Surgical menopause

Find out what surgical and early menopause are and the support available to help manage symptoms.

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The menopause usually happens between the ages of 45–55 when the ovaries no longer release eggs and the levels of the hormone oestrogen slowly fall. These changes eventually cause periods to stop and means you can no longer become pregnant.  

There are different types of menopause, depending on when and how it happens:

  • If you experience the menopause naturally at a young age (less than 40 years old) this is called premature ovarian insufficiency.  
  • If it happens before the age of 45, it’s called early menopause.  
  • If you go into the menopause because your ovaries have been removed by surgery, it’s known as a surgically induced menopause, or surgical menopause.  

What happens during surgical menopause?

The ovaries are the main source of the hormone oestrogen for anyone born with ovaries. There are a few different types of oestrogen made by your body. They're important in regulating your periods as well as for other bodily functions to do with bone, brain and heart health.

If you have surgery to remove your ovaries, the decline in oestrogen will happen very quickly and often straight away. This is different to a natural menopause which happens slowly over time, as the ovaries naturally stop releasing eggs. The symptoms of surgical menopause tend to be similar to natural menopause but are often more intense because of the sudden drop in oestrogen.  

It’s important to discuss how best to manage the symptoms of surgical menopause with your treatment team as early as possible. You can ask to be referred to a local menopause specialist, who may be part of the gynaecology or sexual health team. There may also be a GP in your local Primary Care Network who has a special interest in the menopause. A Primary Care Network is a local group of GP surgeries who work together to provide more joined up care. Speak to your GP about whether you can access another GP in your area.

Watch our session led by Dr Angela Wright, Clinical Sexologist and BMS Accredited Menopause Specialist:

What to expect from surgical menopause?

As well as producing oestrogen, the ovaries produce progesterone and testosterone, which are also hormones. Together all of these hormones have different effects on your body and regulate reproduction, energy levels, brain function, and overall physical health.  

If the ovaries are removed during surgery for ovarian cancer, the level of these hormones immediately falls. The impact of this sudden change varies from person to person. You may not experience any of these symptoms, you may experience a few, or you may experience them all: 

  • Hot flushes, which can vary from occasional to very frequent, during the day or night. They don't usually last long, but can leave you feeling tired, anxious, frustrated, hot and sweaty. Hot flushes can be accompanied by palpitations (faster heartbeats that suddenly become more obvious).  
  • Mood or cognitive symptoms which can include feeling irritable, poor concentration, poor memory, anxiety, mood swings and low self-esteem.  
  • Vaginal discomfort and dryness, which can lead to painful sex. You may also experience lower sex drive or no sex drive.  
  • Bladder symptoms, which include needing to wee more often and more urgently, and more frequent urinary tract infections (UTIs). These symptoms can get worse over time, so it’s best to seek help sooner rather than later.  
  • Changes to energy levels and sleep such as extreme tiredness (fatigue) and difficulty falling asleep or staying asleep (insomnia).
  • Muscle and joint ache or stiffness.
  • Other changes such as brittle nails, thinning of the skin, dry and itchy skin, hair loss and weight gain. 

In many cases, these symptoms will get better on their own, although it's difficult to predict how long you may have them for. If symptoms are impacting your life, speak to your treatment team or GP. They can assess your symptoms and, if needed, refer you to a menopause specialist.   

Your long-term health  

Surgical menopause increases the risk of long-term bone and heart health issues such as:

  • osteoporosis – this is a condition that causes weaker bones, making them more fragile, and  
  • cardiovascular disease – these are conditions that impact the heart and blood vessels.

If you go through surgical menopause, you’ll be advised to take measures to help protect your bones and keep your heart healthy.  

In order to check your bone health, you may be offered a DEXA scan. This is an x-ray which measures bone density and strength. This will be used to help predict your future risk of osteoporosis and fractures (a crack or break in the bone). Depending on your situation, and if you’re on other treatments that affect bone density, this scan may be repeated every few years. Your doctor may also do a blood test to measure your vitamin D levels. Both vitamin D and calcium are important for bone health and strength.

Hormone replacement therapy (HRT) can help prevent loss of bone density. It also reduces future risk of heart disease if started within 10 years of the menopause. Your treatment team will discuss the pros and cons of HRT if it’s suitable for you. This will depend on your type and stage of ovarian cancer. Find out more about HRT further down this page.

There are ways to help keep your bones and heart healthy:

  • A healthy balanced diet that includes 1,000mg of calcium and 10 micrograms of vitamin D a day:
    • You can find calcium in dairy, broccoli, nuts, tofu, paneer, soya beans or sardines.  
    • You can find vitamin D in oily fish (such as salmon, mackerel and sardines), egg yolks or some breakfast cereals if it’s been fortified. This is when extra nutrients are added.
    • If you struggle to get enough calcium or vitamin D from your diet, you may consider taking them as supplements. Always let your treatment team know before starting supplements.
    • There are diets such as the DASH diet or the Mediterranean diet which the British Heart Foundation recommend using as a guide. Again always speak to your treatment team before changing your diet.
  • Doing regular exercise, both weight-bearing (any exercise where you support your weight by standing or through your hands and arms) and aerobic (any exercise which makes you breathe faster). Macmillan have more information on the different types of physical exercise.
  • Giving up smoking, drinking alcohol in moderation, keeping a normal blood pressure and maintaining a healthy weight will also help. 

Hormone replacement therapy (HRT)

HRT is a treatment that can relieve symptoms of menopause and help your long-term health by replacing some hormones. It may not be suitable for everyone so it should be discussed with your treatment team or a menopause specialist.  

In general, HRT isn't offered if your ovarian cancer is hormone sensitive. This is when the cancer cells use hormones to grow, so taking HRT may increase the risk of the cancer cells growing. Hormone sensitive ovarian cancers include many low grade serous tumours and certain sex-cord stromal tumours (like granulosa cell tumours).  

There are many different types and doses of HRT. All of them contain oestrogen but the type and dose of HRT vary between each person. HRT replaces the oestrogen produced by your ovaries. HRT is known to:  

  • prevent the loss of bone strength  
  • maintain a healthy heart  
  • prevent mental decline (memory and thinking skills) in later life  
  • prevent vaginal discomfort e.g. dryness
  • help with hot flushes.   
How is it given?

If you go through surgical menopause as a result of ovarian cancer treatment, HRT is mostly given as one hormone (oestrogen-only therapy). But if you still have a womb you will need both oestrogen and progestogen. This is called combined HRT. Oestrogen can be given via tablets, patches, sprays and gels and progestogen by tablets, patches and intrauterine devices. This is a small T-shaped device that a doctor or nurse places inside your womb.  

Testosterone is also a hormone that can improve symptoms of low libido (sex drive) if other approaches such as psycho-sexual counselling (to help with sexual difficulties) haven't helped. It’s currently not licensed for women in the UK. But it may be available on a prescription from healthcare professionals who specialise in the menopause.  

What are the side effects?

You may not experience any, but side effects of HRT can happen. They can include breast tenderness, headaches and leg cramps and they usually improve with time. Sometimes a change in dose or type of oestrogen can help. Your doctor will work with you to find the most appropriate dose and type of HRT. You may need to try a couple before you find one that suits you.  

What are the risks?

There’s been a lot of research into HRT and its safety in general. But less is known about the risks and the benefits of taking it after surgery for ovarian cancer. According to the British Gynaecological Cancer Society (BGCS) and the British Menopause Society, HRT is generally considered safe for women with most types of ovarian cancer. Whether you can safely take HRT depends on your specific tumour subtype, stage, and personal medical history.

It’s important to discuss your individual situation and the risks and benefits of HRT with your doctor before making a decision. If possible, ask to be referred to someone who specialises in supporting anyone who is experiencing the menopause because of cancer treatment.  

Depending on your situation, you may decide to use HRT on a short-term basis for symptom relief, on a longer-term basis for its health benefits, or not at all. If you're prescribed HRT, you can continue to take it as long as the benefits outweigh risks. This is usually reviewed with your doctor once a year. The dose of HRT and how long you take it for are decided on an individual basis with your treatment team. 

Some questions to discuss with your doctor:  

  • Which of my symptoms will be helped by taking HRT?  
  • What are the possible risks of using HRT?  
  • Should I have a tablet, patch, gel or spray?  
  • How long will I need it for?  
  • Is there anything else I might use instead?  
  • What will happen if I choose not to use HRT? 
Vaginal oestrogen (local HRT) 

Vaginal oestrogen treats changes in the vagina after menopause. It’s also known as topical oestrogen or local HRT, as it’s applied directly to the vagina using creams, gels, pessaries or vaginal rings. It only impacts your vagina and helps treat symptoms such as vaginal dryness or irritation and sexual discomfort. It’s safe for most women with ovarian cancer to use.

Vaginal oestrogen can be used alone or alongside systemic HRT (HRT that’s distributed throughout your whole body) or on its own. Unlike systemic HRT, vaginal oestrogen won't help other menopausal symptoms.

It's common to have no or very few side effects from vaginal oestrogen, but you may experience:

  • Local side effects such as temporary vaginal irritation, itching or changes to discharge.
  • Side effects like headaches or breast tenderness may happen at first. These tend to go away as your body adjusts because very little hormone enters the blood and goes to the rest of your body.

If you experience side effects that last longer than a week or are severe, speak to your treatment team as they may want to adjust your dose or try a different type of vaginal oestrogen.  

If you’re unable to use vaginal oestrogen there are also vaginal moisturisers and lubricants that can help with vaginal dryness and discomfort during intimacy without using hormones.

Other medications

If you choose not to use HRT or have a medical reason not to, other medications can be prescribed to help symptoms of surgical menopause:

  • Fezolinetant and Elinzanetant are targeted, non-hormonal medicines that help reduce hot flushes and night sweats.  
  • Elinzanetant may be prescribed to help you sleep if you have insomnia.  
  • Antidepressants like venlafaxine, citalopram, or paroxetine that can help lower the frequency and intensity of hot flushes and keep your mood stable.  
  • Certain nerve pain medications such as gabapentin and pregabalin can help reduce hot flushes and night sweats.  
  • Clonidine is a blood pressure medication that can help reduce the severity of hot flushes.  
  • Oxybutynin is a medication to help symptoms of an overactive bladder and can be used ‘off-label’ to help manage severe sweating and flushes.
  • If you experience bone density loss later in life, you may be prescribed drugs to treat osteoporosis.

Speak to your treatment team or GP if you want to discuss if these medications might work for you. This may depend on what other medications you take and your personal medical history.  

There are lots of herbal and dietary supplements that claim to help with menopausal symptoms. Before taking them, it’s important to discuss their use with your treatment team. This is to ensure that they don’t interfere with other medications or have a negative impact on the cancer.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) has been proven to be a safe and effective treatment for menopausal symptoms. It can help hot flushes and night sweats with additional benefits to mood, sleep and quality of life. CBT helps you to manage these symptoms by changing the way you think and behave. You can ask your GP for a referral to your free local therapy service or you can search the CBT Register UK for a private therapist in your area.  

Complementary therapies

Complementary therapies like acupuncture, yoga, and mindfulness meditation can safely help manage menopausal symptoms after ovarian cancer treatment. Acupuncture can help reduce the frequency and severity of hot flushes. The gentle movement of yoga and Tai Chi improves mood, balance, and sleep quality. Mindfulness and meditation help lower stress levels and calm anxiety that may come from sudden hormonal changes.

Macmillan and Maggie’s have more information on complementary therapies that can help manage menopausal symptoms.  

Your emotions

A surgical menopause changes your hormone levels, which can affect your emotions and mood. This is on top of the emotions that you may already be feeling relating to your diagnosis and treatment. The impacts of surgical menopause can be more intense than a natural menopause and may impact you even if you’ve previously had the menopause. It might be particularly difficult to adjust to if you were premenopausal before your cancer treatment or if it impacts your fertility needs. You may feel anger, grief or be overwhelmed by the sudden change. You're not alone if you find that going through surgical menopause brings up many difficult emotions.

It may be helpful to speak with your family and friends about how your feelings are affecting you and your relationships. It may also help to speak to a counsellor or with others who have experienced the same.  

You may find it helpful to:

Other organisations that provide support:

  • Menopause and Cancer have information, workshops, events and a podcast about menopause caused by cancer treatments. 
  • The Daisy Network is a charity specialising in supporting those who go through early menopause and surgical menopause.
  • Maggie’s centres offer support and counselling.
  • Macmillan have a support line that’s open 7 days a week, 8am to 8pm. 

Last reviewed: September 2026

Next review: September 2029

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References

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