Over the last 40 years or so, there has been a significant rise in the number of women in the western world who have had their ovaries surgically removed prior to the age of natural menopause. The vast majority of these women were undergoing hysterectomy at the time, usually for a benign gynaecological condition such as menstrual dysfunction. Gynaecologists advised women to have their ovaries removed contemporaneously to eliminate the risk of future ovarian cancer. Many of these women received no counselling about the implications of having their ovaries prematurely removed and how they might feel thereafter. Many subsequently wished they could set the clock back as they experienced a very abrupt onset of vasomotor symptoms, mood change, lack of energy and loss of libido. There were instances of litigation in the UK as women realized that they had not given their informed consent to have this procedure performed. Data from the Mayo Clinic Cohort Study on Oophorectomy and Ageing add a new dimension to this debate. This study has demonstrated trends of increased mortality, cardiovascular disease, cognitive impairment, Parkinsonism and osteoporosis in women following bilateral oophorectomy prior to the age of natural menopause compared with a referent group from the same population in Minnesota. While the data lack the robustness of a randomized trial, they strongly suggest that premature lack of estrogen is detrimental to long-term health and estrogen replacement is beneficial. The study encompassed a 38-year follow-up of women from a population-based sample and as stated by Shuster et al. 1 in the review in this edition of Menopause International, has the potential ‘to guide decision-making for or against prophylactic bilateral oophorectomy before the age of natural menopause’. Women with a personal history of breast cancer or with a strong family history of breast or ovarian cancer are a small but increasing group who may clearly benefit from early oophorectomy to improve their prognosis. They may or may not be the carriers of known genetic mutations and will receive expert guidance from familial cancer specialists. However, it is likely that they will have very little counselling to prepare themselves for life following premature removal of their ovaries and they may be consigned to a markedly poorer quality of life in the future. Many of these women will be discouraged from taking hormone replacement because of their history although the limited evidence that exists suggests that replacement of estrogen does not abrogate the beneficial effect of oophorectomy on breast cancer prognosis. These are often young women with partners and small children who may be at the peak of their lives as home-makers or working professionals. They deserve every opportunity to understand both the shortand long-term benefits and risks of early oophorectomy. Fortunately, there is now an increasing trend that these women are referred to specialist menopause services before surgery, where they can be fully appraised of the consequences and given the best possible advice on hormone replacement. The recent data from the Mayo Clinic Cohort Study help clinicians working in this field to counsel any woman who is considering or has undergone premature surgical oophorectomy.