Oophorectomy for Ovarian Cancer Prevention

Oophorectomy is a surgery to remove one or both ovaries. The ovaries are small organs that make eggs and hormones like estrogen and progesterone. This surgery can help prevent ovarian cancer and might be recommended for people at high risk.

What is a prophylactic oophorectomy?

When an oophorectomy is done to prevent cancer, it is called a prophylactic oophorectomy. In these cases, there’s no evidence of cancer. However, because of a person’s risk of developing cancer in the future, the ovaries are removed to lower that risk. 

How does oophorectomy help prevent cancer?

Ovarian cancer usually starts in the ovaries. Removing the ovaries with an oophorectomy can often prevent ovarian cancer.

Removing the ovaries can also lower your risk of breast cancer. This is because the ovaries produce estrogen and progesterone, which can help fuel the growth of certain breast cancers. Removing the ovaries lowers the levels of these hormones.

When might an oophorectomy be recommended?

To help prevent cancer, an oophorectomy might be recommended for people who have a high chance of getting the ovarian cancer. You might be at higher risk if you have:

• The BRCA1 or BRCA2 gene mutations
• Lynch syndrome
• A strong family history of ovarian or breast cancer

For people with these high-risk features, doctors often recommend oophorectomy between ages 35 and 45, depending on the person’s cancer risk and family plans.

Benefits of oophorectomy for cancer prevention

Having an oophorectomy can:

• Reduce the risk of ovarian cancer
• Reduce the risk of breast cancer (for people at high-risk)
• Remove early-stage cancer before it is found
• Remove the need for frequent ovarian cancer screening, which is not always reliable

Can I still get ovarian cancer if I have an oophorectomy?

Removing the ovaries can prevent most ovarian cancers. However, it is still possible to develop ovarian cancer after the surgery.

• Some ovarian cancers start in the fallopian tubes. To lower the risk as much as possible, the fallopian tubes are often removed along with the ovaries.
• In rare cases, small amounts of ovarian cells may remain after surgery. Cancer may start in these cells.

What are the different types of oophorectomy?

There are different types of oophorectomy, depending on whether 1 or both ovaries are removed, and whether other organs are removed along with the ovaries.

• Unilateral oophorectomy: Only 1 ovary is removed.
• Bilateral oophorectomy: Both ovaries are removed.
• Salpingo-oophorectomy: 1 or both ovaries are removed along with the fallopian tubes.

For cancer prevention, salpingo-oophorectomy is most often used. This is because many ovarian cancers start in the fallopian tubes. Removing both ovaries and the fallopian tubes is more effective for preventing cancer.

Side effects of oophorectomy

Oophorectomy is an effective way to prevent ovarian cancer in women at high risk. However, it can cause serious side effects. Some side effects may happen right after surgery, while others may happen later.

Infertility

• If both ovaries are removed, pregnancy is not possible without using donor eggs or eggs that were collected and stored before the surgery. If this is a concern, talk to your health care team about fertility preservation options before having a bilateral oophorectomy.
• If only one ovary is removed (unilateral oophorectomy), pregnancy is still possible because the remaining ovary can release eggs.

Early menopause

If the oophorectomy is done before natural menopause, it can bring on sudden menopause. This can lead to:

• Hormonal changes
• Hot flashes
• Mood swings
• Trouble sleeping
• Vaginal dryness

In some cases, hormone replacement therapy (HRT) may help balance hormones and ease symptoms.

Other effects of hormone changes

• Mood changes: Some people experience significant mood changes, such as depression or anxiety after an oophorectomy. Support from family, friends, or a counselor can help.
• Bone health: Estrogen helps protect bones, so removing the ovaries can increase your risk of osteoporosis (weak bones).
• Heart health: Estrogen also supports heart health, so removing the ovaries can increase your risk of heart disease.

What to ask your doctor

If you are considering oophorectomy, ask these questions to help make an informed decision:

• What are my risks for ovarian cancer?
• Am I also at risk for breast cancer?
• What are my options other than surgery?
• What are the potential long-term effects?
• Should I consider fertility preservation before surgery?