What They Didn't Tell Me About Surgical Menopause

I had a CT scan recently that showed a complex cyst on my only remaining ovary. I call her Bertha. The ovary, not the cyst. The cyst doesn't deserve a name.

Bertha had been causing me pain for a few months, but I wasn't in the mood to deal with ultrasounds and conversations about surgery, so I mostly ignored it — or complained loudly to anyone who would listen. Same thing, really.

Once we had images showing Bertha was hosting not one but two cysts — one large simple cyst and one small complex cyst with some solid features — my doctor ordered bloodwork to check tumor markers. Just to be safe.

A bunch of them came back elevated.

Ugh. F*cking Bertha.

That kicked off a follow-up MRI and a meeting with an oncologist. She decided that even though the MRI looked okay, there was enough risk that Bertha needed to go. We agreed, we scheduled the surgery, and just like that, Bertha got her walking papers.

Here's the thing nobody fully prepared me for: removing Bertha was kind of a big deal. Not just medically emotionally, physically, hormonally — because she was my only remaining ovary abd my only source for hormones Taking her out meant I would no longer produce estrogen or progesterone, and I would be launched — at 100 miles per hour — directly into menopause. Not easing into it. Not a gradual transition. Just... menopause. Now. Go.

Cool.

I already knew enough about menopause to be terrified of it: night sweats, sleep problems, brittle hair, dry skin, dry everything, osteoporosis, heart disease, mood swings, anxiety, depression. Menopause has the energy of the end of a medication commercial. The one where they spend 45 seconds listing everything that might go wrong.

I was scared.

So when my oncologist confirmed we were firing Bertha from her hormone-making duties, I asked about HRT — hormone replacement therapy.

She said, "Oh, we don't really prescribe HRT prophylactically for heart disease or bone health. If it becomes a real problem, maybe your gynecologist will prescribe something."

Okay, LADY. (And I say it exactly like that — because menopause is coming for her too someday, and I highly doubt she's planning to white-knuckle it. But I know when to argue and when to smile and say "Oh, interesting, okay" and move on.)

So I did.

And then I texted my gyno and asked for HRT. Which I'm starting in a few days.

Anyway — I had the surgery at the hospital because I have a lot going on health-wise and this was a "let's rule out cancer" situation, so we brought in the big team. I was in the women's surgical center — a place that performs surgery on women, all day, every day.

So I asked the nurse who was giving me discharge instructions: "Is there anything I should know about what happens now that I have no lady parts left and am in menopause as of 20 minutes ago?"

She said, "No, not really. You'll just take it as it comes."

I mean. What?

Okay. So here's what the doctor and the nurse failed to mention — what I wish someone had handed me in a pamphlet while I was still in my hospital gown:

(Actually, quick note before we get into it: I am not a doctor. I am a woman who just had her ovary removed and got very little guidance on her way out the door. What follows is a combination of research I did on my own, conversations with women who've been through it, and information I pulled together because nobody handed it to me when I needed it. Talk to your doctor — ideally one who actually wants to talk about this stuff. This is my notes, not a prescription.)

Surgical menopause is not the same as regular menopause. Not even close.

Natural menopause is a transition. It unfolds over years — hormones fluctuate, symptoms come and go, your body gets a slow, annoying heads-up that things are changing. It can take anywhere from four to ten years just to move through perimenopause.

Surgical menopause is none of that. When your ovaries are removed, your estrogen and progesterone don't gradually decline — they disappear. Immediately. It's not a transition. It's a hard stop. Going cold turkey from hormones your body has been making your entire life.

That means the symptoms hit harder and faster than they would in natural menopause. We're talking hot flashes, night sweats, insomnia, mood swings, and low libido — potentially all at once, on top of recovering from actual surgery. Fun! Great! Love that for us!

And the effects go beyond feeling terrible in the short term. Long-term, the sudden loss of estrogen increases the risk of:

Osteoporosis. Estrogen protects your bones. Without it, bone density loss accelerates. The earlier you go into menopause, the more years your bones are at risk. A bone density scan (DEXA scan) is something you should be asking about.

Heart disease. Estrogen also has a protective effect on your cardiovascular system. Losing it abruptly, especially before the natural age of menopause (around 51), increases your risk of heart disease down the road.

Cognitive changes. Brain fog is real, and research suggests that earlier menopause — especially surgical — may be linked to increased risk of cognitive decline and dementia later in life.

Mood disorders. Anxiety and depression are more common after surgical menopause than after natural menopause. The drop in hormones affects the brain's chemistry, and when it happens suddenly, your nervous system doesn't exactly take it gracefully.

Sexual dysfunction. Vaginal dryness, discomfort, and low libido are common — and undertreated. There are options, including vaginal estrogen, that can help specifically with this even if you're not using systemic HRT.

Weight changes. Oophorectomy is associated with more rapid weight gain than either natural menopause or hysterectomy alone. Just so you know.

So what actually helps?

HRT — hormone replacement therapy — is the most effective treatment for surgical menopause, and according to current guidelines, it's recommended for most women who go through surgical menopause before the age of natural menopause. Not as a "let's see if it gets bad enough" afterthought — proactively, because your body lost hormones it wasn't supposed to lose yet.

This is why I made the follow up with my gyno on the day I realized I needed surgery.

Beyond HRT, the basics matter too: weight-bearing exercise for bone health, adequate calcium and vitamin D, monitoring your blood pressure and cholesterol, and not smoking.

Here's my point: I was in a facility that operates on women every single day, surrounded by medical professionals, and I walked out of surgery without a single person handing me a roadmap for what was about to happen to my body. No pamphlet. No conversation. Just "take it as it comes."

We deserve better than that.

So consider this my pamphlet.

You're welcome.