Surgical Menopause Symptoms: What To Expect

A Anna Barbieri, MD, FACOG, NCMP Dec 07, 2022 8 min read

The menopause experience is anything but one-size-fits-all. It varies dramatically person-to-person based on everything from age and health history to ethnicity and socio-economic status. While most people understand menopause as the transition during which the body’s production of estrogen and progesterone begins to progressively decline until you’ve gone 12 consecutive months without a menstrual period, that only refers to what’s known as “natural” menopause, the average age of which is 51. There’s also medically-induced menopause via radiation or chemotherapy, as well as surgically–induced menopause — we dive into the latter below.

Induced menopause as a result of surgery may occur for several reasons:

Surgery to treat uterine — especially endometrial, ovarian, or advanced cervical — cancer, as well as other benign conditions such as severe endometriosis, ovarian cysts, or fibroids requiring surgery with removal of ovaries
Oophorectomy is a surgery to remove the ovaries (one or both) and salpingo-oophorectomy refers to the removal of the fallopian tube and ovary.Hysterectomies, which may be needed in cases of cervical cancer, aren’t alone associated with early menopause. That said, 50-60% of hysterectomy procedures involve oophorectomies.
Surgery to reduce the risk of ovarian cancer and/or breast cancer
Premenopausal women with a family history of breast cancer or ovarian cancer — especially those who inherit BRCA mutations (BRCA1 or BRCA2) — may consider preventative surgery to lower the amount of estrogen in their body and reduce their risk factors.

Below, we’re outlining what symptoms to expect with surgically-induced menopause (for cancer or non-cancer reasons) and how they differ from so-called “natural” menopause.

The type of symptoms

When it comes to surgically-induced premature menopause, the type of symptoms and side effects experienced are, for the most part, the same as those that may occur with natural menopause. Think hot flashes and night sweats, mood changes, insomnia, vaginal dryness, vulvovaginal atrophy (weakening of the muscles in the vulva and vagina), skin changes, and altered sexual function/sex drive. Where things differ between the two experiences is how these symptoms show up and how severe they are…more on that below.

The severity of symptoms

The biggest symptom differences between the two types of menopause are onset (sudden rather than a slow progression) and severity. The reason? With surgery, there’s a more abrupt cessation of ovarian function and, as a result, a more severe, sudden drop in hormone levels (50% reduction in serum testosterone and 80% reduction in the concentration of serum estradiol, a form of estrogen).

Here’s what the existing research and clinical studies have shown:

Severe hot flashes were experienced by approximately 90% of women who had a hysterectomy, compared with 50% for naturally menopausal women.
Compared to women who entered menopause naturally, women with bilateral oophorectomy are at an increased risk of developing cognitive impairment and osteoporosis.
Women entering menopause surgically are at a three-fold risk of anorgasmia (aka inability to reach orgasm) and experience a more profound loss of libido.
Women (regardless of age) who have undergone a bilateral salpingo-oophorectomy (or BSO for short) have a 40% increased risk of cardiovascular disease.

How to prepare for symptom onset

One of our top tips for preparing is to have an honest, open discussion with your healthcare provider BEFORE the surgery…and to come prepared with questions! Here’s what we recommend asking:

Are both of my ovaries going to be removed?
Am I going to go into menopause “overnight”?
What can I expect from this change based on my age and condition?
How can I prepare for it now, before surgery?
Am I eligible for hormone therapy? If so, when can I start post-surgery? Who will prescribe it and monitor/adjust it as needed? If not, what options do I have and who can help me with symptom management?

What you can do about it

While a whole lot about this sudden menopause experience probably feels out of your control — and there are emotional impacts associated with cancer and the loss of fertility that should not be ignored — know that there are treatment options to help manage and mitigate certain symptoms.

Those of us who undergo surgical menopause due to hormone-driven cancer are typically not eligible to take hormone replacement therapy (HRT). That said, it’s important to know whether YOUR reason for an oophorectomy precludes you from this treatment, as it’s an important tool in the management of surgical menopause for those who are eligible (i.e. most ovarian cancer patients).

Without HRT, the core pillars of health come into play as tools to help manage and mitigate symptoms.

1. Nutrition

For specific symptom relief
There are select foods you may want to consider proactively adding to address specific symptoms, including:

For hot flashes/hot flushes & night sweats: soy, flaxseed, legumes (and yes, moderate amounts of soy is safe for breast cancer survivors to eat)
For brain fog: dark leafy greens, berries, raw cacao, caviar, extra virgin olive oil/flaxseed oil
For bloating: ginger

Calcium, calcium, calcium!
Calcium is incredibly important during and post-menopause to support healthy bones, and it’s best to get it from dietary sources whenever possible — the best sources are sardines, dairy (yogurt or cheese), seeds (chia or sesame), and legumes (lentiles and beans). Aim for 1200 mg/day, which is higher than what’s recommended pre-menopause. And don’t forget about Vitamin D, which facilitates the absorption of calcium.

A note on the Mediterranean diet
While there isn’t one perfect diet for all of us, the Mediterranean diet has rightly earned a lot of hype. It’s low in saturated fats and animal proteins, rich in antioxidants and fiber, anti-inflammatory, and low-carb. And because it kicks most refined and concentrated sugars to the curb and focuses instead on non-starchy veggies, beans, fruits, and whole grains, it’s considered a “low-glycemic” diet — meaning it won’t dramatically spike our blood sugar.

For a primer on what’s included, along with other nutrition tips and science, refer to our full guide to nutrition during the menopause transition.

Interested in learning more about supplements to include as part of your daily routine? Learn what to look for and what the research says about the efficacy of certain supplements for postmenopausal women.

2. Exercise

Mix in aerobic exercises for cardiovascular health (since postmenopausal women are at higher risk for cardiovascular disease, aka heart disease), strength training to maintain muscle mass, and resistance training to help support healthy bone density.

3. Stress Management

Chronic stress, like sleep, has far-reaching effects on our physical and mental health. It’s been linked to an increased risk of cardiovascular events as well as high blood pressure (which can pose a high risk for heart attack and stroke).

Here are some tips to help keep stress at bay:

Cultivate a meditation practice
Over time, you’ll condition yourself to be more present while letting thoughts come and go. We recommend guided meditations on apps such as Headspace, Insight Timer, and Calm. Meditation not your thing? Try Heartmath, a form of biofeedback that can help with anxiety management. It focuses on breathing and heart rate, two physiologic functions that can contribute to that anxious feeling.
Cultivate a gratitude and/or journaling practice
Studies have linked both practices to decreased anxiety, and they can also help improve general feelings of well-being and facilitate mindfulness. Here are some great tips on how to start a gratitude practice.
Get high-quality sleep
Sleep disruptions affect neurotransmitter and stress hormone levels which, in turn, impair thinking and emotional regulation. That’s why it’s so important to prioritize those Zzzzsss. Here’s a handy guide with behavioral, nutritional, and supplemental solutions.
Prioritize downtime with family & friends
While we may be conditioned with a “go-go-go” mentality, it’s important to step back and prioritize rest and downtime with loved ones (pencil it into your calendar!). After all, human beings are social creatures, and we derive comfort from connection.
Don’t forget about “me” time
Call it what you want — self care, alone time, R&R — but you deserve it. There’s nothing “selfish” about taking time for yourself, especially when it supports your mental health and overall wellness.