health-and support is available.
For more information, visit Mental Health Foundation of New Zealand.
References
The Menopause Society, formerly known as the North American Menopause Society (NAMS) Position Statement (2022) on Hormone Therapy.
Kingsberg SA, Larkin LC, Liu JH. Clinical Effects of Early or Surgical Menopause. Obstet Gynecol. 2020 Apr;135(4):853-868.
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Rocca WA, Grossardt BR, Geda YE, Gostout BS, Bower JH, Maraganore DM, de Andrade M, Melton LJ 3rd. Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy. Menopause. 2008 Nov-Dec;15(6):1050-9.
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[Updated: 17 July 2025]
Surgical Menopause New Zealand Trust 