The Hormone You Never Thought About, Until It Was Gone
- Jun 2
- 12 min read
Written by Joanne Pagett, Performance & Menopause Coach
Joanne Pagett is a Women’s Wellness Strategist and Mentor who empowers women to navigate the emotional, physical, and mental transitions of midlife. She helps them rediscover their energy, identity, and joy, and partners with organisations to create supportive, wellbeing-focused environments for women in the workplace.
I was in my mid-thirties when I had a full hysterectomy, which put me straight into surgical menopause. I did what I always do, I got on with it, kept performing, delivering, telling everyone, and more dangerously, I told myself I was fine. But I wasn’t fine.
I was lost, confused, and exhausted in a way I didn’t recognise, and sleep didn’t make a difference. I felt strangely disconnected from my own body, as though it had started speaking a language I no longer understood. I had a story running on a loop that said if I just pushed a little harder, I’d get back to myself: You’ll be back to yourself in no time; it was just surgery, an operation; you’ve had operations before.
How wrong could I be! That day never came from pushing on. It came when I finally stopped and started to understand what I had just gone through and what was happening inside my body. Surgical menopause is not, as I once assumed, simply “menopause, slightly early.” It is a different event altogether.
This article comes from the heart and is for a particular person: the one who has undergone surgical menopause while still, by every other measure, of fertile age. The reasons are plentiful:
Perhaps your ovaries were removed as part of cancer treatment or to reduce a known cancer risk. As mine was.
Maybe it followed years of severe endometriosis or large or recurrent fibroids that no other treatment had resolved.
The surgery was, very often, the right decision; it solved a serious problem. But it also created a second one, the one nobody wants to speak about, that almost nobody prepares you for. You’re capable, driven, successful, live life to the fullest, and deserve to understand exactly what has changed and why.
Why it lands so much harder
Natural menopause is a fade; it happens over years, starting in perimenopause, giving the body time to adjust to gradually shifting hormones. Surgical menopause is not like that; it is a switch. When both ovaries are removed, the body doesn’t gently taper off its hormones. It stops.
One specialist menopause clinic describes it plainly: “Instead of being gradually weaned off oestrogen and progesterone, the body goes cold turkey, and the withdrawal can be tough.” You can go to sleep before surgery with your menstrual cycle and wake up fully post-menopausal. There is no transition; there is only before and after.
This matters because of what it does: the hot flushes, broken sleep, mood swings, brain fog, joint pain, low libido, they tend to arrive all at once, and harder. The reassuring news is that there is a horizon: most women report that the intensity of the immediate symptoms stabilises within six to twelve months. But stabilises is not the same as resolves, and the deeper story lies beneath the symptoms.
Here is the part that does the quiet damage, rarely explained in advance.
Many women who face this surgery are usually given excellent clinical care for the problem being treated: the cancer, the endometriosis, the fibroids. Often, they are not given a clear, honest briefing on what removing their ovaries will do to the rest of their bodies, and for how long. They walk into the aftermath without a map, which is not their fault. It is a gap in preparation, not through their fault, but because it is lacking; this article exists to help close it.
Oestrogen was never just a “woman’s hormone”
Here is the piece almost nobody is told before surgery. Oestrogen is not “just” a hormone of fertility and flushes that becomes irrelevant once your family is complete. In my case, I didn’t have any children and never will. It is a hormone of infrastructure. It is woven into nearly every system in the body: skin, hair, vagus nerve, and the gut. Oestrogen acts directly on the vagus nerve, the vaginal and urinary tissues, and most importantly, the heart, brain, and bones. It protects the heart, fuels brain activity, and helps keep bones strong.
Remove the ovaries before the natural age of menopause, and you remove that protection early, years, sometimes decades before the body is expected to lose it. This is why the long-term consequences of early surgical menopause are taken seriously by gynaecologists and surgeons: research links early loss of ovarian hormones with adverse effects on cognition, mood, cardiovascular health, bone health, sexual health, and even an increased risk of early mortality when those lost hormones are not replaced.
"Oestrogen is not a comfort hormone. It is structural. Surgical menopause removes the scaffolding overnight."
That word overnight is the whole point. Any woman in natural menopause has years to adapt to these changes. When you’re in surgical menopause, it's all handed at once.
The part that surprises everyone: Strength
When thinking about menopause, muscle strength is rarely considered. All women should, and those who have had surgical menopause especially should.
From our mid-thirties, all women gradually lose muscle mass: a typical rate is around three to five percent per decade, which accelerates later in life. But oestrogen plays a direct, active role in how muscle is maintained and repaired. This is where the science becomes compelling.
Muscle has its own resident repair crew: tiny stem cells called satellite cells, which sit dormant in the muscle and spring into action to rebuild fibres after damage, whether by a workout, a stumble, or an injury. Oestrogen is one of the signals that keeps that repair crew healthy and ready.
In studies in which female mice had their ovaries removed, satellite cell populations declined sharply, and the leg muscles showed poor recovery of strength even after minor injury. When researchers disabled the oestrogen receptor entirely, satellite cell numbers dropped by 30 to 60% across different muscles, and the surviving cells struggled to reproduce. Crucially, treatment with oestradiol reversed it. Human studies matched the animal findings: in women, the population of muscle satellite cells dwindled sharply at menopause, in step with the fall in blood oestrogen.
"It is not only that you have less muscle; it is that the muscle you have repairs itself less readily."
What that means for a woman in surgical menopause is not simply that she has less muscle; it is that the muscle she does have has lost some of its capacity to repair and rebuild itself. Oestrogen deficiency reduces muscle mass and prevents full recovery of strength following injury.
Why recovery takes longer, and why that isn’t “just age”
This is the quiet frustration I hear repeatedly from the women I work with after surgical menopause:
The niggle that used to clear up in a week now lingers for a month.
The training session they could once shrug off leaves them sore for days. A small injury becomes a long recovery.
These women tend to blame themselves or simply assume this is what getting older feels like. It isn’t; it’s physiology. When oestrogen levels drop, the body's healing processes slow down: satellite cells take longer to respond, inflammation becomes harder to control, and recovery that once happened naturally now requires intentional support. The injury itself may be no bigger than before, but the repair budget is smaller.
Understanding this changes everything because it moves the problem from “something is wrong with me” to “my body is running a different operating system, and my strategy needs to catch up.”
Where HRT fits, and why it’s not optional symptom relief
If there is one fact any woman facing surgical menopause should carry into that consultation, it is this: for anyone whose ovaries have been removed before the natural age of menopause, Hormone Replacement Therapy is a different proposition entirely from the choice an older woman makes about managing hot flushes.
The guidance from menopause specialists is firm: if your ovaries are removed under the age of fifty-one, you should replace those lost hormones, at least up to the natural age of menopause, because you would still be producing them naturally were it not for the surgery.
As always, there are exceptions. HRT is not suitable for every woman; a history of certain hormone-sensitive cancers can change the picture, which is precisely why this belongs in an informed clinical conversation rather than a leaflet. But too many facing surgery still think of HRT after surgical menopause as an indulgence or something to be “brave” about going without. For a younger woman, that framing has the stakes the wrong way around.
This is not topping up a comfort. It is restoring something the body is still expected to have. There is also a specific note worth raising with your doctor: sexual function and desire are affected by ovary removal, particularly in younger women, so the role of testosterone, not only oestrogen, should be part of the conversation.
The gap between the guidance and the reality is striking. One recent study of women who had lost ovarian function early found that only around 36% were receiving hormone therapy, despite clear international guidance that they should be, and despite many already showing early signs of bone thinning. That is not a small shortfall; this is a great many women unprotected, often simply because no one sat them down and explained what was at stake.
"This isn’t about topping up a comfort. It’s about replacing something your body still expects to have."
The part nobody prepares you for: The psychological weight
Everything above is physical. But the hit of surgical menopause is rarely only physical, and this is often the part that does the most serious and lasting damage, precisely because it is the part nobody names or talks about face-on.
Let’s start with the genuinely physiological piece, because you need to hear this clearly. The low mood I felt after surgical menopause is neither weakness nor ingratitude. It hit me hard.
When oestrogen is withdrawn gradually, the brain has time to recalibrate. Prior to surgery, oestrogen played a direct role in the systems that regulate mood and influence the chemistry of neurotransmitters such as serotonin. These underpin how steady and resilient we feel, like ourselves.
When it is withdrawn overnight, I experienced something that is not “feeling a bit down” but genuine depression and anxiety, arriving suddenly, often overwhelmingly, in a way that I had never struggled with my mental health before.
Research links surgical menopause, particularly when it happens early, with higher rates of depression and anxiety. If that has been your experience, you were not failing to cope. Your brain was responding to a real and abrupt biochemical event.
"Low mood after surgical menopause is not weakness. It is a brain responding to an abrupt biochemical event."
Then there is the loss that has nothing to do with brain chemistry at all: the loss of identity, which hit me in a way I could never have imagined.
Being a woman who was still of fertile age, 36, surgical menopause closed a door that I wasn’t ready to walk away from. Despite being unable to conceive a child or never wanting children, there is something disconcerting in having the choice removed in a single morning. My fertility ended abruptly, not as a gradual expected transition but as a surgical fact. That deserves to be grieved, and now I see too many women in this position being told, or telling themselves, that they just must accept it. They don’t.
On top of this sits a stranger feeling: I felt like I had been fast-forwarded. I was in my mid-thirties and woke up from surgery into a completely different life stage, which I associated with being an old woman. I felt angry, angry that my body had put me in this position.
My body, symptoms, the language around me, all of it suddenly belongs to a chapter I did not expect to be at just yet. It is profoundly disorienting to feel out of step with your own age. I was only 36, not 66.
I was a high-achieving, career-focused woman, the type of woman this article is written for, who has one more layer. So much of how I progressed in life and the world was built on being capable, reliable, and strong both physically and mentally: the one who holds it together, the one others lean on.
Surgical menopause arrives and rearranges the ground beneath all of that. My ability to recall even simple things faltered, reliable energy waned, and the emotional steadiness I counted on faded. I didn’t just feel unwell; I felt like a stranger, and because my competence was so much a part of who I was, that estrangement cuts deeper than any single symptom.
So why is none of this talked about?
If the psychological impact is this significant, the obvious question is: why isn’t this talked about, or worse, why is it so rarely supported? There are several reasons, and they compound one another.
The first is the reason why the surgery is necessary. Surgical menopause is almost always the solution to something serious: a cancer, a cancer risk, years of debilitating endometriosis, or fibroids that had taken over a woman’s life. The surgery is, rightly, presented as good news: the problem is dealt with. But that framing leaves no room for the aftermath. Following my surgery, I struggled for months afterwards. I was left feeling that to speak up is to be ungrateful, as though sadness is a betrayal of the surgeon who helped me. So I stayed quiet and tried to find out what was happening to me, made more difficult because this was before the Internet became widespread.
The second is that at that time, menopause was still somewhat of a taboo subject, and personally, I feel it is still under-discussed, early menopause even more so. The cultural conversation, where it exists, is built around women in their early fifties. Women who go through this at 36 or 43 find almost nothing that reflects their experience. These women are not just unsupported; they are uncatalogued.
The third is the cruellest. I had grown, almost by definition, good at appearing fine. I was high-functioning, still delivering. From the outside, nothing looked wrong, and so nothing prompted anyone to ask. The very competence that defined me became the thing that kept me hidden. I accepted it because I didn’t want to worry my partner, friends, or family, alarm my colleagues, or become a source of concern. I just carried on, and the depletion stayed hidden. That invisible suffering is lonely in a way that is hard to describe to anyone who has not felt it.
I want to say something plainly to anyone reading this who recognises themselves here. The silence around the psychological side of surgical menopause is not evidence that your experience is rare, unreasonable, or yours alone to carry quietly. It is simply evidence of a conversation that society isn’t brave enough to hold, or hasn't had, or hasn't had loudly enough. Naming it is not a weakness; it is how it stops being something you just have to endure alone or put up with.
What I want you to take from this
If you are reading this in the thick of it, I know the statistics can frighten. So let me be just as clear about the other half of the picture, because it is every bit as true.
Surgical menopause raises the stakes, but it does not remove the levers. The decline in muscle and strength is real, but it can be rebuilt. I went on to be a fitness bodybuilding athlete in my late 40s, but it is also, to a significant degree, a use-it-or-lose-it process.
Those who lose the most are consistently the women doing the least to counter it:
Strength is buildable at any age.
Recovery can be actively supported.
HRT, where appropriate, can restore much of what was lost.
The six-to-twelve-month horizon is real, and understanding your physiology properly, without the fog of half-information, is itself the first act of taking your power back.
This is why I do not call myself a wellness coach. I work in performance because that is the honest frame for what is possible here. Surgical menopause is not the end of the most capable and strongest years. With the right knowledge and the right strategy, it can be the start of the most deliberate, best-informed chapter of your life.
I say this with confidence and experience, as I have walked exactly this path. I am not standing on the other side shouting advice down. I know precisely what the ground feels like under your feet, and I also know what is on the other side of it.
If you are facing surgical menopause or finding your way through its aftermath, I want you to know that the disorientation you may be feeling is not a failure of resilience. It is an entirely reasonable response to a significant physiological event, one that, until now, very few people thought to explain properly.
You do not have to navigate it in the dark, and you do not have to navigate it alone. If anything here has put words to something you have been carrying quietly, I would simply love for you to come and find me at my website, or wherever this article found you. Sometimes the most useful thing in the world is simply knowing that another woman gets it.
Read more from Joanne Pagett
Joanne Pagett, Performance & Menopause Coach
Joanne Pagett is a Multi-Award-Winning Performance & Menopause Coach, ICF-certified Life Coach, NLP Practitioner, and founder of the StrongHer FAB Method. She works with women in business and female founders navigating perimenopause, helping them restore their optimal performance and sense of self without the drama. She also partners with organisations to build meaningful workplace menopause strategies ahead of incoming legislation. Joanne knows this territory because she has lived it. Based in Leicestershire, she shares her home with a Ragdoll, a Mainecoon, and a husband, in no particular order of chaos.
References:
Muscle loss 3-5% per decade – Harvard Health Publishing. After age 30, you begin to lose as much as 3% to 5% per decade.
Collins, Lowe et al., Cell Reports (2019) – oestrogen and muscle satellite cells. This is the satellite cell study. Oestrogen deficiency severely compromises the maintenance of muscle stem cells (satellite cells) and impairs self-renewal and differentiation into muscle fibres. Note the human side is described by the authors as "early data" from a biopsy study of women transitioning from peri- to post-menopause. PubMed.
The Menopause Society (Jan 2026) – HRT underused in POI. The 36% figure is confirmed: of women with POI, only 36% received hormone therapy.
This article is general information and not a substitute for individual medical advice.
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