Surgical Menopause: Symptoms, How Long It Lasts and Treatment

Surgical menopause is the menopause that starts when both ovaries are removed in an operation called a bilateral oophorectomy. It often happens together with a hysterectomy, but it is not caused by the hysterectomy itself: taking out the uterus ends periods, while taking out the ovaries ends the body’s main supply of estrogen. Because that supply stops in a single day instead of fading over several years, the symptoms tend to arrive quickly and can be strong. This guide explains which operations cause surgical menopause, what it feels like, how long it lasts, why age at surgery matters so much, and the treatments that help.

Does a hysterectomy cause menopause?

Only if your ovaries are removed as well. The words used for these operations are easy to mix up, so it helps to look at each one separately:

Total hysterectomy removes the uterus and cervix. Despite the name, it does not include the ovaries, so on its own it does not cause menopause. The same is true of a partial (supracervical) hysterectomy, which keeps the cervix.
Hysterectomy with bilateral salpingo-oophorectomy (BSO) removes the uterus, both fallopian tubes and both ovaries. If you have not been through menopause yet, this causes surgical menopause straight away.
Removal of both ovaries without a hysterectomy also causes surgical menopause. Some women have this alone, for example to lower the risk of ovarian cancer.
Removal of one ovary usually does not cause menopause, because the remaining ovary normally keeps working.
Removal of the fallopian tubes only (salpingectomy) leaves the ovaries in place and does not cause menopause.

If you keep your ovaries, menopause comes naturally later on, sometimes a little earlier than it otherwise would. That situation is covered in our guide to menopause after hysterectomy with ovaries intact. Our comparison of partial vs total hysterectomy explains the other terms. If you are not sure what was removed in your own operation, your operation notes or discharge letter will say exactly.

Chemotherapy and radiation to the pelvis can also stop the ovaries working. That is sometimes called induced or medical menopause rather than surgical menopause, but the symptoms and treatment are very similar.

Why the ovaries are sometimes removed

Removing healthy ovaries is a decision with long-term effects, so surgeons weigh it carefully. Common reasons include:

A high inherited risk of ovarian cancer, such as a BRCA1 or BRCA2 variant. For these women, removing the tubes and ovaries once childbearing is finished is the most effective way to lower that risk, and guidelines suggest timing it by the gene involved.^[14]
Cancer of the ovary, or some cancers of the uterus. For cervical cancer, younger women can often keep their ovaries, as our guide to radical hysterectomy for cervical cancer explains.
Severe endometriosis that involves the ovaries, or that keeps coming back. See hysterectomy for endometriosis for the pros and cons.
Ovarian cysts, abscesses or masses that cannot be treated while saving the ovary.
Age. After natural menopause, some women and their surgeons choose to remove the ovaries during a hysterectomy because they no longer produce much estrogen.

For a woman without one of these reasons, especially one under about 50, keeping the ovaries is generally the better choice for long-term health (see below). This is a good question to raise before surgery, along with the others in our list of things to do before your hysterectomy.

How surgical menopause differs from natural menopause

In natural menopause, the ovaries slow down gradually. Hormone levels rise and fall unevenly for several years during perimenopause, and the body has time to adjust. After both ovaries are removed, estrogen levels fall within a day or two. There is no perimenopause and no gradual adjustment.

The ovaries also make testosterone and other androgens, and they keep making some even after natural menopause. Removing them lowers these hormones too, which may play a part in the drop in sexual desire that some women notice.

Because of this sudden change, symptoms after surgical menopause are often more intense than those of natural menopause, especially in younger women.^[1]

Symptoms of surgical menopause

Symptoms usually begin within a few days to a few weeks of surgery, sometimes while you are still recovering from the operation. They are the same symptoms as natural menopause, but they can arrive all at once:

Hot flashes and night sweats, often the first and most noticeable sign.
Poor sleep, from night sweats or from waking for no clear reason. Our guide on how to sleep after a hysterectomy covers the first weeks.
Vaginal dryness, discomfort during sex and more frequent urinary symptoms. Unlike hot flashes, these tend to get worse over time without treatment.
Lower sexual desire.
Mood changes: irritability, low mood, anxiety or tearfulness.
Trouble concentrating or a sense of “brain fog”.
Joint and muscle aches.

It can be hard to tell which feelings come from the hormone change and which come from recovery after major surgery, such as tiredness and low mood. If you are not sure, tell your doctor; you do not need to wait until you have fully healed to start treating menopause symptoms.

How long does surgical menopause last?

Menopause itself is permanent once both ovaries are gone: your body will not start making ovarian estrogen again. What people usually want to know is how long the symptoms last.

There is no single answer, and studies have not measured it as well for surgical menopause as for natural menopause. As a guide, a large U.S. study of women going through natural menopause found that hot flashes and night sweats lasted a median of 7.4 years, and longer in women whose symptoms started early.^[3] After surgical menopause, symptoms often follow a similar pattern: strongest in the first year or two, then easing gradually, although some women have them for many years.

Two points matter in practice:

Hormone therapy controls the symptoms while you take it. If you stop it later, some symptoms can come back for a while, which is why doctors usually reduce it gradually.
Vaginal and bladder symptoms do not fade on their own. They are caused by low estrogen in the tissues and tend to continue or worsen, but they respond well to treatment, as described below.

Why your age at surgery matters

Estrogen does more than control the menstrual cycle. It helps protect the bones, the heart and blood vessels, and possibly the brain. When the ovaries are removed years before natural menopause, which in the United States happens at around age 51, the body loses that estrogen earlier than it would have.

Long-term studies have found that women who had their ovaries removed before menopause had higher risks of the following, and that several of these risks were lower in women who took estrogen:

Osteoporosis and fractures, because bone loss speeds up when estrogen falls.^[7]
Heart disease. In the Nurses’ Health Study, women whose ovaries were removed at hysterectomy had more coronary heart disease than women who kept them, and among women under 50 who never used estrogen, removal was linked to higher overall mortality.^[4]
Memory problems and dementia. In a Mayo Clinic study, the risk was higher the younger the woman was at surgery.^[5]
Several chronic conditions overall, including depression, high cholesterol and arthritis, which accumulated faster in women who had surgery before age 46.^[6]

These are averages from observational studies. They do not mean any one woman will develop these conditions, and removing the ovaries does bring benefits: in the Nurses’ Health Study it sharply lowered the risk of ovarian cancer and also lowered the risk of breast cancer.^[4] For women who need the operation, the main lesson is that replacing estrogen, unless there is a medical reason not to, appears to lower many of these risks.^[1][7]

Treatment: hormone therapy

For most women who go into surgical menopause before about age 45 to 50, hormone therapy (HRT) is the main treatment. Expert guidelines from The Menopause Society (formerly the North American Menopause Society) and from ESHRE recommend that women with early or premature menopause, including surgical menopause, take hormone therapy at least until the average age of natural menopause, unless there is a reason they should not.^[1][8] At that point you and your doctor can decide whether to continue, based on your symptoms and health.

Estrogen alone if you have no uterus

If your uterus was removed, you can usually take estrogen on its own. A progestogen is needed only to protect the lining of the uterus, so women without a uterus do not normally need one.^[2] The exception your doctor may discuss is endometriosis, because estrogen alone can sometimes reactivate leftover endometriosis tissue.

Estrogen-only therapy also has a reassuring safety record for breast cancer. In the Women’s Health Initiative, women without a uterus who took estrogen alone had a lower rate of breast cancer than those who took a placebo, a difference that was still present after about 20 years of follow-up.^[9] Those women were on average in their 60s; the risks for younger women replacing hormones they would naturally still have are generally considered lower.^[1]

Forms and timing

Estrogen comes as tablets, skin patches, gels and sprays. Patches, gels and sprays pass through the skin rather than the liver and appear to carry a lower risk of blood clots than tablets, so they are often preferred for women with clot risk factors.^[1][2] Many surgeons start hormone therapy soon after the operation, sometimes before you go home. Ask about this before your surgery so the plan is in place.

Who may not be able to take estrogen

Hormone therapy is not suitable for everyone. Doctors are usually cautious after breast cancer, some other hormone-sensitive cancers, a previous blood clot or stroke, or active liver disease. Women who carry a BRCA variant but have not had breast cancer can often take hormone therapy after risk-reducing surgery, but this should be discussed with a specialist.^[1]

Testosterone

Some women notice a marked drop in sexual desire after their ovaries are removed. An international consensus statement found that testosterone can help postmenopausal women whose low desire causes them distress, and that there is not enough evidence to use it for other symptoms such as tiredness or mood.^[10] In the United States no testosterone product is approved for women, so doctors who prescribe it use carefully reduced doses of products made for men.

Treatment: vaginal symptoms

Vaginal dryness and painful sex respond well to low-dose vaginal estrogen, as a cream, tablet or ring. Very little reaches the bloodstream, and it can be used alongside regular hormone therapy if dryness persists.^[2] Non-hormonal vaginal moisturizers used a few times a week, and lubricants during sex, also help. For more on intimacy after surgery, see rediscovering pleasure after hysterectomy.

Treatment without hormones

If you cannot take estrogen or prefer not to, several treatments have good evidence for hot flashes:^[11]

Fezolinetant (Veozah), approved by the FDA in 2023, and elinzanetant (Lynkuet), approved in October 2025. Both are non-hormonal tablets that act on the brain’s temperature-control center.^[12][13]
Certain antidepressants (SSRIs and SNRIs) at low doses, including low-dose paroxetine, which is FDA-approved for hot flashes.
Gabapentin, sometimes taken at bedtime when night sweats disturb sleep.
Cognitive behavioral therapy (CBT) and clinical hypnosis, which can reduce how much hot flashes bother you.

The Menopause Society’s review did not find good evidence that herbal supplements such as black cohosh, or most diet changes, reliably relieve hot flashes.^[11] Some of these products can also interact with other medicines, so check with your doctor or pharmacist before taking them.

Protecting your bones and heart

Whatever treatment you choose, these steps help after surgical menopause, especially if it happened before age 50:^[7]

Ask whether you should have a bone density scan (DEXA), particularly if you are not taking estrogen.
Do regular weight-bearing and strength exercise, such as walking and resistance training, once your surgeon says you have healed. Our week-by-week recovery guide explains when to restart activity.
Get enough calcium and vitamin D, from food first.
Keep an eye on blood pressure, cholesterol and blood sugar, and stop smoking if you smoke.

Questions to ask before surgery

If your operation may include removing your ovaries, these questions are worth asking:

Are you planning to remove my ovaries, and why? Could they be kept?
Could only my tubes be removed instead?
If my ovaries are removed, will I start hormone therapy, in which form, and when?
Is there any reason I should not take estrogen?
Should I have genetic testing before the decision is made?
Who will manage my menopause care after surgery: you, my primary care doctor or a menopause specialist?

NICE guidance in the UK recommends that women who are likely to go through menopause because of surgery are given information about it, and about their treatment options, before the operation.^[2] It is reasonable to expect the same here. Our hysterectomy FAQ answers other common questions.

When to get help

Contact your doctor promptly if:

Hot flashes, night sweats or poor sleep are making daily life hard. You do not have to wait them out.
You feel low, hopeless or anxious most days. If you have thoughts of harming yourself, call or text 988 (the Suicide & Crisis Lifeline) or go to the nearest emergency room.
You have any vaginal bleeding after your recovery from a hysterectomy.

If you are taking estrogen, get emergency care for pain or swelling in one leg, sudden chest pain or shortness of breath, or sudden weakness, numbness or difficulty speaking. These can be signs of a blood clot or stroke, which are uncommon but serious.

Sources

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
National Institute for Health and Care Excellence. Menopause: identification and management (NG23). nice.org.uk
Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. 2015;175(4):531–539. pubmed.ncbi.nlm.nih.gov
Parker WH, Broder MS, Chang E, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses’ Health Study. Obstetrics & Gynecology. 2009;113(5):1027–1037. pubmed.ncbi.nlm.nih.gov
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
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
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
ESHRE, ASRM, CREWHIRL and IMS Guideline Group on POI; Panay N, et al. Evidence-based guideline: premature ovarian insufficiency. Human Reproduction Open. 2024;2024(4):hoae065. pubmed.ncbi.nlm.nih.gov
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
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
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
U.S. Food and Drug Administration. FDA approves novel drug to treat moderate to severe hot flashes caused by menopause. May 12, 2023. fda.gov
Contemporary OB/GYN. FDA approves elinzanetant (Lynkuet) for vasomotor menopausal symptoms. October 24, 2025. contemporaryobgyn.net
American College of Obstetricians and Gynecologists. Practice Bulletin No. 182: Hereditary breast and ovarian cancer syndrome. Obstetrics & Gynecology. 2017;130(3):e110–e126. pubmed.ncbi.nlm.nih.gov

This article is for general information and is not a substitute for medical advice. Whether to remove or keep your ovaries, and how to treat menopause afterwards, depends on your own health and history, so always discuss your situation with your gynecologist or doctor, and contact them or emergency services if you are worried about any symptom.