What is surgical menopause ? 

Surgical menopause occurs when a person enters menopause because their ovaries are surgically removed. This can happen during a procedure called an oophorectomy (removal of one or both ovaries) or during a hysterectomy (removal of the uterus), if the ovaries are removed simultaneously.

Since the ovaries produce most of the body's oestrogen and progesterone, their removal leads to a sudden and abrupt drop in these hormones, triggering menopause symptoms like hot flashes, mood changes, and bone density loss. Changes come on quite quickly, and this sudden loss of ovarian function, especially in younger (pre-menopausal women) may have more significant and dramatic consequences including sexual dysfunction, strokes, heart disease and overall mortality.  

This is in contrast to natural menopause which happens more gradually over a period of time, when ovarian function progressively declines between the ages of 45 and 55 years. For most women natural menopause will have occurred around the age of 51 years. This means they will not have had a period like bleed for more than 12 months and will likely exhibit some symptoms related to a reduction in hormone levels. 

What are the common reasons for having a surgical menopause ?

  • Treating ovarian cancer or other gynaecological cancers.
  • Addressing symptoms due to conditions like endometriosis or chronic pain
  • Prophylactically removing the ovaries in order to minimize the risk of cancer in the future, when people are at high risk of developing cancer due to a genetic predisposition (e.g., BRCA gene mutations).
  • Ovarian cysts : recurrent ovarian cysts; suspicious, very large or complex cysts
  • Gender reassignment 

What are the common symptoms of surgical menopause ?

Surgical menopause causes a sudden and significant drop in oestrogen, progesterone and androgens leading to a range of symptoms. Common symptoms include:

Hot Flashes and Night Sweats (known as vasomotor symptoms) : 

  •  Sudden feelings of intense heat, often accompanied by sweating and flushing.

Urogenital symptoms 

  •  Reduced oestrogen can lead to thinning of vaginal tissues, causing dryness, irritation, or pain during intercourse and recurrent urinary tract infections.

Mood changes 

  •  Increased risk of anxiety, depression, or mood swings due to hormonal shifts.

Sleep Disturbances

  • Difficulty falling or staying asleep (insomnia), often linked to night sweats.

Bone density loss and risk of osteoporosis

  •  Higher risk of osteoporosis and fractures due to reduced oestrogen, as oestrogen is important for bone health.

Decreased Libido

  •  Hormonal changes may reduce sexual desire or arousal.

Cognitive Changes

  •  Some may experience memory lapses or difficulty concentrating, often called “brain fog.”

How are symptoms managed?

Hormone Replacement Therapy (HRT)

  •  HRT replaces the hormones lost after surgery, especially oestrogen. Current evidence advocates the use of HRT for all women under the age of 45 years who have had a surgical menopause to improve health outcomes, unless this is contra-indicated. HRT should be continued until the age of 51 years (average age of natural menopause) and then re-evaluated whether this needs to continue for a longer period of time. Always discuss the risks and benefits of HRT with a suitably trained healthcare provider

Non-Hormonal Medications

  • Antidepressants (e.g., SSRIs) can help manage hot flashes and mood symptoms.
  • Medications like gabapentin or clonidine may also help with hot flashes
  • Neurokinin 3 receptor antagonists (Fezolinetant) for treatment of vasomotor symptoms
  • Alternative / complementary therapies such as red clover or black cohosh

Lifestyle Adjustments

  • Regular exercise improves mood, sleep, and bone density.
  • A calcium- and vitamin D-rich diet supports bone health.
  • Having blood pressure, glucose and lipid level monitored and / managed in primary care. 
  • Wear light, breathable fabrics and avoid triggers like caffeine or spicy foods to manage hot flashes.

Vaginal Moisturizers and Lubricants

  • Over-the-counter products can help with dryness and discomfort during intercourse.
  •  Prescription options like vaginal oestrogen creams, pessaries or rings are often recommended and helpful.

Mental Health Support

  • Psychological support including cognitive behavioural therapy, support groups, or mindfulness practices can help manage emotional challenges.

 

More information and support is available @ : 

https://www.womens-health-concern.org

https://menopause.org/patient-education

https://www.themenopausecharity.org

https://menopausesupport.co.uk