Oophorectomy





Definition

Unilateral oophorectomy (also called an ovariectomy) is the surgical removal of an ovary. If one ovary is removed, a woman may continue to menstruate and have children. If both ovaries are removed, a procedure called a bilateral oophorectomy, menstruation stops and a woman loses the ability to have children.


Purpose

Oophorectomy is performed to:

  • remove cancerous ovaries
  • remove the source of estrogen that stimulates some cancers
  • remove a large ovarian cyst
  • excise an abscess
  • treat endometriosis

In an oophorectomy, one or a portion of one ovary may be removed or both ovaries may be removed. When an oophorectomy is done to treat ovarian cancer or other spreading cancers, both ovaries are removed (called a bilateral oophorectomy). Removal of the ovaries and fallopian tubes is performed in about one-third of hysterectomies (surgical removal of the uterus), often to reduce the risk of ovarian cancer.

Oophorectomies are sometimes performed on premenopausal women who have estrogen-sensitive breast cancer in an effort to remove the main source of estrogen from their bodies. This procedure has become less common than it was in the 1990s. Today, chemotherapy drugs are available that alter the production of estrogen and tamoxifen blocks any of the effects any remaining estrogen may have on cancer cells.

Until the 1980s, women over age 40 having hysterectomies routinely had healthy ovaries and fallopian tubes removed at the same time. This operation is called a bilateral salpingo-oophorectomy . Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs. Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years.

In the 1990s, the thinking about routine oophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than 1%. Meanwhile, removing the ovaries increases the risk of cardiovascular disease and accelerates osteoporosis unless a woman takes prescribed hormone replacements.

Under certain circumstances, oophorectomy may still be the treatment of choice to prevent breast and ovarian cancer in certain high-risk women. A study done at the University of Pennsylvania and released in 2000 showed that healthy women who carried the BRCA1 or BRCA2 genetic mutations that pre-disposed them to breast cancer had their risk of breast cancer drop from 80% to 19% when their ovaries were removed before age 40. Women between the ages of 40 and 50 showed less risk reduction, and there was no significant reduction of breast cancer risk in women over age 50. A 2002 study showed that five years after being identified as carrying BRCA1 or BRCA2 genetic mutations, 94% of women who had received a bilateral salpingo-oophorectomy were cancer-free, compared to 79% of women who had not received surgery.

The value of ovary removal in preventing both breast and ovarian cancer has been documented. However, there are disagreements within the medical community about when and at what age this treatment should be offered. Preventative oophorectomy, also called prophylactic oophorectomy, is not always covered by insurance. One study conducted in 2000 at the University of California at San Francisco found that only 20% of insurers paid for preventive bilateral oophorectomy (PBO). Another 25% had a policy against paying for the operation, and the remaining 55% said that they would decide about payment on an individual basis.


Demographics

Overall, ovarian cancer accounts for only 4% of all cancers in women. But the lifetime risk for developing ovarian cancer in women who have mutations in BRCA1 is significantly increased over the general population and may cause an ovarian cancer risk of 30% by age 60. For women at increased risk, oophorectomy may be considered after the age of 35 if childbearing is complete.

Other factors that increase a woman's risk of developing ovarian cancer include age (most ovarian cancers occur after menopause), the number of menstrual periods a woman has had (affected by age of onset, pregnancy, breastfeeding, and oral contraceptive use), history of breast cancer, diet, and family history. The incidence of ovarian cancer is highest among Native American (17.5 cases per 100,000 population), white (15.8 per 100,000), Vietnamese (13.8 per 100,000), white Hispanic (12.1 per 100,000), and Hawaiian (11.8 per 100,000) women; it is lowest among Korean (7.0 per 100,000) and Chinese (9.3 per 100,000) women. African American women have an ovarian cancer incidence of 10.2 per 100,000 population.


Description

Oophorectomy is done under general or regional anesthesia. It is often performed through the same type of incision, either vertical or horizontal, as an abdominal hysterectomy . Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity. After the incision is made, the abdominal muscles are stretched apart, not cut, so that the surgeon can see the ovaries. Then the ovaries, and often the fallopian tubes, are removed.

Oophorectomy can sometimes be done with a laparoscopic procedure. With this surgery, a tube containing a tiny lens and light source is inserted through a small incision in the navel. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor. When the ovaries are detached, they are removed though a small incision at the top of the vagina. The ovaries can also be cut into smaller sections and removed.

The advantages of abdominal incision are that the ovaries can be removed even if a woman has many adhesions from previous surgery. The surgeon gets a good view of the abdominal cavity and can check the surrounding tissue for disease. A vertical abdominal incision is mandatory if cancer is suspected. The disadvantages are that bleeding is more likely to be a complication of this type of operation. The operation is more painful than a laparoscopic operation and the recovery period is longer. A woman can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities.


Diagnosis/Preparation

Before surgery, the doctor will order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman's condition. The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. A colon preparation may be done, if extensive surgery is anticipated.

On the evening before the operation, the woman should eat a light dinner, then take nothing by mouth, including water or other liquids, after midnight.


Aftercare

After surgery a woman will feel discomfort. The degree of discomfort varies and is generally greatest with abdominal incisions, because the abdominal muscles must be stretched out of the way so that the surgeon can reach the ovaries. In order to minimize the risk of postoperative infection, antibiotics will be given.

When both ovaries are removed, women who do not have cancer are started on hormone replacement therapy to ease the symptoms of menopause that occur because estrogen produced by the ovaries is no longer present. If even part of one ovary remains, it will produce enough estrogen that a woman will continue to menstruate, unless her uterus was removed in a hysterectomy. To help offset the higher risks of heart and bone disease after loss of the ovaries, women should get plenty of exercise , maintain a low-fat diet, and ensure intake of calcium is adequate.

Return to normal activities takes anywhere from two to six weeks, depending on the type of surgery. When women have cancer, chemotherapy or radiation are often given in addition to surgery. Some women have emotional trauma following an oophorectomy, and can benefit from counseling and support groups.


Risks

Oophorectomy is a relatively safe operation, although, like all major surgery, it does carry some risks. These include unanticipated reaction to anesthesia, internal bleeding, blood clots, accidental damage to other organs, and post-surgery infection.

Complications after an oophorectomy include changes in sex drive, hot flashes, and other symptoms of menopause if both ovaries are removed. Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for cardiovascular disease and osteoporosis. Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation.

Complications may arise if the surgeon finds that cancer has spread to other places in the abdomen. If the cancer cannot be removed by surgery, it must be treated with chemotherapy and radiation.


Normal results

If the surgery is successful, the ovaries will be removed without complication, and the underlying problem resolved. In the case of cancer, all the cancer will be removed. A woman will become infertile following a bilateral oophorectomy.


Morbidity and mortality rates

Studies have shown that the complication rate following oophorectomy is essentially the same as that following hysterectomy. The rate of complications associated with hysterectomy differs by the procedure performed. Abdominal hysterectomy is associated with a higher rate of complications (9.3%), while the overall complication rate for vaginal hysterectomy is 5.3%, and 3.6% for laparoscopic vaginal hysterectomy. The risk of death is about one in every 1,000 women having a hysterectomy. The rates of some of the more commonly reported complications are:

  • excessive bleeding (hemorrhaging): 1.8–3.4%
  • fever or infection: 0.8–4.0%
  • accidental injury to another organ or structure: 1.5–1.8%

Because of the cessation of hormone production that occurs with a bilateral oophorectomy, women who lose both ovaries also prematurely lose the protection these hormones provide against heart disease and osteoporosis. Women who have undergone bilateral oophorectomy are seven times more likely to develop coronary heart disease and much more likely to develop bone problems at an early age than are premenopausal women whose ovaries are intact.


Alternatives

Depending on the specific condition that warrants an oophorectomy, it may be possible to modify the surgery so at least a portion of one ovary remains, allowing the woman to avoid early menopause. In the case of prophylactic oophorectomy, drugs such as tamoxifen may be administered to block the effects that estrogen may have on cancer cells.


Resources

PERIODICALS

Kauff, N. D., J. M. Satagopan, M. E. Robson, et al. "Risk-Reducing Salpingo-oophorectomy in Women With a BRC1 or BRC2 Mutation." New England Journal of Medicine 346 (May 23, 2002): 1609–15.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345. http://www.cancer.org .

American College of Obstetricians and Gynecologists. 409 12th St., SW, PO Box 96920, Washington, DC 20090-6920. http://www.acog.org .

Cancer Information Service, National Cancer Institute. Building 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800) 4-CANCER. http://www.nci.nih.gov/cancerinfo/index.html .

OTHER

"Ovarian Cancer: Detailed Guide." American Cancer Society. October 20, 2000 [cited March 14, 2003]. <http://www.cancer.org/downloads/CRI/CRC_-_OVARIAN_CANCER.pdf� 3E; .

"Prophylactic Oophorectomy." American College of Obstetricians and Gynecologists. September 7, 1999 [cited March 14, 2003]. <http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZON HKUJC&sub_cat=9> .

"Removing Ovaries Lowers Risk for Women at High Risk of Breast, Ovarian Cancer." ACS News Today November 8, 2000. [cited May 13, 2003]. http://www.cancer.org .

Surveillance, Epidemiology, and End Results. "Racial/Ethnic Patterns of Cancer in the United States: Ovary." National Cancer Institute. 1996 [cited March 14, 2003]. http://seer.cancer.gov/publications/ethnicity/ovary.pdf .


Tish Davidson, A.M.
Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Oophorectomies are usually performed in a hospital operating room by a gynecologist, a medical doctor who has completed specialized training in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics.

QUESTIONS TO ASK THE DOCTOR


  • Why is a oophorectomy being recommended?
  • How will the procedure be performed?
  • Will I have a remaining ovary (or portion of ovary)?
  • What alternatives to oophorectomy are available to me?


User Contributions:

Tina DiScalfani
Report this comment as inappropriate
Mar 29, 2008 @ 6:06 am
Why would a doctor remove the ovaries on someone who's breast cancer had already spread to her bones? Why not remove the cancerous tumor from it's original site, then start her on hormone therapy?

Thank you
Vines Garcia
Report this comment as inappropriate
Nov 14, 2008 @ 10:10 am
what exercises is recommended 6 months after the operation?, can i take fat eliminator pills( ortistat?)
Report this comment as inappropriate
Oct 15, 2010 @ 3:15 pm
Very informative reading into Oophorectomy. I had bleeding from the uterus on April 21 and it subsided 11 days later. I saw my family doctor, who suggested I go and see a Obstetrics & Gynecologist on June 15 and he thought it was thickening of the lining of the uterus or polyps that had burst and suggested I have a biopsy. This was taken and sent to the lab. and the report came back ok. However 4 months later on Aug. 22 the bleeding from the uterus started again and back I went to my obstetrician, who recommended I have a D&C and Hysteroscopy done on Sept. 20. The report again came back from the Lab. as being inconclusive and was not 100% and the obstetrician said the uterus could possibly be pre-cancerous and suggested I have a hysterectomy done on Nov. 2.
I have read your reports regarding the risks involved and health issues and I am really concerned about this op. when the lab. report from the D&C and Hysteroscopy is not 100% sure that it could be pre-cancerous.
Could you possibly give me your opinion and feedback regarding this, or should I arrange here for a second and third opinion before going ahead.
Report this comment as inappropriate
Nov 10, 2010 @ 3:03 am
I had a salpingo oophorectomy done on my left ovary which had to be removed because of an 8.3x7.8cm cyst. This was done end July 2010 via incision and all went well. However, I am now experiencing bad pain on my right side. I had a scan done this week and the diagnostician found nothing. My gynae told me that I am possibly growing cysts on the right side now which are bursting and causing the pain. I am only 19 years old and am now worried that I may lose both ovaries. I live in Zimbabwe so it is difficult to get a second opinion. Please help.
Report this comment as inappropriate
Jan 27, 2011 @ 1:13 pm
I am 61 years old. I have bilateral ovarian cysts that have increase in size over the past few years. I am scheduled for a bilateral oophorectomy. Is it suggested that I speak to the gynecologist about removing my uterus at the time of the bilateral oophorectomy?

Thank you in advance for your assistance with this matter.
Report this comment as inappropriate
Aug 18, 2011 @ 9:21 pm
Is it normal too bleed within 7 days of a unilateral oophorectomy? I also had several cysts blasted off the other ovary, and endomitrial cells cleaned out of the same tube as the oophorectomy. My normal period is a week and a half away. Was my cycle changed due to the surgery?
Mrs.Neelam Narayanan
Report this comment as inappropriate
Sep 4, 2011 @ 9:09 am
Dear Sir,

I am running with 41 yrs and got married only 39 yrs, due to issueless problem, thru laprascopic surgery recently i got operated for tube cleaning and also they performed D&C. After surgery i feeled blood flow on my S Part for a day only and no flow of blood for next 2 days, it was stopped and after 28 days again i feel blood for a day only. B4 operation i am not faced this type of problem, i felt for 3 days. Why i am facing this , i am deeply worrying. Pl. respond whether it will be normal in coming days or not , and also is there any problem for getting conceiveness or pregenacy? Pl. respond.

regards,

Mrs.Neelam N
jill
Report this comment as inappropriate
Dec 7, 2011 @ 9:21 pm
I'm 44 and scheduled for a bilateral oophorectamy. I'm brca2 positive and have a family history of breast cancer. So the surgery is preventative. I am in very good shape naturally, don't exercise too much and eat pretty much what I want and have been told I look younger than I am. I'm afraid removal of my ovaries will age me faster, I will gain weight and lose my feminine features. Is any of this true?
jill
Report this comment as inappropriate
Dec 8, 2011 @ 7:07 am
I'm 44 and scheduled for a bilateral oophorectamy. I'm brca2 positive and have a family history of breast cancer. So the surgery is preventative. I am in very good shape naturally, don't exercise too much and eat pretty much what I want and have been told I look younger than I am. I'm afraid removal of my ovaries will age me faster, I will gain weight and lose my feminine features. Is any of this true?
amoulee
Report this comment as inappropriate
Jan 14, 2012 @ 6:06 am
I'm 62 and have just had a bilateral oophorectomy due to the presence of a tumour, which is benign.
Do I need to take any hormones?
Janemercy
Report this comment as inappropriate
Jan 20, 2012 @ 3:03 am
I am 41,mother of 20year old.I derperately want a child.Had ectopic pregnany in 2000.Left tube was removed ,still not conceived.Had surgery on 2-6-2011,and myomectomy + Right tuboplasty and Right oopherectomy perfomed.Please,is it possible to conceive with only left ovary and Right tube?
Joan
Report this comment as inappropriate
Feb 15, 2012 @ 2:14 pm
I am 48yrs old (will be 49 in Oct), no children. Overall health good. I am 5"4' 134 lbs. On synthroid & birth control pills for apprx 10-15 yrs. Since Aug 2010 free fluid has been found in my abdomen by routine transvaginal ultrasound. In Nov 2011, I had pain & swelling in abdomen. CAT scan & ultrasound showed inflammation around colon. In Dec 2011 a paracentesis removed apprx 35cc of fluid which was diagnosed as normal,no malignacy. In Feb 2012 ultrasound showed a small to moderate amount of fluid in same area. Per OBGYN & Internist all organs are normal. Blood tests showed CRP,ESR & platelet count high in past but now very low, almost normal. CA125 normal. I do not have celiac disease or rhuematoid arthritis. I do not drink or smoke. I am of Jewish descent. My mother died at age 81 due to ovarian cancer. To date, the pain & swelling in abdomen is gone. I feel very well. I am scheduled next month for my first colonoscopy & endoscopy to rule out any digestive problems. My question is, should I have a bilateral oomphorectomy as a preventive measure against ovarian cancer? Should I consider having a total hystorectomy at this stage in my life? Or just keep monitoring the situation with blood test & ultrasounds? I do not have endometriosis, PID or any ob/gyn issues. I am having another blood test & transvaginal ultrasound in 3 months to monitor free fluid in abdomen. My internist says surveillance does not work against ovarian cancer. I look forward to your response. Thank you.
Aparna
Report this comment as inappropriate
Apr 2, 2012 @ 11:11 am
I am 25 yrs old. I had 2 miscarriage. My doctor done Pelvic ultrasound. The Reports are normal. will my Dr. do Diagonal Hysteroscopy to find out the reasons of 2 miscarriage? Please tell me?
julia shaw
Report this comment as inappropriate
Oct 18, 2012 @ 7:19 pm
im 42 been trying for a baby for 3 years had eptopic 15 years ago removel ov tube...just had overie removed 2 weeks ago so i have 1 overie on 1 side and 1 tube on the other side can i still get pregnant? also will i need to go on hormone replacement please help
brenda
Report this comment as inappropriate
Oct 24, 2012 @ 6:06 am
I am 17 years old only when I had an operation on my ovary...( salphingo oophorectomy [Right])... It was my mom who talked to the doctor... He said to my mom that both of my ovaries should be remove... Cause my left ovary bleeds... She pleases him to do some way so I can still have one ovary... But, I'm so confused that after a month, I still menstruate... Is it possible that only one ovary is removed??? Even it was written on my medical certificate that my left ovary has cyst??
Please I'm just confused and it bothers me... Thank you!
Report this comment as inappropriate
Mar 26, 2013 @ 11:11 am
Hello, I'm 31 yrs old and about a month ago found out that I have a cyst on my left ovary, I'm scheduled for an unilateral salpingo oophorectomy (laporatomy)
Tomorrow. I have been on google since I found out trying my best to search for answers. My main questions are, number one, How bad is the pain, is it worse than childbirth?What is the recovery time? I live on the second floor(no elevator) how hard will it be to climb these steps after my operation? How hard is it to get out of bed, and take a shower? I didn't know where to look, then I found this page. I'm scared to death, I don't know what to expect, any answers would be greatly appreciated! Thank you.
Tena
Report this comment as inappropriate
Apr 8, 2013 @ 12:00 am
I'm 50, had bilateral salpingo oophorectomy 5 1/2 yrs ago because of chronic painful periods and family history of ovarian cancer. I have not had any issues with the surgery other then going into menopause. Last November I started bleeding, had a 6 week period. Dr. Took me off progesterone. Period stopped. Then started again after 3 wks later. Put me back on progesterone. Ok here's the question...no problems for 5 1/2 yrs. now periods every other week, no libido weight gain, and very very fraustrated. Anyone else ever have this?
Report this comment as inappropriate
Jun 19, 2013 @ 8:08 am
My mom (56years old woman)still had Tumour of Low Malignant Potencial after surgery and her surgery or Operation date was Note : 06/03/13 RT Ovarian Esystic mas was removed and the result was "

1. it`s a Granulosa Cell Tumour Of Ovaries Figo(tinxmx) or THE LOW MALIGNENT TUMUOR
2. Simple Endometral Hyperlasia
3.Lermyoma Uter
4.Normal Cervix
I want the need of the result of the stage to determined the kind of medecine that will be suitable for her and pls she sweating at night or hot flashes (feeling cold and hot )!!! please i need help as soon as posible ?
JANET
Report this comment as inappropriate
Dec 13, 2013 @ 1:01 am
HI HOPE YOU CAN HELP I HAD BOTH OVARIES / FALLOPIAN TUBES REMOVED THREE AND A HALF YEARS AGO DUE TO LARGE PRE CANCEROUS CYSTS . ALL WENT WELL WITH OP I WAS TOLD THAT I WOUD NO LONGER HAVE PERIODS . BUT THEY RETURNED AND I WAS BLEEDING ON A DAILY BASIS . I WAS REFERED TO GYN AND WAS ASKED TO GO ON ZOLODEX INJECTIONS ? I REFUSED AS I FELT CHEATED AND WANTED MY WOMB REMOVING . I WAS SENT TO SEE A CONSULTANT BUT NEVER GOT THERE AS MY HUSBAND DIDNT WANT ME TO UNDER GO ANOTHER OP DUE TO HEALTH PROBLEMS . A FEW MONTHS LATER THE BLEEDING DID STOP BUT AS RETURNED OVER THE LAST SIX MONTHS . I WENT TO VISIT A GP WHO SENT ME FOR A SCAN . BUT WHILST WAITING FOR THE SCAN HAD TO RETURN TO SEE A GP AS THE BLEEDING WAS GETTING ME DOWN THAT WAS THREE MONTHS AGO HE PUT ME ON THEZOLODEX INJECTIONS AND SAID THEY WOULD HELP . THE BLEEDING CONTINUES AND I HAD THE SCAN THREE DAYS AGO IT REVEALED THE LINING OF MY WOMB WAS VERY THICK AND ALSO A MASS ? I WAS ASKED TO WAIT OUTSIDE SO THEY COULD CONTACT A CONULTANT BUT NO ONE WAS ON CALL . I WAS ASKED TO GO HOME AND WAIT FOR THE RESULT TO GO TO MY GP . I AM OUT OF MY MIND WITH WORRY CAN ANYONE HELP ?

Comment about this article, ask questions, or add new information about this topic:

CAPTCHA


Oophorectomy forum