I kept my ovaries with the hysterectomy but they cut the blood supply so they would gradually but more rapidly than usual, die. Normally I would have had the ovaries taken but my sensitivity to hormonal changes was known before surgery and they were afraid that removing the ovaries or trying HRT would lead to "catastrophe". I had had a Mirena IUD in and the tiny bit of hormones from it had made me very unstable and very dangerous to myself (and when it was removed things improved for the first time since it was placed, within a few days). Birth control pills caused problems and any steroid causes mania (even my inhaler for asthma does to the point that I just am a little wheezy but only use the steroid if I'm sick or having allergies and I've also reacted to topical steroids in a gel that increased absorption) so HRT was out because it would have made things much worse. I'm not sure how I would have felt about it anyway; knowing how my body has responded to declining hormones I can't imagine replacing them but I had no way of knowing this until we tried it. My gyn surgeon thought that this might happen because I was so much better without the Mirena hormones but there was no way of knowing and apparently there is a sad lack of research on women with bipolar and menopause/responses to drastic hormone shifts/early menopause/etc. I was the first person that my surgeon or pdoc had known to react to the Mirena that way but once I did and it was clearly that they started finding more people with the same reaction almost immediately. I think they may be working on a paper about that. But it is still unusual enough that my blog post about it is one of the most read ones I ever wrote as others find themselves in the same situation.