The menopause usually happens naturally between the ages of 45–55 when levels of the female hormone oestrogen gradually decline and periods stop. If you experience the menopause naturally at a young age it's called primary ovarian insufficiency. More simply, early menopause. If you go into a menopause because your ovaries have been removed by surgery, it's known as a surgically induced menopause.
If you have surgery to remove your ovaries, these hormonal changes will happen very quickly and often straight away. Surgical menopause can be overwhelming. If possible, discuss how best to manage this with your medical team before your surgery. If you have already had surgery it's important to share any worries that you have with your medical team or GP. You can ask to be referred to a menopause specialist, who may be part of a gynaecology or sexual health team.
What to expect from surgical menopause
When the ovaries are removed during surgery you may experience symptoms more intensely. This is because the ovaries are responsible for producing the hormones oestrogen, progesterone and testosterone. Once ovaries are removed the level of these hormones immediately fall. But you may not experience any of these symptoms, you may experience a few or you may experience all of them:
- Hot flushes can vary from occasional to very frequent, day and 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 (heartbeats that suddenly become more obvious).
- Emotional symptoms can include feeling irritable, poor concentration, poor memory and loss of self-esteem.
- Vaginal discomfort and dryness, which can lead to painful sex. You may experience lower sex drive or no sex drive.
- Bladder symptoms can include increased urinary frequency and urgency (needing to wee more often and more urgently). These symptoms tend to worsen with time, so it’s best to seek help sooner rather than later.
- Other bodily changes can include brittle nails, thinning of the skin, hair loss, insomnia and joint aches and pains.
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 causing problems in 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
After a surgical menopause, you’ll be advised to take measures to ensure that you stay healthy in the years ahead. This will include protecting your bones from osteoporosis (a condition that causes weaker bones, making them more fragile) and maintaining a healthy heart.
Early menopause can increase the likelihood of developing osteoporosis. This may lead to an increased risk of fractures (a crack or break in the bone). You should be offered a DEXA scan (an x-ray which measures bone density) to assess the density or strength of your bones. A DEXA scan will help to predict your future risk of fracture. What can help:
- Hormone replacement therapy (HRT) can help prevent loss of bone density and also reduces future risk of heart disease. Your medical team will be able to advise whether this is suitable for you to take.
- A healthy balanced diet that includes around 700mg calcium a day. You can find calcium in dairy and in food such as sardines, chocolate, almonds and oranges.
- Doing regular moderate exercise. This should be 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).
- Giving up smoking, drinking alcohol in moderation and maintaining a healthy weight will also help.
Hormone replacement therapy (HRT)
HRT is a treatment that can relieve symptoms of early menopause and help your long-term health by replacing some hormones. It may not be suitable for all women so should be discussed with your medical team or a menopause specialist.
There are many different types and doses of HRT. All types of HRT contain the hormone oestrogen and the type and doses of HRT you need vary between each person. HRT replaces the oestrogen that your ovaries no longer make after the menopause. HRT is known to:
- prevent loss of bone strength
- maintain a healthy heart
- prevent mental decline (memory and thinking skills) in later life
- prevent vaginal discomfort
- help with hot flushes
How is it given?
After surgical menopause, HRT is mostly given as one hormone (oestrogen therapy). If you still have a womb, you'll need two hormones: oestrogen and progestogen. Both can be given via tablets, patches, sprays and gels.
Testosterone is also a hormone which can improve symptoms of low mood, reduced energy, brain fog and low libido (sex drive). It’s currently not licensed for women in the UK. But it’s still available on a prescription from healthcare professionals who specialise in the menopause.
What are the side effects?
You may not have 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 will be necessary. Your doctor will work with you to find the most appropriate dose and type. 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 not so much is known about the risks and the benefits of taking it after surgery for ovarian cancer. It’s important to discuss this with your doctor. If it’s possible, get a referral 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 symptoms relief, on a longer-term basis for its health benefits or not at all. The guidelines and evidence state that you can continue to take HRT as long as the benefits outweigh the risks.
Some questions to discuss with your doctor:
- Which of my symptoms will HRT help with?
- 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 it?
Vaginal oestrogen is given to treat changes in the vagina after a surgical menopause. It can be used alone or alongside conventional HRT. Vaginal oestrogen helps treat vaginal dryness and improve comfort. Vaginal oestrogen won't help other menopausal symptoms but can have fewer side effects and risks. It’s also known as topical oestrogen as it’s applied directly to the vagina using creams, gels, pessaries or vaginal rings. If you use vaginal oestrogen you can also safely take HRT, all of which are effective at reducing vaginal dryness and sexual discomfort.
Alternatives to HRT
If you choose not to use HRT or have a medical reason not to, other medications can be prescribed. Citalopram, paroxetine and venlafaxine are classed as antidepressant medicines, but they've been found to help menopausal flushes and sweats when used at low doses. Clonidine is a blood pressure medicine that may help flushes.
If later in life you experience bone density loss, you may be prescribed drugs to treat osteoporosis.
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 local therapy service or you can search the CBT Register UK for a therapist in your area.
There are lots of herbal and dietaries supplements that claim to help with menopausal symptoms. Before taking them, it’s important to discuss their use with your treating team. This is to ensure that they don’t interfere with other medications or have a negative impact on the cancer.
A surgical menopause changes your hormone levels, which can affect how you feel. This is on top of the emotions that you may already be feeling relating to your diagnosis and treatment. You may benefit from talking to 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.
Our information on body image and sexuality offers more advice on how to deal with these emotions.
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Last reviewed: January 2022
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