Menopause is a natural process in a woman's life, marked by amenorrhoea for at least 12 consecutive months. It generally occurs around the age of 55. However, on some occasions, it can be triggered abruptly and at an earlier age. In this case, it is known as surgical menopause (1). 

This is one of the consequences of certain elective or emergency pelvic surgeries. So, if you have just undergone one or are about to enter the operating theatre, let us tell you what to expect.  

What is surgical menopause, and when does it occur? 

It occurs when the ovaries are removed in a procedure known as an oophorectomy. Since these organs play a crucial role in the production of female hormones, such as oestrogen and progesterone, their removal results in an immediate and complete loss of hormonal function. This leads to instantaneous menopause, regardless of the medical reason behind the surgery (1,2). 

It is essential to note that oophorectomy and hysterectomy are different procedures. While hysterectomy involves the removal of the uterus due to medical problems such as myomatosis or cancer, oophorectomy involves the removal of the ovaries while keeping the uterus intact. In this case, menstruation ceases, as this is one of the functions of the uterus together with the ovaries. Since the uterus is absent, there is no way to menstruate. However, the ovaries continue to produce hormones until the body naturally reaches the menopausal stage (2,3). 

Sometimes, in early-stage cancer diagnoses, the removal of the ovaries can be crucial to a woman's survival. Removing these organs deprives the malignant tissue of the hormones necessary for its growth and spread, making it easier to control the progression (2). 

At other times, the process is performed to reduce pain and discomfort caused by endometriosis. This is a condition in which uterine tissue grows outside the uterus and affects the ovaries and fallopian tubes (2). Other non-malignant causes for removal of the ovaries are (2): 

• Ovarian torsion.   

• Ovarian cysts. 

• Benign ovarian tumours. 

Signs and symptoms

A sudden loss of estrogen and progesterone supply due to surgical removal of the ovaries can cause more intense and abrupt symptoms for a hormonally balanced woman compared to one who has experienced gradual alterations in ovarian hormone concentrations (4). Therefore, the symptoms will generally be the same as in natural menopause, but with greater intensity. 

Consequently, younger women with surgical menopause are at greater risk of presenting alterations such as (4): 

• Depression. 

• Bipolar disorder. 

• Insomnia. 

• Night sweats and hot flushes. 

• Irritability. 

• Decreased concentration. 

Intimate relations may also become painful. This is due to the vaginal dryness that accompanies the drop in hormone levels (4). 

Implications of surgical menopause 

Surgical menopause can have several side effects. For example (2): 

• Loss of bone density. 

• Decreased sexual desire. 

• Vaginal dryness. 

• Infertility. 

• Increased risk of cardiovascular disease and osteoporosis. 

Surgical menopause management 

Unless the removal of the ovaries is related to some form of cancer, such as ovarian or breast cancer, hormone replacement therapy may be recommended to help the body maintain a proper balance. This is crucial for women under 45, as early menopause increases the risk of cardiovascular disease. It also has a negative impact on bone health (2,4). 

Improving quality of life after this procedure 

Alongside medical treatment, there are measures that can improve your quality of life. These include (2,4):  

• Carry a portable fan. 

• Stay well hydrated. 

• Avoid spicy foods and limit alcohol and smoking.  

• Keep your bedroom cool at night. 

• Practise good sleep hygiene.  

• Exercise regularly. 

• Maintain a healthy weight. 

• Practise relaxation techniques, such as meditation, yoga, and mindfulness.  

• Make sure you get enough calcium in your diet to prevent osteopenia and osteoporosis. 

• Use lubricants during sex. 

• Join a support group. This is useful for finding advice, support, sympathy, and friends with whom you can even commemorate World Menopause Day. 

Surgical menopause, although it can be challenging, has the advantage of letting you know the changes you will experience. It is always important to consult with a gynaecologist to determine if hormone therapy is appropriate and to adopt healthy habits to help you cope as well as possible. 

Referencias bibliográficas 

1. Surgical menopause [Internet]. London: Target Ovarian Cancer. 2022 [cited 2024 Apr 2]. Available from: https://targetovariancancer.org.uk/about-ovarian-cancer/your-situation/im-younger-woman-diagnosis/surgical-menopause 
2. Riggins V. Surgical Menopause [Internet]. Healthline Media; 2020 [cited 2024 Apr 3]. Available from: https://www.healthline.com/health/surgical-menopause 
3. Considerations - Hysterectomy [Internet]. UK: NHS Choices. 2024 [cited 2024 Apr 3]. Available from: https://www.nhs.uk/conditions/hysterectomy/considerations/ 
4. ‌What You Need to Know About Surgical Menopause. [Internet]. EE.UU.: Basser Center; 2019 [cited 2024 Apr 3]. Available from: https://www.basser.org/resources/what-you-need-know-about-surgical-menopause