The ovary question: kept, removed, or one of each — what it means for your recovery
One of the most consequential decisions made during a hysterectomy — what happens to the ovaries — is also one of the least discussed with patients before or after surgery. Whether your ovaries were kept, one or both were removed, or the decision was made during the operation based on what was found: each scenario has distinct and far-reaching implications for your hormonal health, your recovery experience, and your long-term wellbeing. This blog explores each possibility in full.
Why the ovaries matter so much
The ovaries are the primary producers of oestrogen and progesterone in premenopausal women. They also produce testosterone, which plays roles in libido, energy, muscle mass, and cognitive function. These hormones are not merely reproductive — they influence bone density, cardiovascular health, brain function, skin integrity, urinary tract health, mood, and sleep. What happens to the ovaries during a hysterectomy determines the hormonal landscape of the entire recovery and the decades of health that follow.
This is why understanding exactly what happened to your ovaries — not just your uterus — is one of the most important pieces of post-surgical information a woman can have.
When both ovaries are removed: bilateral oophorectomy
If both ovaries are removed as part of or alongside a hysterectomy, and you had not yet reached natural menopause, you enter surgical menopause immediately. The hormonal drop is abrupt and complete — oestrogen, progesterone, and testosterone all fall sharply, often within hours of surgery.
The implications are significant. In the short term: hot flushes, night sweats, sleep disruption, mood changes, brain fog, joint pain, and vaginal dryness can begin within days. In the medium term: libido changes, fatigue, and cognitive shifts become apparent. In the long term: the risks of untreated surgical menopause extend to bone density, cardiovascular health, and cognitive function in ways that are well established in research.
If both ovaries were removed before the natural age of menopause, current guidelines from major menopause organisations recommend that HRT should be offered and discussed — not as an optional extra but as the clinically appropriate default, unless there is a specific contraindication such as certain hormone-sensitive cancers. If you have had bilateral oophorectomy and have not been offered or had a thorough discussion about HRT, please raise this with your GP or ask for a referral to a menopause specialist.
It is also important to know that testosterone is lost in bilateral oophorectomy — not just oestrogen. Testosterone replacement for women is increasingly recognised as an important component of post-surgical care, with specific benefits for libido, energy, and cognitive function. It is worth asking about specifically, as it is not always proactively offered.
When both ovaries are kept: bilateral ovarian conservation
If both ovaries are retained, you do not enter surgical menopause as a direct consequence of the hysterectomy. Your ovaries continue to produce oestrogen and progesterone, and you may not experience menopausal symptoms as a result of the surgery.
However, several nuances are worth understanding.
First, the surgery itself can temporarily disrupt blood supply to the ovaries — which are partly supplied by vessels that travel through the broad ligament, a structure altered during surgery. Some women experience transient hormonal changes in the weeks following hysterectomy even with both ovaries intact. In most cases, ovarian blood supply is restored and function normalises. In some cases, it does not fully recover.
Second, research consistently suggests that women who have had hysterectomies with ovaries retained reach natural menopause an average of one to four years earlier than women who have not had the surgery. The mechanism is not fully understood but may relate to the disruption of blood supply during surgery. This is worth knowing for the purposes of monitoring hormonal health in the years following surgery.
Third, because you no longer have periods after hysterectomy, the usual marker of the approach to menopause — changing cycle patterns — is absent. Hormone testing (FSH, LH, and oestradiol) and attention to symptoms become the primary ways to monitor where you are in the menopausal transition.
When one ovary is removed: unilateral oophorectomy
This scenario is perhaps the most complex and the most rarely explained clearly. If one ovary was removed and one remains, the remaining ovary continues to produce hormones — but it is doing so alone.
In most cases, a single functioning ovary is sufficient to maintain hormonal balance and prevent immediate menopause. The remaining ovary may actually compensate somewhat, producing more than it would have if both were present. Many women with one ovary have no significant hormonal symptoms and continue to cycle normally — though without periods, there is no cycle to observe.
However, research suggests that women with one ovary may reach natural menopause somewhat earlier than those with two. The remaining ovary is doing the work of two, and it has a finite supply of follicles. This is not a cause for alarm — but it is worth monitoring, and if hormonal symptoms emerge, they warrant investigation and potentially treatment.
Which ovary was removed also matters, to some extent. Studies suggest that removing the left ovary may have a slightly different impact than removing the right, due to differences in blood supply anatomy. This is not well-established enough to guide clinical decisions, but it is part of the emerging understanding of ovarian biology.
When the decision was made during surgery
In some cases, the status of the ovaries is determined not before surgery but during it — based on what the surgeon finds when they are inside. Ovaries that appear unexpectedly affected by disease, by endometriosis, by cysts, or by adhesions may be removed when pre-operatively the plan was to keep them. Conversely, ovaries that were planned for removal may be conserved if the surgical picture suggests it is safe to do so.
This can leave women waking from surgery without a clear understanding of what happened — and this communication gap is significant. If you are unsure what happened to your ovaries during surgery, your operative notes will specify. You are entitled to request and review these notes, and your GP can help you interpret them.
The preventive surgery question
For some women, ovarian removal is recommended as a risk-reduction measure — particularly for women with BRCA1 or BRCA2 gene mutations, which substantially increase the risk of ovarian cancer. In these cases, the decision to remove the ovaries is made prophylactically, as a deliberate intervention to reduce cancer risk rather than to treat current disease.
For women in this situation, the hormonal consequences of bilateral oophorectomy are still significant and still require management. The fact that the surgery was preventive does not make the experience of surgical menopause less real or the need for hormonal support less important. These women often benefit from specialist care that bridges oncological risk management and menopause medicine.
Questions worth asking about your ovaries — at any stage
Whether you are preparing for surgery or navigating recovery months later, these are the questions worth having answers to: Were both ovaries removed, one, or neither? If one was removed, which one and why? If both were retained, were there any concerns about blood supply or function during surgery? What hormonal changes should I watch for, and when? Should I be having hormone level testing, and how often? If I am experiencing symptoms, what treatment options are available to me?
If you cannot get clear answers from your GP, ask for a referral to a gynaecologist or a menopause specialist who can review your surgical notes and provide personalized guidance. Your ovaries — or their absence — are too important to your long-term health to leave as an unanswered question.
Ready to feel supported in your recovery?
Whether you still have your ovaries, lost one, or lost both — the Complete Comeback Program supports you in understanding your specific hormonal picture and what it means for your recovery and your long-term health. We help you ask the right questions, navigate the right support, and build a recovery that reflects your actual biology. That level of specificity is what good recovery looks like.