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Understanding Surgical Menopause - following a hysterectomy and removal of the ovaries

For some women the onset of menopause can be overnight. This is often the case for women following a total hysterectomy and bilateral oophorectomy (removal of both ovaries).

Surgical hysterectomy and oophorectomy can cause the onset of menopause because they involve the removal of the uterus and ovaries, respectively.

The ovaries are responsible for producing the hormones oestrogen and progesterone, which regulate the menstrual cycle and maintain various bodily functions. When the ovaries are removed, the body experiences an immediate and significant drop in these hormone levels, leading to the abrupt onset of menopause. This sudden hormonal change contrasts with the gradual process of natural menopause and can result in more severe menopausal symptoms and health risks.

Menopause following surgery or hysterectomy
Surgical Menopause - hysterectomy and oophorectomy

Symptoms and Risks of Surgical Menopause

The abrupt hormonal changes result in various menopausal symptoms, including hot flushes, night sweats, vaginal dryness, mood swings, increased anxiety, low energy levels, fatigue, sleep disturbance, and decreased libido. Additionally, the sudden loss of oestrogen heightens the risk of cardiovascular disease and osteoporosis, posing long-term health challenges.

The Role of Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is a primary treatment option for managing the symptoms and health risks associated with surgical menopause. HRT involves the administration of oestrogen alone or combined with progesterone (not required after a total hysterectomy) with the addition of testosterone, offering several benefits:

  1. Symptom Relief: HRT effectively alleviates hot flushes, night sweats, vaginal dryness, and mood swings, significantly improving the quality of life for women undergoing surgical menopause.

  2. Bone Health: By replenishing oestrogen levels, HRT helps maintain bone density, reducing the risk of osteoporosis and fractures. This is crucial given the heightened bone loss associated with surgical menopause.

  3. Cardiovascular Protection: Oestrogen has protective effects on the cardiovascular system. HRT can mitigate the increased risk of heart disease that accompanies the sudden drop in oestrogen levels.

When to start HRT after surgical menopause

We recommend starting HRT within days of having your surgery to prevent having a severe acute onset of symptoms.

Considerations and Alternatives

While HRT offers substantial benefits, it is essential to consider individual health profiles and potential risks. Women with certain medical conditions may need to explore non-hormonal alternatives such as antidepressants or other medications targeting menopausal symptoms. Lifestyle changes, including regular exercise, a balanced diet, and smoking cessation, also play a critical role in managing symptoms and improving overall health.


Surgical menopause presents unique challenges due to the immediate cessation of ovarian hormone production. Hormone Replacement Therapy stands out as an effective treatment, providing significant relief from symptoms and reducing long-term health risks. Comprehensive management, tailored to individual needs, ensures that women can navigate this transition with improved well-being and quality of life.

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