Menopause means the final menstrual period. The average age of menopause is around 51 years, but most women will start to notice menopausal symptoms from around 47 years.  This may be noticed as the onset of hot flushes, night sweats or vaginal dryness or a change in menstrual periods to more infrequent and sometimes heavier menstrual bleeding. Removal of both ovaries (bilateral oophorectomy) before the normal menopause is called “surgical menopause”.

Surgical menopause is commonly performed at the time of hysterectomy for benign (non cancerous) disease, most commonly for heavy menstrual bleeding or fibroids. Another common reason to remove normal ovaries at the time of hysterectomy is to reduce the risk of ovarian cancer. Some premenopausal women will elect to have their ovaries removed for other indications, such as endometriosis or chronic pelvic pain.  Depending on the circumstances, removal of the ovaries may improve pain, but it is not always effective.  Some doctors may suggest a trial of a drug to bring on a short term “chemical menopause” before surgery to try and mimic the effects of surgical menopause. However, it is not currently possible to predict how surgical menopause will affect individual women.

Potential positive effects of surgical menopause

• Reduced risk of ovarian cancer in women who are known to be at high inherited risk. Having this operation also usually reduces anxiety about developing ovarian cancer. In some high risk women, surgical menopause may also reduce their risk of breast cancer.
• Reduced pelvic pain for women with endometriosis or dense adhesions around the ovary.

Potential negative effects of surgical menopause

• Sudden and more severe onset of menopausal symptoms: in particular; hot flushes, night sweats and vaginal dryness
• Loss of bone density and increased risk of osteoporosis and fracture
• Impaired sexual function due to reduced desire and to discomfort from vaginal dryness
• Reduced sex drive (libido) associated with loss of ovarian testosterone production
• Loss of fertility
• Increased risk of cardiovascular (heart) disease

Surgical menopause may have other adverse effects on health including affecting mood (increased depression), cognition (thinking), dementia and potential increased risk of

Parkinson’s disease but the evidence for these is not well established. Large population based studies have reached different conclusions about whether surgical menopause impacts on cardiovascular, cancer or all-cause mortality. Use of Menopausal Hormone Therapy (MHT), also known as Hormone Replacement Therapy (HRT) may reduce these risks, but again there is insufficient evidence. The proven value of MHT after surgical menopause is in managing vasomotor symptoms and maintaining bone density.

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