What Really Happens to Your Hormones After a Hysterectomy?| Amy Brenner, MD & Associates

What happens to your hormones after a hysterectomy mostly depends on age at the time of surgery and what you had removed during your hysterectomy. If your ovaries remain, they usually continue producing estrogen, progesterone, and testosterone, although some women experience an earlier decline in ovarian function, and often the ovaries don’t continue functioning as they did prior to surgery. Your uterus and ovaries share a blood supply. When the uterus is removed, the blood supply is disrupted, and the ovarian function can start to decline.

A prospective cohort study found women who had a hysterectomy with ovaries kept had nearly a doubled increased risk of ovarian failure within 5 years. The bottom line is keeping your ovaries doesn’t guarantee they’ll work perfectly. The surgery itself creates a hormonal ripple effect.

If both ovaries are removed (bilateral oophorectomy), hormone production drops abruptly, causing surgical menopause and often immediate menopausal symptoms. A study found that women who had a hysterectomy with both ovaries removed had testosterone levels 40-50% lower than women with intact ovaries. This gap persisted all the way through ages 50-89 years old. Even women who kept their ovaries, but lost their uterus had 29% lower levels of testosterone.

Why does testosterone matter? It’s a hormone that assists with energy, libido, muscle mass, mood, bone strength, and more!

One of the most common questions patients ask before or after a hysterectomy is: “Will my hormones be affected?”

It’s an understandable concern. Many women worry about hot flashes, weight gain, mood changes, fatigue, low libido, brain fog, or whether they’ll need Bio-Identical Hormone Replacement Therapy (BHRT).

The answer isn’t the same for everyone because there are several different types of hysterectomy, and not everyone has the same health outcomes. The research does show, for most of the risks and symptoms associated with hormonal decline, hormone replacement therapy can bring them back to down to normal.

What Most Patients Experience

From a provider’s perspective, patients generally fall into two groups.

If Your Ovaries Are Removed

Bilateral salpingo-oophorectomy (BSO) means both ovaries and fallopian tubes are removed.

BSO causes instant surgical menopause. Estrogen, progesterone, and testosterone drop rapidly. Unlike natural menopause, which develops gradually over several years, surgical menopause occurs almost overnight. Because hormone levels fall suddenly, symptoms are often more noticeable.

Common symptoms of menopause or hormonal decline include:

Hot flashes
Night sweats
Vaginal dryness
Mood changes
Sleep disturbances
Brain fog
Reduced libido
Joint aches
Skin and hair changes
Increased risk of osteoporosis or bone fractures

Some of these symptoms can begin within days after surgery. Several factors influence how your body responds after a hysterectomy.

Your Age

A woman who undergoes surgery at age 35 will generally experience hormone changes differently than someone who is already approaching natural menopause.

Earlier loss of hormones is associated with increased long-term risks for:

Osteoporosis
Cardiovascular disease
Cognitive decline in some patients (such as dementia)

These risks should be discussed individually with a qualified healthcare provider to determine what is best and if hormone replacement therapy could benefit you.

What Our Providers Want Patients to Know

One of the biggest misconceptions is: a hysterectomy does not automatically mean your hormones disappear.

The ovaries, not the uterus, produce most reproductive hormones prior to menopause. However, even when ovaries remain, hormones are affected.

Many patients are surprised that they can still experience hormonal cycles after a hysterectomy if their ovaries remain, even though they no longer have menstrual bleeding.

If symptoms develop after surgery, providers evaluate:

Age
Symptoms
Surgical history
Medical history
Family history
Whether the ovaries were preserved
Whether hormone therapy is appropriate

For many generally healthy women who undergo surgical menopause at a younger age, menopausal hormone therapy may be recommended to reduce symptoms and help protect bone and cardiovascular health until the average age of natural menopause, unless contraindications exist. Treatment decisions should be individualized and discussed with a medical provider.

Risks or Considerations When Considering a Hysterectomy with Removal of Ovaries

A 2024 systematic review found that removal of both ovaries was associated with significantly higher risks across multiple body systems:

Heart and Vascular:

18% higher risk of total cardiovascular disease
17% higher risk of coronary heart disease
20% higher risk of stroke

Metabolic (especially under the age of 50):

44% higher risk of high cholesterol
16% higher risk of diabetes
13% higher risk of hypertension

Brain and Neurological:

70% higher risk of dementia, especially in women over 50
Increased risk of Parkinson’s disease

Mental Health:

39% higher risk of depression

Bone Health:

Estrogen deficiency can cause bone density loss and increased fracture risk

Mortality per Canadian study with 200,000+ women:

Women under 45 who had BSO had a 31% higher risk of all cause mortality
Women ages 45-49 had a 16% higher risk
Women over 50 did not show the same increased mortality risk

What the American College of Obstetrics and Gynecology (ACOG) Officially Says Today

Perimenopausal average-risk women should strongly consider retaining the ovaries
Postmenopausal women — removal of the ovaries can be considered at the time of the hysterectomy
BRCA mutation carriers — risk reducing removal of ovaries is recommended
ACOG supports opportunistic salpingectomy, the surgical removal of fallopian tubes, as the preferred cancer risk-reduction strategy for average risk women

Replacing Hormones Brings Your Risks Back to Baseline

While the statistics mentioned when having a hysterectomy or BSO sound alarming, the research shows that for most of these risks, hormone replacement therapy can bring them back to normal.

Hormone Replacement Therapy is NOT about adding extra hormones — it’s about replacing what was surgically taken away after a hysterectomy. The Endocrine Society and ACOG strongly recommend HRT after premenopausal surgical menopause.

Depending on a patient’s medical history, hormone therapy may require more monitoring or may not be recommended for individuals with certain conditions, including:

Certain hormone-sensitive cancers
Active liver disease
History of blood clots or stroke (depending on formulation and individual risk)
Certain cardiovascular conditions

These decisions require evaluation by a qualified healthcare professional. One of the biggest reasons women have concerns surrounding HRT is due to the fear of breast cancer. The data shows that estrogen-only therapy after ovary removal is associated with lower breast cancer risk, not higher. A 2026 meta-analysis found a 22% reduction in breast cancer risk with estrogen only HRT after ovary removal.

Final Takeaway

A hysterectomy does not always automatically change your hormones. There are many factors that can contribute. Women who keep their ovaries often continue producing hormones and may not experience immediate menopause, while removal of both ovaries leads to a sudden drop in estrogen and progesterone, causing surgical menopause. If you’re experiencing symptoms after surgery, a personalized evaluation can help determine whether hormone therapy or other treatments are appropriate for your situation.

Listen to Dr. Amy Brenner on our recent podcast to learn more about the correlation between Hysterectomies and Menopause.

Schedule a Gynecology visit today with one of our medical providers to discuss Hysterectomy or Hormone Replacement Therapy options.

What Really Happens to Your Hormones After a Hysterectomy?