If you’re at high risk for ovarian cancer, you may be thinking about reducing that risk by having your ovaries removed – what’s known as a preventative bilateral salpingo-oophorectomy (BSO) (which means the removal of both fallopian tubes and ovaries). No matter what your age, this is a highly personal decision.
The benefits and risks of an oophorectomy are certainly not one-size-fits-all. If you’re considering this procedure, either during perimenopause or after menopause, it may help to reduce the chances of a cancer diagnosis. However, there are side effects that accompany ovary removal before or after menopause that may occur and that you should be aware of.
Here we’ll discuss the pros and cons of an oophorectomy and go into more detail about the reasons why your healthcare provider may recommend it as an option to consider.
What is an Oophorectomy?
An oophorectomy is a surgical procedure that is done to remove one or both ovaries. It’s conducted for a variety of reasons, more commonly to remove ovarian cysts, abscesses, or tumors, but also to address a twisted ovary (torsion), or to reduce the risk of or to treat ovarian cancer.1
When an oophorectomy is elective, it’s designed to reduce the possibility of a cancer diagnosis, rather than treating an existing disease. While there are benefits of undergoing this procedure, there are some side effects from removing ovaries after menopause to know of, which we’ll discuss a bit later.
The ovaries are the female body’s main source of estrogen. Before menopause, most of our body’s estrogen comes from the ovaries. After menopause, the ovaries continue to produce a smaller amount of estrogen, as well as a small amount of androgens, or male hormones, such as androstenedione, and testosterone (with the majority of these male hormones being made in the adrenal gland). These androgens get converted into estrone, a weak form of estrogen, in fat, muscle, and skin.2 No matter what your age, an oophorectomy reduces the impact, both positive and negative, of estrogen in the body.
Does Having an Oophorectomy Differ from a Hysterectomy After Menopause?
An elective oophorectomy is sometimes recommended for postmenopausal women who are also undergoing a hysterectomy for benign conditions, including fibroids, prolapsed uterus, or pelvic pain.3 This is conducted to simplify the process so that both procedures can be done during the same surgery.4 Additionally these surgeries may be done together to further mitigate cancer risk – the decision to retain the ovaries in these cases is done on an individualized, case-by-case basis.
The reasons for these procedures vary. Unlike an oophorectomy, which is done to remove the ovaries, a hysterectomy is done to remove the uterus and sometimes, the cervix. Hysterectomies are also done to treat certain cancers of the female reproductive organs, such as endometrial or uterine cancer, as well as to address other non-cancerous issues such as uterine fibroids, endometriosis, or chronic pelvic pain.5
Reasons for Getting an Oophorectomy
Despite advancements in cancer research, there is currently no reliable screening test for ovarian cancer. This condition is typically asymptomatic until it’s in its later stages, meaning earlier stages often have vague symptoms. So, ovarian cancer is often discovered late when treatments may be less effective. For this reason, if you are at a high risk for ovarian cancer, your healthcare provider may recommend an oophorectomy. This procedure also reduces the risk of breast cancer in women with certain BRCA gene mutations.6
Additionally, as mentioned earlier, women who are dealing with ovarian cysts, which can lead to ovary pain after menopause or before, may also benefit from this procedure.
Oophorectomy in Postmenopausal Women
Aging is an unavoidable risk factor for many conditions in life, including ovarian cancer and breast cancer. In fact, according to the American Cancer Society, most ovarian cancers develop after menopause.7 To be clear, being postmenopausal does not mean you are at a high risk for ovarian cancer – and, of course, getting older doesn’t mean you will automatically get this or any other type of cancer.
To determine your risk level, your healthcare provider will ask about your lifestyle, health history, and family health history. If you’ve already had cancer or have a family history of ovarian or breast cancer, your provider will likely recommend additional genetic testing.
Anomalies in the BRCA1 or BRCA2 gene can indicate an increased risk for both ovarian and breast cancer.8 Inherited cancer syndromes, like Lynch syndrome, a form of hereditary colorectal cancer, may also increase your risk, and can be identified during genetic testing.9
Other ovarian cancer risk factors include:10
- Being overweight or obesity
- Taking hormone therapy after menopause
- Having your first full-term pregnancy after age 35
- Never carrying a pregnancy to term
You and your healthcare provider should plan to discuss the combination of all your risk factors, to determine if having an oophorectomy makes sense for you.
Oophorectomy in Premenopausal Women
As mentioned, mitigating cancer risk is not the only reason why an oophorectomy may be recommended by your healthcare provider. In perimenopausal and younger women, certain conditions that affect the ovaries may also warrant consideration of this procedure.
Conditions potentially treated with oophorectomy include:11
- Ovarian torsion (twisting of an ovary on its stalk which results in compromised blood flow)
- Endometriosis within one or both ovaries or fallopian tubes
- Benign (non-cancerous) ovarian cysts or tumors
- Tubo-ovarian abscess (pus pocket affecting an ovary and fallopian tube)
If you’re interested in getting pregnant, keep in mind that removing your ovaries will eliminate the possibility of conception without specific medical interventions. These include freezing your eggs prior to the procedure or using eggs from a donor.
What Are the Types of Oophorectomy Procedures?
It’s important to know that there are several different kinds of oophorectomy surgeries. Each type requires general anesthesia, although not every kind requires a hospital stay. You and your healthcare provider can determine which procedure will best serve your individualized needs and health goals.
Specific oophorectomy procedures include:12
- Bilateral oophorectomy – removal of both ovaries
- Unilateral oophorectomy – removal of one ovary
- Salpingo-oophorectomy – removal of one ovary and one fallopian tube (on the same side)
- Bilateral salpingo-oophorectomy – removal of both ovaries and both fallopian tubes
- Unilateral salpingo-oophorectomy – removal of a fallopian tube and ovary on the same side
If you’ve spoken in-depth with your healthcare provider, and it’s been decided that an oophorectomy makes sense for you, your surgeon may recommend that the procedure be done laparoscopically. For this minimally invasive procedure, several small incisions will be made in the lower abdomen. Surgical tools, operated with or without robotic assistance, and a tube with a tiny camera will be used to view and remove the ovaries through the incisions.12
In some instances, women may need a laparotomy instead. This type of surgery is done through one longer abdominal incision, rather than several small ones.13
The type of surgery needed will be determined by multiple factors, including reasons for the procedure, a patient’s age, and overall health as well as surgeon experience and preference. Recovery time will depend upon the extent of the surgery needed. Additionally, surgeons may recommend that you curtail activities like lifting heavy objects, driving, exercising, and sex, for two to six weeks after the surgery is complete.
Pros and Cons of Removing Ovaries After Menopause
Considering any type of surgery takes thought, planning, and knowledge. If you’re at high risk for ovarian or breast cancer due to genetic anomalies, having an elective oophorectomy may save you from the rigors of dealing with a cancer diagnosis and/or the anxiety of undergoing regular screening surveillance. This procedure may even save your life. For many women, this is a huge positive.
Oophorectomies do reduce the rate of ovarian cancer occurrence across all age groups. In premenopausal women with BRCA mutations, having a bilateral salpingo-oophorectomy (a removal of both ovaries and both fallopian tubes) has been found in studies to reduce risk by 98%.14 In pre- and postmenopausal women with BRCA mutations, oophorectomies have also been shown to significantly reduce the occurrence of breast cancer.15
Many theorize that certain ovarian cancers actually originate in the fallopian tubes.16 Some women, who are at high risk for ovarian cancer, but who are not yet in menopause, will undergo a bilateral salpingectomy (removal of fallopian tubes) for cancer risk reduction. This lowers cancer risk while still maintaining natural estrogen production to protect bone health. Others who have not gone through menopause, may undergo a bilateral salpingectomy oophorectomy and add back estrogen.17, 18
There are, however, potential downsides. It’s important to note that estrogen has protective benefits, which will be reduced or eliminated once you have an oophorectomy.
If you undergo this procedure prior to menopause, you will immediately go into menopause. Vasomotor symptoms, like hot flashes and night sweats, as well as other menopausal symptoms, like vaginal dryness, are likely to occur. Since estrogen is heart-protective, your risk for cardiovascular disease can also increase.19 This can be minimized, however, by living a healthy lifestyle that includes exercise, a heart-healthy diet, and stress reduction.
Other potential side effects of ovary removal after menopause may include:20
- Osteoporosis and hip fracture
- Reduced sexual desire
- “Brain fog” (reduced cognition)
- Depression and anxiety
Questions to Ask Your Healthcare Provider About Removing Ovaries After Menopause
Much of life can’t be predicted, but decisions about your health and well-being are still yours to make. There is no right or wrong answer to whether you should have an oophorectomy. There is only the answer that makes the most sense for you. To help you decide, consider asking your healthcare provider or surgeon these questions:
- Why are you recommending this procedure to me?
- How often do you perform elective oophorectomy?
- What type of oophorectomy do you think I should have, and why?
- What are the potential risks of this surgery?
- What will my recovery be like?
- How long will recuperation take?
- What are my chances of getting or not getting ovarian or breast cancer after having this procedure?
- How can I maintain a healthy lifestyle that reduces cardiovascular risk?
- Are there alternatives to oophorectomy that may be a better choice for me?
- Should I have a hysterectomy as well as an oophorectomy?
Equipping yourself with the right information can help you and your provider make the decision that’s best for your individualized needs.