Hysterectomy With Both Fallopian Tubes Removed but Ovaries Kept: Do Hormones Change, Will Menopause Come Earlier, and How to Recover Well After Surgery

A common question in women’s health groups: the ovaries are still there, so what changes now?

A member of a women’s health group recently had surgery for a uterine fibroid with both fallopian tubes removed, while her surgeon kept both ovaries.
She wondered whether she would go into menopause, whether her hormones would change, and how to look after herself during recovery — questions many others in the group ask too.

First step: be clear which operation you had

1. With the ovaries kept, do hormones still work, and will menopause come earlier?

The ovaries keep making hormones and ovulating

The ovaries make estrogen and progesterone; the uterus and tubes do not.
With both ovaries kept, your body still gets sex hormones on its usual cycle. Eggs are still released each month and are harmlessly absorbed in the abdomen.
This is different from removing both ovaries, which brings on menopause within days.

But menopause may come earlier

• Moorman 2011
  followed women aged 30–47 (406 with hysterectomy, 465 without) for 5 years. The hysterectomy group had 1.92 times the risk of earlier ovarian failure —
  14.8% vs 8.0% within 4 years — and the risk was still 1.74 times higher in women who kept both ovaries.
• Farquhar 2005
  found that over 5 years, 20.6% of the hysterectomy group reached menopause vs 7.3% of the comparison group, and women with low pre-surgery FSH reached menopause about 3.7 years earlier.

Does removing the tubes as well make the ovaries decline faster?

A meta-analysis of 15 studies (Gelderblom 2022)
found no significant short-term drop in AMH, the hormone that reflects the remaining egg supply, after tube removal.
A Cochrane review (van Lieshout 2019)
of 7 randomized trials with 350 women also concluded that any hormonal effect is unlikely to be clinically important, but most data only cover 6 months.
Long-term effects in younger women still need more study.

Without periods, how will you know menopause is starting?

• Watch for symptoms instead of periods: hot flashes, night sweats, trouble sleeping, mood swings, palpitations and vaginal dryness
• FSH levels fluctuate around menopause, so a single test is hard to read; doctors usually look at symptoms too
• If symptoms start before age 40, see a doctor — premature ovarian insufficiency affects bones and heart and may need hormone therapy
• If you have menopause-like symptoms after surgery, read Hot flashes and insomnia after a hysterectomy with ovaries kept: causes and options

2. How much does removing both fallopian tubes lower ovarian cancer risk?

Why remove healthy tubes?

Pathology research shows that many high-grade serous ovarian cancers — the most common and aggressive type — start in cells at the far end of the fallopian tube,
then spread to the ovary and the lining of the abdomen. Removing the tubes during gynecologic surgery done for another reason is therefore a preventive step.
The ACOG Clinical Practice Update 2026
supports offering complete removal of both tubes during obstetric and gynecologic surgery, after explaining benefits and risks.

What the numbers show

• Falconer 2015
  used Swedish national data on 251,465 people who had surgery for benign reasons, compared with the general population. Tube removal was linked to lower ovarian cancer risk (HR 0.65),
  and removing both tubes to HR 0.35 — about 65% lower.
• Hanley 2022
  followed 25,889 people in British Columbia, Canada, who had their tubes removed with ovaries kept. No serous ovarian cancers were found where 5.27 were expected,
  though follow-up was still short (median 3.2 years).

Why surgeons usually keep healthy ovaries

The Nurses’ Health Study (Parker 2013)
followed 30,117 women who had a hysterectomy for benign disease for 28 years. All-cause death was 16.8% in women who had both ovaries removed vs 13.3% in those who kept them (HR 1.13).
Removing the ovaries lowered ovarian cancer deaths, but at no age did it improve survival, and it clearly raised risk in women under 50 who never used estrogen.
That is why removing the tubes while keeping the ovaries is an option many surgeons offer — lowering cancer risk without losing hormones.
Read more on this decision in Keep or remove the ovaries: ovarian conservation.

3. Recovery after surgery: a timeline by surgical route

The surgical route matters a lot

A Cochrane review (Pickett 2023) of 63 randomized trials with 6,811 women
found return to normal activities took about 22–25 days after laparoscopic hysterectomy versus about 37 days after open abdominal surgery,
and vaginal hysterectomy was also faster than open surgery.
A Dutch study (Bouwsma 2017)
also found recovery times varied widely between people, and most activities took longer than experts had advised — so try not to compare yourself with others.

Lifting: start light and build up

• In the first 2 weeks, lift only light items such as a handbag or a small water bottle; stop if the wound hurts or you feel pulling inside
• Avoid heavy straining or bracing — sit-ups, lifting heavy things from the floor, carrying older children — until your surgeon says it is fine
• When you cough or sneeze, press a pillow against the wound for support

Walk early to lower clot risk

Complications after hysterectomy (Clarke-Pearson 2013)
include infections of all types at about 9–13% and symptomatic blood clots at about 1%.
The ERAS 2019
guideline therefore stresses early walking, early eating and risk-based clot prevention. During the day, get up and walk every 1–2 hours and move your ankles often when sitting or lying for long periods.

Wound care

• Keep the wound clean and dry; shower as your hospital advises, then pat the wound dry
• No baths or swimming until the wound has fully closed and your doctor agrees
• Do not put creams, powders or herbal remedies on the wound yourself
• Mild bruising or numbness around the wound is common, but spreading redness, swelling, heat, pus or an opening wound needs a doctor

Prevent constipation so you do not strain

• Drink enough that your urine is pale yellow — about 1.5–2 liters a day for most people; ask your doctor first if you have heart or kidney disease
• Eat cooked vegetables, fruit such as ripe papaya, oranges and prunes, and whole grains, and walk often to keep the bowel moving
• Opioid pain medicines cause constipation; if you take one, ask your doctor or pharmacist about a laxative or stool softener alongside it

Sex and the vaginal cuff

When the uterus and cervix are removed, the top of the vagina is stitched closed and this wound needs time to heal.
Cuff separation is rare — about 0.39% overall — and more common after total laparoscopic hysterectomy (1.35%) than after open (0.15%) or vaginal (0.08%) hysterectomy
(Clarke-Pearson 2013).
A review by Uccella 2021
found no study directly comparing early with delayed return to sex, so avoiding sex for about 6 weeks or until your follow-up check is standard practice.

This table is a general guide by surgical route; individual advice may differ. On mobile it shows as cards.

Sources: summarized from Pickett 2023, Vonk Noordegraaf 2011, Bouwsma 2017 and Uccella 2021. Figures are approximate, not fixed rules.

4. Long-term effects to know about, beyond menopause

Periods and pregnancy

After a hysterectomy there are no more periods and pregnancy is not possible, even though the ovaries still release eggs. Cyclical symptoms such as breast tenderness or mood changes
may still occur because hormones still rise and fall on the usual cycle.

Do you still need cervical screening?

The USPSTF 2018
recommends against cervical screening in people whose uterus and cervix were removed and who have no history of high-grade lesions (CIN2 or worse) or cervical cancer.
If the cervix was kept, or you have had high-grade lesions, keep screening as scheduled. Ask for your operation summary and pathology report to plan this.

Heart and metabolic health

A Mayo Clinic study (Laughlin-Tommaso 2018)
followed 2,094 women who had a hysterectomy with ovaries kept for a median of 21.9 years and found a higher risk of coronary artery disease (HR 1.33),
plus small increases in high cholesterol, high blood pressure and obesity; women operated on at age 35 or younger had 2.5 times the coronary risk.
These are observational links and do not prove the surgery is the cause, but they are a good reason to check blood pressure, cholesterol and blood sugar yearly and to exercise regularly after recovery.

Mood and mental health

The same group (Laughlin-Tommaso 2020)
found small increases in depression (HR 1.26) and anxiety (HR 1.22) after hysterectomy even with ovaries kept, especially in women operated on at a younger age.
If low mood, loss of motivation or insomnia lasts more than 2 weeks, tell your doctor; if you have thoughts of self-harm, call a crisis line (1323 in Thailand).

5. Keeping the ovaries vs removing them too: what is different?

This table compares outcomes after hysterectomy with both tubes removed, with the ovaries kept versus removed as well. On mobile it shows as cards.

6. Which post-op symptoms are expected, and which need urgent care?

A first-step urgency guide only. If unsure, call the hospital where you had surgery. On mobile it shows as cards.

7. Is a yearly ultrasound needed, and what should women who still have a uterus do?

Fibroids are very common. An ultrasound study of women aged 35–49
(Baird 2003)
estimated that about 70–80% of women develop fibroids before age 50, and most have no symptoms.
ACOG guidance (Practice Bulletin No. 228)
focuses treatment on fibroids that cause symptoms; fibroids without symptoms can usually be watched.

What to do instead

• Keep up with pelvic checks and cervical screening on the recommended schedule
• See a doctor for symptoms: periods that are heavy or last more than 7 days, tiredness from anemia, worsening pelvic pain or period pain, frequent urination or constipation from pressure, or a lump you can feel in the lower abdomen
• Have an ultrasound when you have symptoms, when a doctor finds an enlarged uterus, or to follow a known fibroid as scheduled
• If several relatives have had ovarian or breast cancer, ask about a hereditary risk assessment

8. Popular beliefs: how accurate are they?

• “With the ovaries kept, hormones stay exactly the same” — menopause does not start immediately, but research shows it may come earlier; watch for symptoms
• “With the tubes removed, ovarian cancer cannot happen” — the risk drops by about 65%, but not to zero
• “Everyone must avoid lifting for exactly 8 weeks” — it depends on the surgical route and how you feel, and lying still for long periods raises clot risk
• “Douche to keep clean after surgery” — do not; it raises infection risk
• “Every woman should have a yearly ultrasound to prevent fibroids” — no international guideline recommends it without symptoms, and ultrasound does not prevent fibroids

Frequently Asked Questions (FAQ)

If the uterus and both tubes are removed but both ovaries are kept, will menopause start right away?

No. The ovaries keep making estrogen and progesterone. But a study following women aged 30–47 found that those who had a hysterectomy had about 1.92 times the risk of earlier ovarian failure (14.8% vs 8.0% within 4 years), and another study found menopause came about 3.7 years earlier than in women without surgery. In short, menopause does not start immediately, but it may come earlier.

Without periods, how will I know when menopause is starting?

Watch for symptoms instead of periods: hot flashes, night sweats, trouble sleeping, mood swings and vaginal dryness. If these persist, talk to your doctor. A single FSH test is hard to interpret because levels fluctuate. If symptoms start before age 40, see a doctor to check for premature ovarian insufficiency, which affects bone and heart health.

Why does removing both fallopian tubes lower ovarian cancer risk, and by how much?

Many aggressive serous ovarian cancers start in cells at the far end of the fallopian tube, not in the ovary itself. A Swedish nationwide study found that removing both tubes was linked to about 65% lower ovarian cancer risk (HR 0.35), and a Canadian study of 25,889 women found no serous cancers where 5.27 were expected. Still, the surgery lowers the risk but does not make it zero, because the ovaries and the lining of the abdomen remain.

How long is recovery after laparoscopic or open surgery, and when can I lift things?

Recovery time and lifting limits depend on the surgical route. A 2023 Cochrane review found people returned to normal activities about 22–25 days after laparoscopic hysterectomy versus about 37 days after open abdominal surgery. Fixed rules on how many kilograms for how many weeks mostly come from expert opinion rather than trials, so start with light items, build up gradually as pain allows, and follow your surgeon, especially after an abdominal incision.

When can I have sex or use tampons again?

After a total hysterectomy, the top of the vagina is stitched closed and needs time to heal. Most surgeons advise avoiding sex and tampons for about 6 weeks, or until a follow-up exam confirms healing. This is common practice, because no study has directly compared early with delayed resumption. Vaginal douching is not recommended, during recovery or afterwards.

Which symptoms after gynecologic surgery need urgent care?

Go to hospital right away for a fever of 38 °C (100.4 °F) or higher or chills, vaginal bleeding that soaks a pad within an hour, a sudden gush of clear fluid from the vagina or a feeling that something is coming out, very foul discharge, a red swollen wound with pus or a wound that opens, worsening abdominal pain with vomiting or no gas, being unable to pass urine, or a swollen painful leg on one side. For chest pain or shortness of breath, call emergency services.

Do I still need cervical cancer screening after a hysterectomy?

It depends on whether the cervix was removed and whether you have had high-grade changes. If the uterus and cervix were fully removed for reasons other than cancer or high-grade lesions (CIN2 or worse), the USPSTF recommends against further screening. If the cervix was kept, or you have had high-grade lesions or cancer, keep screening as your doctor advises. Keep a copy of your operation report and pathology results.

Should women aged 30–40 with no symptoms have a fibroid ultrasound every year?

No international guideline recommends yearly ultrasound for women without symptoms. Fibroids are very common; research estimates about 70–80% of women have them by age 50, and most need no treatment without symptoms. For ovarian cancer, the USPSTF recommends against ultrasound screening in women without symptoms or a known hereditary risk. Instead, keep up with pelvic checks and cervical screening, and see a doctor for heavy periods, pelvic pain, frequent urination from pressure, or a lump you can feel.

The science in brief

Summary by Asst. Prof. Dr. Norawit Raatpiboon:
the ovary gets blood from two sources — the ovarian artery, which branches from the aorta, and a branch connecting from the uterine artery.
Hysterectomy ties off that second branch, so one hypothesis is that reduced blood flow speeds up depletion of the remaining follicles, which could explain why menopause may come earlier even with the ovaries kept.
It is still unclear whether this is due to the surgery itself or to the condition that led to it.
In the tube, the lining cells at the far end sit right next to the ovary and are exposed to inflammatory fluid from ovulation every month; TP53 mutations are found in early lesions called STIC.
Removing the tubes therefore removes the tissue where many serous cancers begin.
As for wound healing, tissue lays down new collagen and gains strength over several weeks. Pressure inside the abdomen from straining, heavy lifting or impact at the vaginal cuff
is why activity should increase step by step, while early walking keeps venous blood moving and reduces the pooling that leads to clots.

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