Surgical Menopause? Keep healthy ovaries if you can and how to find support

Hot off the guidelines: for most premenopausal women without an inherited cancer risk, taking out healthy ovaries just because of cancer worry is not the recommended path. Both the Australasian Menopause Society (AMS) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) say the upsides and downsides need a careful, personal chat — and keeping healthy ovaries is often the better call.

What AMS says about elective ovary removal

Surgical menopause means both ovaries are removed before natural menopause. That sudden hormone drop can bring intense symptoms and raise longer-term risks for bones, heart, mood, sexual function and thinking.

The AMS Surgical Menopause information sheet is clear on average-risk women: bilateral oophorectomy (removal of both ovaries) is not recommended for premenopausal women who are worried about ovarian cancer but have no inherited increased risk. For that group, the disadvantages of removing normal, healthy ovaries before the usual age of menopause far outweigh the very small ovarian-cancer risk.

Inherited risk is different. Women with gene changes such as BRCA or Lynch syndrome may be offered risk-reducing surgery for good reason. That is a specialist conversation — not the same as elective removal “just in case” with average risk.

What RANZCOG found on survival

RANZCOG’s C-Gyn 25 guideline looks at managing the ovaries and tubes at hysterectomy for benign (non-cancer) disease. A key line from the evidence summary:

“There was no age when removing the ovaries improved overall survival.”

In plain English: taking both ovaries out at benign hysterectomy cut ovarian-cancer diagnoses, but it did not improve overall survival at any age. For younger women (under 50), later mortality was higher — especially when menopausal hormone therapy (MHT) was not used. So the guideline steers clinicians toward careful benefit–harm talks, not automatic ovary removal.

Tubes only: opportunistic salpingectomy

Many “ovarian” cancers are now understood to start in the fallopian tubes. RANZCOG notes that the majority of ovarian cancers reported arise in the fallopian tubes. That is why opportunistic salpingectomy — removing the tubes while keeping the ovaries — is often discussed at hysterectomy for benign disease: a cancer-risk reduction step that does not trigger surgical menopause.

Keeping the ovaries (when that is safe for you) means you keep making hormones until natural menopause. Removing only the tubes still means permanent sterilisation, so that needs to be part of consent too.

If you are already in surgical menopause

You are not alone. Peer support helps when the change is sudden. An Australian Facebook group for women in surgical or chemical menopause is Surgical & Chemical Menopause Support Australia (PMDD, Endo etc): join the group.

AMS also advises that MHT is recommended for women who have surgical menopause before the average age of natural menopause, unless there is a reason they cannot use it. Please talk that through with your GP or a menopause-aware practitioner — this post is information, not personal medical advice.

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