What is surgical menopause?

Surgical menopause is menopause that occurs as a result of the removal of the ovaries in a woman who is still having periods.

Why would the ovaries be removed surgically?

There are many reasons why the ovaries might be recommended to be removed before the natural age of menopause (around age 50-52). These include:

• Chronic pain due to endometriosis or pelvic inflammatory disease (PID).
• Endometriosis involving both ovaries.
• Chronic pelvic infection with pain and adhesions of ovaries.
• Ovarian cancer.
• Prophylactic oophorectomy, when the ovaries are removed because there is a high risk of developing breast or ovarian cancer. This may be due to a strong family history of breast or ovarian cancer, or where a woman has the BRCA gene, a breast cancer gene that also gives a higher risk of ovarian cancer.

Sometimes a doctor may recommend the ovaries be removed at the time of the hysterectomy, where the woman is over the age of 45 but has not yet reached menopause.

Check there is a good reason to have the ovaries removed before consenting to the operation. 

Why does menopause occur when the ovaries are removed?

Menopause takes place naturally when a woman’s ovaries stop producing the hormones oestrogen and progesterone and her periods stop. When a woman’s ovaries are surgically removed before menopause, there is a very sudden drop in both oestrogen and testosterone in the body, so menopause occurs. Within 24 hours of removal of the ovaries, the oestradiol (the main oestrogen our ovaries produce) level falls by more than 50 per cent and testosterone level also falls by 50 per cent.

What symptoms occur with a surgical menopause?

The symptoms are similar to those in women who are going through natural menopause; but they are often very severe and interfere with quality of life. The symptoms usually start within 48 hours of surgery.

Symptoms experienced may include:

• Hot flushes and night sweats
• Aches and pains
• Insomnia or sleeping difficulty
• Itchy or crawling sensations under the skin
• Headaches
• Vaginal dryness
• Reduced sexual drive (loss of libido)
• Reduced sexual function
• Tiredness
• Irritability
• Forgetfulness

Other feelings that a woman may experience include:

• Mood changes
• Depression
• Lack of self esteem
• Loss of femininity
• Feeling that you are no longer a woman because you have no ovaries (especially if combined with hysterectomy)
• Feeling that you won’t be seen as a sexually attractive by your partner
• Feeling that you have been ‘castrated’ or have lost your identity

Are there any risks with having a surgical menopause?

The lack of oestrogen and testosterone after surgical menopause may lead to early onset:

• Thinning of the bones (osteoporosis) with an increased risk of fractures
• Increase in the risk of heart disease and heart attack
• Possible decline in sexual function

For more information see Risks and speak to your doctor about what you can do to decrease your risk.

How can I manage my symptoms?

The primary treatment for severe symptoms induced by a surgical menopause is high dose hormone replacement therapy. In women who have had their ovaries removed but their uterus remains, hormone replacement therapy will include an oestrogen and a progesterone, with or without testosterone. If a hysterectomy is performed with the removal of the ovaries, then progesterone is not necessary. Some women can not undergo hormone replacement therapy due to possible contra-indications (something that makes a treatment or procedure not advisable) for example, women who have had breast cancer. In this case, other therapies which are non-hormonal may be prescribed.

For more information see Management and Therapies

Content updated June 8, 2010