Premature surgical menopause is becoming increasingly common in the setting of both benign and malignant disease. These women are at an increased risk of all-cause and cardiovascular mortality, cognitive dysfunction and metabolic bone disease. We present the case of a 28-year-old woman with premature surgical menopause due to bilateral oophorectomy, following ovarian torsion occurring on two separate occasions, one episode during her second trimester of pregnancy. The decision regarding hormone replacement therapy in this lady was complicated due to the presence of Factor V Leiden heterozygosity. A brief discussion and review of the literature follow.