Short answer: Surgical menopause, triggered when both ovaries are removed, causes a far more sudden and often more severe hormonal drop than natural menopause. Oestradiol can fall by around 80 percent and testosterone by around 50 percent within days, not over the years-long transition of natural perimenopause. Knowing this in advance changes how you prepare and how quickly you seek support afterwards.
I know this one from both sides of the consulting room. I carry a BRCA1 mutation, and at the time of my fourth caesarean, I had a risk-reducing hysterectomy and salpingectomy done at the same time. I went from full hormonal function to surgical menopause in the space of an operation. Nobody sat me down beforehand and explained what that would actually feel like. I found out in real time, the way most women do.
So let me tell you what I wish someone had told me.
Why Surgical Menopause Hits Differently
Natural menopause is a wind-down, a gradual transition usually over several years, that gives your body and your nervous system time to adjust. Surgical menopause, when both ovaries are removed, doesn’t taper. It stops. There’s no adjustment period. One day your ovaries are producing hormones, the next, they’re not.
The numbers back up what it feels like:
- Severe hot flashes affect a much higher proportion of women after surgical menopause than after natural menopause
- Women who’ve had both ovaries removed face a higher long-term risk of reduced bone density and cognitive changes if hormones aren’t replaced
- Sexual function, including libido, arousal, and the ability to reach orgasm, is affected more significantly with surgical menopause, largely because testosterone drops as sharply as oestrogen
None of this is a reason to fear a surgery that may be resolving something serious. It’s a reason to walk in with your eyes open, instead of being blindsided in recovery the way I was.
Why Women End Up Here in the First Place
Surgical menopause isn’t one single story. The reason behind the surgery often shapes how it’s approached, what’s discussed beforehand, and sometimes what treatment options are appropriate afterwards. Common reasons include:
- Endometriosis, where oophorectomy is sometimes used alongside hysterectomy to relieve severe, treatment-resistant pelvic pain
- Ovarian cysts or masses, particularly where a cyst is large, recurrent, or can’t be safely assessed as benign
- Fibroids, when a hysterectomy is being performed for fibroids and ovaries are removed at the same time for other clinical reasons
- A BRCA1 or BRCA2 gene mutation, or other high hereditary ovarian and breast cancer risk, where risk-reducing surgery is offered well before menopause would otherwise occur, as in my own case
- A personal history of ovarian, breast, or uterine cancer, where oophorectomy is part of cancer treatment
Each of these comes with its own timeline, its own urgency, and its own considerations for what happens next hormonally. A risk-reducing surgery for a BRCA mutation, for example, often happens well before natural menopause age and carries a longer stretch of years living without those hormones unless therapy is started. Many women, myself included, choose to combine it with another planned surgery, such as a caesarean, to avoid a separate operation and recovery. A cancer-related oophorectomy may come with specific restrictions on which hormone therapies, if any, are appropriate afterwards. This is exactly why the conversation needs to be individual rather than generic.
What the Pre-Surgery Conversation Usually Misses
Surgical consent conversations, understandably, focus on the surgery itself: the cancer risk being reduced, the fibroid or endometriosis being treated. What tends to get left out:
- The hormone replacement timeline. For many women without a contraindication, starting hormone therapy soon after surgery meaningfully softens the transition.
- That a hysterectomy alone, uterus removed, ovaries kept, doesn’t cause immediate menopause, though it may bring it forward by a few years.
- That testosterone drops as sharply as oestrogen. Almost nobody mentions this, despite its role in energy, mood, muscle, and libido.
- The emotional weight of it. No amount of preparation fully softens a hormonal cliff-edge instead of a slope.
Questions Worth Asking Before You Go In
- Will both ovaries be removed, or is conservation possible for me?
- If both are removed, what’s the hormone replacement plan, and how soon after surgery can I start?
- Given my personal and family history, does anything change my options?
- What should I actually expect in the first few weeks, beyond the surgical recovery itself?
If You’re Already Through It
If the symptoms hit harder than you expected, that’s physiology, not a failure to cope. I hear this constantly from women in clinic: the shock of realising natural menopause and surgical menopause are not the same experience at all. What tends to help:
- A proper review of whether hormone therapy is right for you, including oestrogen and, where appropriate, testosterone
- Attention to bone and cardiovascular health, given the higher long-term risk profile
- Treating sleep, mood, and sexual function as distinct, treatable threads, not things to just push through
Frequently Asked Questions
Does a hysterectomy always cause menopause?
No. If the ovaries stay in place, hormone production continues, though natural menopause may arrive somewhat earlier than it otherwise would.
How soon after surgery can hormone therapy start?
This varies by individual circumstance and surgical reason. It’s worth discussing with your surgical and GP team before the operation, not after.
Is surgical menopause worse than natural menopause?
Often more sudden and more intense, because there’s no gradual hormonal transition. Individual experiences still vary.
Can testosterone be replaced too, not just oestrogen?
In appropriate cases, yes, particularly where libido, energy, or mood are significantly affected.
If I have the BRCA gene, will I definitely go into surgical menopause early?
Not necessarily, but many women with a BRCA1 or BRCA2 mutation choose risk-reducing surgery before natural menopause age, which does bring on surgical menopause. This is a decision made individually with your specialist team, weighing cancer risk against the impact of early hormone loss.
Can I still have hormone therapy after oophorectomy for cancer?
This depends entirely on your specific cancer type and treatment history. It isn’t automatically ruled out, but it needs to be assessed with your oncology and GP team together.
If you’re heading into this surgery, or you’re already on the other side of it wondering why nobody warned you, that conversation is worth having properly, ideally before you’re on the table.
| WHERE TO START: Menopause Consultation – works through your hormone replacement options, including testosterone where appropriate, against your surgical and family history. Meet Our Menopause Team – the doctors who will be working through it with you. Available at Forresters Beach and The Junction. No GP referral needed. |
This article is general information and doesn’t replace individualised medical advice.