Hysterectomy and Hormones: What Changes and Does It Make You Age Faster?

Many women are told, or read online, that a hysterectomy “throws your hormones out of balance” or “makes you age overnight.” The real answer depends almost entirely on one question: were your ovaries removed? The uterus does not make the estrogen, progesterone or testosterone that circulate in your blood. The ovaries do. This guide explains what happens to your hormones after each type of surgery, what the research says about faster aging, and how hormone therapy and other treatments fit in.

Where your hormones come from

Before menopause, the ovaries are the main source of the three sex hormones that matter most here:

• Estrogen (mainly estradiol). It drives the menstrual cycle and also helps keep bones strong, the vagina and bladder lining healthy, and blood vessels flexible.
• Progesterone. Made after ovulation, its main job is to prepare the lining of the uterus each month.
• Testosterone and other androgens. Women make them in smaller amounts, in the ovaries and the adrenal glands. They play a part in sexual desire and energy.

The uterus responds to these hormones, but it does not send them into the bloodstream. That is why removing the uterus alone stops periods and ends the possibility of pregnancy, but does not, by itself, cause menopause. Your ovaries keep working on their own schedule.

Even after natural menopause, the ovaries do not switch off completely. A study that measured blood coming straight from the ovaries of postmenopausal women found they still release testosterone, and that this contribution can continue for 10 years or more after menopause.^[2] This matters if you are deciding whether to keep your ovaries at an older age.

What happens to your hormones, by type of surgery

“Partial” and “total” hysterectomy describe whether the cervix is removed; neither term tells you about the ovaries. Our comparison of partial vs total hysterectomy explains the names. For hormones, this is what counts:

What was removed	Effect on hormones
Uterus only (with or without the cervix), both ovaries kept	No sudden change. Your ovaries keep making hormones and you reach menopause naturally, possibly a little earlier than you otherwise would.
Uterus and fallopian tubes, ovaries kept	Same as above. Removing the tubes (salpingectomy) is done to lower ovarian cancer risk, and studies so far have not shown that it brings menopause forward.[15]
Uterus and one ovary	The remaining ovary usually makes enough hormones, but menopause is more likely to come earlier.[4]
Uterus and both ovaries, before natural menopause	Surgical menopause: estrogen, progesterone and much of your testosterone fall within days. Symptoms tend to start quickly and can be stronger than in natural menopause.
Uterus and both ovaries, after natural menopause	Little change in estrogen, which was already low, but you lose the testosterone the ovaries were still making.[2]

If you are not sure what was removed in your own operation, your operation notes or discharge letter will say. You can also ask your surgeon’s office for a copy.

If you kept your ovaries

With your ovaries in place, your hormone cycle usually carries on much as before. Some women still notice monthly breast tenderness, bloating or mood changes, just without bleeding. What you lose is the clearest sign of where you are in that cycle, and later, the clearest sign that menopause has started.

Menopause may come somewhat earlier

Two prospective studies found that ovarian function tends to end sooner after a hysterectomy:

• In a New Zealand study, among women whose hormone levels were normal before surgery, menopause came on average 3.7 years earlier in those who had a hysterectomy.^[3]
• In a US study of women aged 30 to 47, those who had a hysterectomy had nearly twice the risk of ovarian failure over the following years. After four years, about 15% had reached it, compared with 8% of women who had not had surgery. The risk was higher if one ovary was removed, but it was also raised when both ovaries were kept.^[4]

Researchers do not know for sure whether this is caused by the surgery itself (one theory is a change in blood flow to the ovaries) or by the conditions that led to the hysterectomy. Either way, it is a gradual change, not an overnight one. Our guide to menopause after hysterectomy with ovaries intact explains how to recognize it without periods and how it is diagnosed.

Long-term heart and metabolic health

A Mayo Clinic study followed more than 2,000 women who had a hysterectomy with both ovaries kept, for a median of almost 22 years, and compared them with women of the same age who had not. The hysterectomy group had modestly higher rates of high cholesterol, high blood pressure, obesity, heart rhythm problems and coronary artery disease. The increase was largest in women who had surgery at 35 or younger.^[5]

This kind of study shows a link, not proof of cause. Still, it is one reason to keep up with blood pressure, cholesterol and blood sugar checks after a hysterectomy, especially if you had it young. Our article on weight gain or weight loss after hysterectomy looks at the weight side of this research.

If your ovaries were removed

Removing both ovaries before natural menopause (bilateral oophorectomy) causes surgical menopause. Instead of the gradual decline of natural menopause, which usually takes several years, hormone levels drop within days. Hot flashes, night sweats, poor sleep, vaginal dryness, mood changes and lower sexual desire can all start in the first week or two after surgery.

Because the ovaries also make testosterone, women who lose them before menopause lose a large share of their testosterone too. Some notice a clear drop in desire. An international consensus statement found that testosterone can help postmenopausal women whose low desire causes them distress, but that there is not enough evidence to use it for other symptoms such as tiredness, mood or memory.^[11] No testosterone product is approved for women in the United States, so doctors who prescribe it use carefully reduced doses of products made for men.

Our full guide to surgical menopause covers how long symptoms last and how they are treated. For hot flashes and sleep problems specifically, see hot flashes and insomnia after hysterectomy.

Does a hysterectomy make you age faster?

The idea of “rapid aging after hysterectomy” mixes up two different things. Here is what the evidence actually shows.

Hysterectomy with your ovaries kept

There is no good evidence that removing the uterus alone makes you look or feel older. The two real effects are the ones described above: menopause may come a few years earlier, and there may be a modest rise in heart and metabolic risk over the following decades.^[3][4][5] Once menopause arrives, the changes are the same as in any woman going through it.

Ovaries removed before natural menopause

This is where the concern comes from, and here it has a real basis. Losing estrogen years before the natural age of menopause (around 51 in the United States) has been linked in large studies to:

• More chronic conditions, earlier. A Mayo Clinic study found that women who had both ovaries removed before menopause, especially before age 46, built up chronic conditions such as heart disease, arthritis, depression and osteoporosis faster than women who kept their ovaries.^[7]
• Higher risk of memory problems and dementia, with the risk greater the younger the woman was at surgery.^[8]
• Higher overall mortality in women under 50 who never took estrogen. In the Nurses’ Health Study, which followed more than 30,000 women for 28 years after hysterectomy, removing both ovaries before 50 was linked to more deaths overall in women who never used estrogen therapy, but not in those who had used it. At no age was removing the ovaries linked to living longer.^[6]
• Faster “biological aging” on a blood test. Researchers who measured an “epigenetic clock” (a marker of biological age based on chemical tags on DNA) found it ran ahead in women who had an earlier menopause or had both ovaries removed.^[9] This is a lab marker, and what it means for an individual woman is still unclear.

Two points put this in perspective. First, these risks apply mainly to women who lose their ovaries well before natural menopause. Second, in several of these studies the extra risk was smaller or absent in women who took estrogen until around the natural age of menopause.^[6][17] That is why guidelines recommend estrogen for women with early surgical menopause unless there is a medical reason not to take it.^[1]

What about skin and appearance?

Estrogen helps keep skin thick, elastic and hydrated. After menopause, from any cause, skin tends to become thinner and drier, with less collagen and more wrinkles.^[10] So a woman who goes into menopause earlier may notice these changes earlier. But this is a menopause effect, not a hysterectomy effect, and it happens gradually. Hormone therapy is not recommended solely to prevent skin aging; sun protection, not smoking and a good moisturizer remain the basics.^[1]

Hormone therapy after a hysterectomy

Hormone therapy (often called HRT or MHT) replaces some of the estrogen your ovaries no longer make. It is the most effective treatment for hot flashes and night sweats, and it helps prevent bone loss.^[1][14]

Estrogen alone is usually enough

Women who still have a uterus need a progestogen alongside estrogen to protect the lining of the uterus from cancer. Without a uterus, you can usually take estrogen alone.^[13] There are exceptions: your doctor may add a progestogen if you had endometriosis, or if part of the cervix was left in place and could still contain some lining tissue. Ask which applies to you.

The estrogen-only arm of the Women’s Health Initiative, which studied women who had had a hysterectomy, found a slightly lower rate of breast cancer among women who took estrogen than among those who took a placebo, over long-term follow-up.^[12] That finding does not apply to combined estrogen and progestogen therapy.

Forms

Estrogen comes as tablets, skin patches, gels and sprays. Patches, gels and sprays avoid passing through the liver first and carry a lower risk of blood clots than tablets.^[13][14] Low-dose vaginal estrogen (cream, tablet or ring) treats vaginal dryness and some bladder symptoms with very little reaching the rest of the body. It can be used on its own or together with other hormone therapy.

Who may not be able to take it

Hormone therapy is not right for everyone. Doctors are usually cautious or advise against it if you have had breast cancer or another hormone-sensitive cancer, a blood clot or stroke, active liver disease, or unexplained vaginal bleeding. Talk through your personal and family history before you start.^[1]

If you cannot or prefer not to take hormones

Several non-hormonal treatments help with hot flashes, including some antidepressants (SSRIs and SNRIs), gabapentin and newer medicines that act on the brain’s temperature center, such as fezolinetant. Cognitive behavioral therapy and clinical hypnosis also have good evidence.^[16] For vaginal dryness, regular vaginal moisturizers and lubricants help many women; see our guide to sex after hysterectomy.

Can a blood test check your hormones?

Often not in a useful way. Hormone levels go up and down from day to day, especially in the years before menopause, so a single result can be misleading. UK guidelines advise diagnosing menopause from symptoms in women over 45, and using a blood test for follicle-stimulating hormone (FSH) mainly in younger women, where it can help confirm early menopause.^[14] After a hysterectomy with the ovaries kept, an FSH test may help in some cases, because there are no periods to go by. If your ovaries were removed, no test is needed: you are in menopause.

Saliva tests and “hormone panels” sold online are not reliable for guiding treatment.

Looking after your long-term health

• Bones. Ask whether you need a bone density scan (DEXA), particularly if you had your ovaries removed before menopause and are not taking estrogen.
• Heart. Keep up with blood pressure, cholesterol and blood sugar checks. Regular exercise, not smoking and a healthy weight matter more after early menopause, not less.
• Review hormone therapy over time. If you started it after early surgical menopause, guidelines suggest continuing at least until around age 51, and then deciding with your doctor whether to go on.^[1][17]
• Mood. Hormone changes can affect mood and sleep. If low mood lasts more than two weeks, tell your doctor.

Our article on life after hysterectomy in the months and years later covers the other long-term changes.

Questions to ask before surgery

If you have not had your operation yet, the decision about your ovaries is the one that most affects your hormones. Questions worth asking:

• Do you plan to remove my ovaries? If so, why, and what happens if we keep them?
• Do I have a family history or gene change (such as BRCA) that changes this advice?
• Will you remove my fallopian tubes to lower ovarian cancer risk while keeping my ovaries?^[15] Our guide to salpingectomy explains this option.
• If my ovaries are removed, can I start estrogen right after surgery, and is there any reason I should not take it?

When to talk to your doctor

• Hot flashes, night sweats or sleep problems that disrupt your daily life.
• Vaginal dryness, pain during sex or repeated urinary infections.
• Signs of menopause before age 45, even if you kept your ovaries.
• Low mood, anxiety or loss of interest that lasts more than two weeks.
• Any vaginal bleeding after menopause, even with no uterus.

If you are taking estrogen, get urgent care for pain and swelling in one leg, sudden shortness of breath or chest pain, or sudden weakness, numbness or trouble speaking. These can be signs of a blood clot or stroke.

Frequently asked questions

Does the uterus produce hormones?

Not the ones that drive menopause. The uterus responds to estrogen and progesterone but does not release them into the bloodstream. The ovaries, and to a lesser extent the adrenal glands and body fat, do.

Will I need hormones after a hysterectomy?

Not if you kept your ovaries and have no symptoms. If your ovaries were removed before menopause, most guidelines recommend estrogen until around the natural age of menopause unless you have a medical reason not to take it.^[1] After that, it is a personal choice based on your symptoms and risks.

Can a hysterectomy cause hormone imbalance if I kept my ovaries?

Usually not right away. Some women notice temporary symptoms in the weeks after surgery, and menopause may come a few years earlier than it otherwise would.^[3][4] If you have new symptoms long after surgery, they may be the start of menopause.

Can my ovaries still cause pain or cysts after a hysterectomy?

Yes. Ovaries that are left in place can still form cysts or cause pain. See ovary pain after hysterectomy for causes and warning signs.

Sources

1. The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. pubmed.ncbi.nlm.nih.gov
2. Fogle RH, Stanczyk FZ, Zhang X, Paulson RJ. Ovarian androgen production in postmenopausal women. Journal of Clinical Endocrinology & Metabolism. 2007;92(8):3040–3043. pubmed.ncbi.nlm.nih.gov
3. Farquhar CM, Sadler L, Harvey SA, et al. The association of hysterectomy and menopause: a prospective cohort study. BJOG. 2005;112(7):956–962. pubmed.ncbi.nlm.nih.gov
4. Moorman PG, Myers ER, Schildkraut JM, et al. Effect of hysterectomy with ovarian preservation on ovarian function. Obstetrics & Gynecology. 2011;118(6):1271–1279. pubmed.ncbi.nlm.nih.gov
5. Laughlin-Tommaso SK, Khan Z, Weaver AL, et al. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018;25(5):483–492. pubmed.ncbi.nlm.nih.gov
6. Parker WH, Feskanich D, Broder MS, et al. Long-term mortality associated with oophorectomy compared with ovarian conservation in the Nurses’ Health Study. Obstetrics & Gynecology. 2013;121(4):709–716. pubmed.ncbi.nlm.nih.gov
7. Rocca WA, Gazzuola-Rocca L, Smith CY, et al. Accelerated accumulation of multimorbidity after bilateral oophorectomy: a population-based cohort study. Mayo Clinic Proceedings. 2016;91(11):1577–1589. pubmed.ncbi.nlm.nih.gov
8. Rocca WA, Bower JH, Maraganore DM, et al. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology. 2007;69(11):1074–1083. pubmed.ncbi.nlm.nih.gov
9. Levine ME, Lu AT, Chen BH, et al. Menopause accelerates biological aging. Proceedings of the National Academy of Sciences. 2016;113(33):9327–9332. pubmed.ncbi.nlm.nih.gov
10. Thornton MJ. Estrogens and aging skin. Dermato-Endocrinology. 2013;5(2):264–270. pubmed.ncbi.nlm.nih.gov
11. Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. Journal of Clinical Endocrinology & Metabolism. 2019;104(10):4660–4666. pubmed.ncbi.nlm.nih.gov
12. Chlebowski RT, Anderson GL, Aragaki AK, et al. Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Women’s Health Initiative randomized clinical trials. JAMA. 2020;324(4):369–380. pubmed.ncbi.nlm.nih.gov
13. NHS. Types of hormone replacement therapy (HRT). nhs.uk
14. National Institute for Health and Care Excellence. Menopause: identification and management (NG23). nice.org.uk
15. American College of Obstetricians and Gynecologists. Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. ACOG Committee Opinion No. 774. Obstetrics & Gynecology. 2019;133(4):e279–e284. pubmed.ncbi.nlm.nih.gov
16. The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society Advisory Panel. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573–590. pubmed.ncbi.nlm.nih.gov
17. Faubion SS, Kuhle CL, Shuster LT, Rocca WA. Long-term health consequences of premature or early menopause and considerations for management. Climacteric. 2015;18(4):483–491. pubmed.ncbi.nlm.nih.gov

This article is for general information and is not a substitute for medical advice. Whether hormone therapy is right for you depends on your surgery, age and health history, so always discuss your own situation with your gynecologist or doctor, and contact them or emergency services if you are worried about any symptom.