Do you have normal menstrual cycles after an oophorectomy (removal of one or both ovaries)?

Menstrual Cycles After Oophorectomy

After a bilateral oophorectomy (removal of both ovaries), normal menstrual cycles will completely cease, resulting in surgical menopause with permanent and immediate hormonal changes. 1

Effects of Bilateral Oophorectomy

• Bilateral oophorectomy causes surgical menopause, with hormonal changes occurring acutely rather than progressively over 5-10 years as in natural menopause 1
• Signs of estrogen deficiency appear suddenly and are permanent after this surgery 1
• Plasma estradiol levels drop dramatically (by approximately 78% compared to pre-menopausal levels) within 3 months after surgery 2
• FSH levels increase significantly (approximately 14 times the preoperative value) and remain elevated, unlike after natural menopause where they may decline with age 2

Effects of Unilateral Oophorectomy

• Women with a single ovary (either congenital or after unilateral oophorectomy) have normal potential to conceive, either naturally or through in vitro fertilization (IVF) 3
• However, these women should expect a shorter reproductive period compared to women with both ovaries 3
• Surprisingly, some studies suggest that unilateral oophorectomy may maintain more normal ovarian activity as estimated by menstrual regularity compared to ovarian salvage procedures 4
• In one study, continuation of regular menses after surgery was higher in the oophorectomy group (70%) compared to the ovarian salvage group (15%) 4

Ovarian Function After Partial Oophorectomy

• Research in primate models has shown that even with removal of approximately 95% of visible ovarian tissue, normal menstrual cyclicity can be maintained 5
• After near-total oophorectomy in primates, there was an acute elevation of FSH and LH lasting approximately 11 days, followed by resumption of normal menstrual cycles 5
• This suggests that a very small amount of remaining functional ovarian tissue may be sufficient to maintain normal hormonal cycling 5

Long-term Considerations

• Women who undergo bilateral oophorectomy commonly experience symptoms including:

  • Depression (62% of patients in one study) 2
  • Insomnia (48% of patients) 2
  • Loss of libido (46% of patients) 2
  • Dyspareunia (38% of patients) 2
  • Vasomotor symptoms like hot flashes (initially in 94% of patients, with 60% experiencing relief within 6 months) 2

• After bilateral oophorectomy, quality of life may decrease over time, with significant increases in sinonasal symptoms and other quality of life measures observed over a one-year follow-up period 1

Clinical Implications

• For cancer survivors with a single ovary (after unilateral oophorectomy), regular assessment of menstrual cycles, sexual function, and Tanner stage is recommended until sexual maturity 3
• Baseline LH, FSH, and estradiol levels should be assessed at age 13 years in these patients 3
• For sexually mature patients who have undergone oophorectomy, evaluation should include menstrual and pregnancy history and history of sexual difficulties or changes 3
• Women with abnormal hormone levels or symptoms of ovarian dysfunction should be referred to an endocrinologist or gynecologist 3