Risk-reducing removal of the ovaries and tubes is recommended to many women with a BRCA variant in their thirties or forties. The surgery is discussed in detail. What follows it — immediate menopause, decades earlier than it would otherwise have happened — is often discussed for about five minutes.

Where we stand: Menova is an independent publication. We sell no hormones and no testing, we are not your doctor, and this is general education, not medical advice. Decisions here belong with a genetics service and a specialist team who know your variant, your history and your family history.

What the surgery is

Risk-reducing salpingo-oophorectomy — removal of both ovaries and both fallopian tubes. It is the most effective option for reducing ovarian cancer risk in women with a BRCA variant, because there is no reliable screening test for ovarian cancer.

Timing is generally guided by variant and by completed childbearing: broadly, from the late thirties for BRCA1 and somewhat later for BRCA2, reflecting the different age at which risk rises. Your own team will give you the timing that applies to you, and the range in published guidance is wider than a single number suggests.

This is not the same operation as a hysterectomy. The uterus is usually left in place, and whether it is removed changes what hormone regimen is available afterwards. It is a reasonable thing to ask about in advance rather than after.

What happens the day after

Natural menopause takes years. This takes hours.

Removing both ovaries before the natural age of menopause produces an abrupt drop rather than a decline, and women commonly describe symptoms that are more sudden and more intense than the gradual version — hot flashes, sleep disruption, mood change, joint pain, and genitourinary symptoms that can arrive within weeks rather than years.

Our fuller description of this is early and surgical menopause.

The part that is most often got wrong

The belief that a BRCA variant rules out hormone therapy.

For a woman who has not had breast cancer, major guidelines generally support hormone therapy after risk-reducing surgery, up to around the usual age of menopause, precisely because losing ovarian function that early carries its own long-term cost. Published evidence has not shown that this replacement approach removes the risk-reduction benefit of the surgery.

That is a general position, not a decision about you. But it matters, because a great many women are told flatly that it is not an option — and where that is wrong, the consequence is decades of avoidable symptoms plus the bone and cardiovascular effects of very early estrogen loss.

If you have had breast cancer, this is a different conversation entirely and systemic hormone therapy is usually not appropriate. See menopause after breast cancer and non-hormonal prescription options.

If you are still deciding about risk-reducing mastectomy, that decision and this one interact. Raise them together rather than separately.

Why the early years matter beyond symptoms

Estrogen loss at 38 is not the same event as estrogen loss at 51, and the reason to take it seriously is not comfort.

Bone. Loss is fastest in the years immediately after estrogen falls, and starting a decade or more early means more of it. Resistance training twice a week is the intervention that builds bone — see bone health in menopause and strength training in menopause.

Cardiovascular. Early loss of ovarian function is a recognised marker of later cardiovascular risk, which is a reason to have blood pressure, lipids and HbA1c established as a baseline now — see heart health in menopause.

Genitourinary symptoms progress without treatment, unlike hot flashes. Local vaginal estrogen is low-dose and acts locally, and it is a separate question from systemic therapy — worth asking about specifically even when systemic hormones are not suitable. See how to use vaginal estrogen and GSM and urinary changes.

Sexual function and libido change for most women after this surgery, and it is under-discussed to the point that many assume it is only them — see low libido and dryness and when sex hurts.

Ask before the operation, not after

The single most useful thing you can do is have the after-care conversation while you still have a pre-operative appointment.

  • "What is your plan for managing menopause afterwards, and who owns it?" Surgical teams and menopause care are frequently separate services, and this is where women fall between them
  • "Am I a candidate for hormone therapy after this, and if not, why not?" Ask for the reason to be recorded
  • "Will my uterus be removed?" It determines whether you need a progestogen alongside estrogen — see progesterone in menopause
  • "Can a prescription be ready before I am discharged?" Starting promptly avoids a gap that is difficult to sit through
  • "What about testosterone?" The ovaries produce testosterone too, and this is rarely mentioned — see testosterone for women
  • "When are my baseline bone density and cardiovascular tests?"

Our printable visit prep sheet holds these on one page.

If you have already had the surgery

Nothing above stops applying because time has passed.

If you were not offered hormone therapy and were not told why, that is worth reopening — particularly if you are still under the usual age of menopause and have not had breast cancer. If you were told no, ask what specifically the reason was. A considered clinical reason and an unexamined assumption look identical from the patient's side, and only one of them should stand.

If systemic hormones genuinely are not appropriate, the alternatives are real: non-hormonal prescription options, local vaginal estrogen, CBT for symptom impact, and the bone and cardiovascular work above — see non-hormonal options and CBT for menopause.

On making the decision itself

We are not going to tell you whether to have this surgery. It is a decision about risk, timing, fertility and how you want to live, and it belongs with your genetics team.

What we will say is that "the menopause part is manageable" and "the menopause part will be managed" are different statements. The first is generally true. The second depends on someone taking responsibility for it, and that is the question to ask out loud before you consent.

Our free 30-day symptom tracker gives you a before-and-after record, which is unusually useful here because the change is abrupt. The free 2-minute Menova self-check organizes your symptom picture — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice, and not a recommendation for or against surgery. Guidance on timing, hormone therapy and surveillance differs by variant, by personal and family history, and by country. Decisions belong with a genetics service and a specialist clinical team.

Sources: NICE NG23 — Menopause, National Cancer Institute — BRCA Gene Changes, ACOG — BRCA1 and BRCA2 Mutations, and The Menopause Society.