Oophorectomy Surgery: What You Need to Know

June 6, 2024

Oophorectomy Surgery: What You Need to Know

Facing ovarian cancer is a daunting experience, but understanding your treatment options can help you feel more empowered. One of the most common surgical procedures for ovarian cancer is oophorectomy surgery, which involves removing one or both ovaries. 

In this comprehensive guide, we’ll dive deep into what oophorectomy is, how it’s performed, and what to expect during recovery. We’ll also explore the impact on fertility and menopause, potential side effects and risks, and life after surgery. 

What is Oophorectomy? 

Oophorectomy is the surgical removal of one or both ovaries. The ovaries are small, almond-shaped organs on either side of the uterus that produce eggs and hormones like estrogen and progesterone. When only one ovary is removed, it’s called a unilateral oophorectomy. When both ovaries are removed, it’s known as a bilateral oophorectomy.

Oophorectomy may be recommended for several reasons:

  • As part of treatment for ovarian cancer: Removing the affected ovary or ovaries can help stop the spread of cancer.
  • To prevent ovarian cancer in high-risk individuals: Those with certain genetic mutations like BRCA1 and BRCA2 have a much higher lifetime risk. Prophylactic oophorectomy can significantly reduce that risk.
  • To treat other conditions: Oophorectomy may be used for endometriosis, large or painful ovarian cysts, or other gynecologic disorders.

Understanding Oophorectomy Surgery

During oophorectomy surgery, the patient is put under general anesthesia. The surgeon makes an incision in the abdomen, either vertically from the belly button to the pubic bone or horizontally along the bikini line. They carefully separate the ovary and its blood supply from the surrounding tissue. The surgery typically takes 1-4 hours, depending on whether it’s performed alone or with other procedures.

There are two main surgical approaches to oophorectomy:

  • Open surgery (laparotomy): The surgeon makes a 5-7 inch incision to access the ovaries directly. This allows them to see the organs clearly and remove larger masses. Open surgery has a longer recovery time but may be necessary for advanced cancer.
  • Minimally invasive surgery (laparoscopy): The surgeon makes a few small incisions (about 1/2 inch each) and inserts a thin, lighted scope with a camera (laparoscope). Specialized instruments are used to detach and remove the ovary through the small incisions or the vagina. Because it’s less invasive, laparoscopy typically means less pain, lower infection risk, and a faster recovery.

Is Oophorectomy Considered a Major Surgery? 

Generally, yes. Any procedure involving general anesthesia and organ removal is significant. However, the extensiveness can vary. A laparoscopic oophorectomy removing only the ovaries may have a quicker recovery than open surgery that also removes the uterus and other organs.

In many cases, oophorectomy is combined with salpingectomy: removing the fallopian tubes. The fallopian tubes carry eggs from the ovaries to the uterus. Research suggests that many of the most common types of epithelial ovarian cancers actually start in the ends of the fallopian tubes. Removing the tubes along with the ovaries, a process known as salpingo-oophorectomy is increasingly common, especially for those at high risk.

When both ovaries and both fallopian tubes are removed, it’s called a bilateral salpingo-oophorectomy (BSO). For those at high risk of ovarian cancer due to BRCA mutations, BSO can lower the risk of ovarian cancer by 85 to 95% and the risk of breast cancer by 50 to 60%.

Sometimes, oophorectomy is done alongside ovarian cancer hysterectomy (surgical removal of the uterus). This may be recommended for those with gynecologic cancers or disorders affecting multiple pelvic organs. 

Preparing for Oophorectomy Surgery

Before scheduling an oophorectomy, you’ll have a comprehensive evaluation with your gynecologic oncologist. This may include:

  • Physical exam
  • Pelvic exam
  • Imaging tests like ultrasound, CT or MRI 
  • Blood tests like CA-125 (a tumor marker)
  • Genetic testing for BRCA or other ovarian cancer mutations

Your doctor will also review your medical history, medications, and any allergies. Be sure to disclose all supplements and herbs, as some may affect bleeding risk.

If you hope to have children in the future, talk to your doctor about options for preserving fertility before surgery. Depending on your age and cancer type/stage, you may be able to freeze eggs, embryos, or ovarian tissue. A reproductive endocrinologist can guide you through the process. 

As you prepare for surgery, your doctor will give you specific instructions, which may include:

  • Stop taking blood thinners, NSAIDs, and certain other medications 7 to 10 days before
  • Don’t eat or drink anything after midnight the night before
  • Shower with a special antiseptic soap the morning of surgery
  • Have someone available to drive you home and stay with you for the first 24 hours

Remember, it’s normal to feel anxious or overwhelmed when facing surgery. But know that you’re in skilled and compassionate hands. Your healthcare team is there to guide you through every step of the process and ensure your safety and comfort. Don’t hesitate to voice your concerns or ask for the support you need: whether that’s additional information, a pre-surgery counseling session, or a hand to hold on the day of the procedure. You are not alone in this journey.

Recovering from Oophorectomy

Immediately after surgery, you’ll be taken to a recovery area to wake up from anesthesia. Nurses will monitor your vital signs and pain levels closely. You may have some nausea, grogginess, and discomfort, which can be managed with medications.

Most people stay in the hospital for 1 to 2 days after an oophorectomy. During this time, your healthcare team will help you start moving around and encourage you to do breathing exercises to prevent complications like blood clots or pneumonia.

Before you’re discharged, your doctor or nurse will review instructions for recovery at home:

  • Caring for your incision (keeping it clean and dry)
  • Pain management (prescription and over-the-counter medications)
  • Activity restrictions (no heavy lifting, strenuous exercise, or sex for several weeks)
  • Signs of complications to watch for (excess bleeding, fever, worsening pain)
  • Schedule for follow-up appointments 

Recovery time varies, but most people can return to desk jobs within 2 to 4 weeks. It may be 4 to 6 weeks before you can resume more physical work and activities. Your doctor will advise you based on your specific procedure and progress.

Even after the initial healing, you may have some longer-term adjustments:

  • Early menopause symptoms like hot flashes and vaginal dryness
  • Increased risks of osteoporosis and heart disease 
  • Emotional changes like depression, anxiety, or grief
  • Body image concerns or changes in sexual function

Your healthcare team can recommend treatments and strategies to manage these issues. Depending on your individual situation and the type of cancer treatment you received, you may benefit from counseling, support groups, or pelvic floor physical therapy. In some cases, hormonal therapies may be an option, but it’s important to note that many women cannot have additional estrogen after cancer treatment due to the potential risks. Don’t hesitate to seek help; you deserve to feel your best.

Impact on Fertility and Menstruation

Oophorectomy’s impact on fertility depends on several factors, including whether one or both ovaries are removed, your age, and your overall health.

If only one ovary is removed, the remaining ovary may still produce eggs and hormones to support a pregnancy. However, your fertility may be reduced. According to research, women who had a single ovary removed before age 35 had a 7.9% chance of early menopause, compared to 1.1% of those with both ovaries.

If both ovaries are removed (bilateral oophorectomy), you’ll no longer produce eggs and will experience surgical menopause. This means you cannot get pregnant naturally. However, if your uterus remains, you may be able to carry a pregnancy using in-vitro fertilization (IVF) with donor eggs.

Even if you keep your uterus and one ovary, you may still notice menstrual changes after oophorectomy. Periods may become irregular or stop altogether due to hormonal shifts. 

If you hope to expand your family after oophorectomy, talk to your doctor about fertility preservation options before surgery. Techniques like egg or embryo freezing have made it possible for many cancer survivors to build their families.

Side Effects and Risks of Oophorectomy

While oophorectomy is generally a safe and effective procedure, all surgeries carry some risks. Potential complications include:

  • Bleeding or blood clots
  • Infection 
  • Damage to nearby organs like the bladder, uterus, or bowel
  • Adverse reactions to anesthesia

These complications are relatively rare, occurring in less than 10% of cases. Your surgical team will closely monitor you and take precautions to reduce these risks.

More commonly, women face side effects related to the loss of ovarian hormones, especially if both ovaries are removed before natural menopause. These may include:

  • Hot flashes and night sweats
  • Vaginal dryness or discomfort 
  • Sleep disturbances or insomnia
  • Mood changes like irritability, anxiety, or depression
  • Cognitive changes or “brain fog”
  • Decreased libido or sexual response

Additionally, the loss of estrogen can increase your risk of certain long-term health issues:

  • Osteoporosis and fractures
  • Heart disease 
  • Stroke
  • Cognitive decline or dementia
  • Parkinsonism 

Low estrogen levels can start to impact bone density within the first year after oophorectomy. Women who have oophorectomy before age 45 are also at increased risk of multimorbidity (multiple chronic health conditions), particularly if they don’t receive appropriate hormone therapy.

The decision to use hormone replacement therapy (HRT) after oophorectomy is complex and should be made on an individual basis in consultation with your healthcare provider. For women without a history of ovarian cancer or high-risk genetic mutations, HRT can help relieve menopausal symptoms and protect against bone loss and heart disease, especially when started before age 45.

However, for women with a history of estrogen-sensitive cancers like some types of ovarian cancer, the safety of HRT is controversial. In these cases, the potential risks of HRT, such as stimulating cancer growth or recurrence, must be carefully weighed against the benefits. The decision to use HRT should be based on factors such as the type and stage of ovarian cancer, age, and other individual risk factors.

Similarly, for women with BRCA mutations who undergo risk-reducing salpingo-oophorectomy (RRSO), the use of HRT until the natural age of menopause is generally considered safe and is often recommended to mitigate the adverse effects of premature menopause. However, even in this population, the decision to use HRT should be individualized based on personal risk factors and preferences.

Ultimately, the choice to use HRT after oophorectomy is a personal one that should be made in close collaboration with your healthcare team. They can help you assess your unique risks and benefits and develop a plan that prioritizes your long-term health and quality of life.

Managing Side Effects and Risks of Oophorectomy Surgery

Healthy lifestyle choices can support your long-term health after oophorectomy. Aim for:

  • A balanced diet rich in calcium, vitamin D, and other nutrients for bone and heart health
  • Regular weight-bearing exercise to maintain bone strength and muscle mass
  • Stress management techniques like meditation, deep breathing, or yoga
  • Avoiding smoking and limiting alcohol intake
  • Staying up to date on health screenings and vaccinations

Life After Oophorectomy

The emotional impact of oophorectomy can be significant. You may feel a sense of loss, especially if you didn’t complete your family before surgery. You might grieve the sudden change in life stage or worry about your health and sexuality. These feelings are valid and deserve attention and support.

Some women report positive changes after oophorectomy, like relief from chronic pain or peace of mind about ovarian cancer risk. Still, adjusting to surgical menopause and an altered sense of self can take time. Don’t expect to bounce back overnight. Healing is a journey.

Prioritizing self-care can help you navigate the challenges. Surround yourself with loving friends and family who understand what you’re going through. Consider joining a support group for women after oophorectomy or ovarian cancer. Seek counseling if you’re struggling with depression, anxiety, or sexual issues. And don’t forget to make time for activities that bring you joy and relaxation.

Life Expectancy After Oophorectomy

One common concern after oophorectomy is life expectancy. In general, ovarian cancer patients who have oophorectomy tend to have better survival rates than those who don’t. The earlier the cancer is caught, the better the prognosis. For stage 1 ovarian cancer, the 5-year survival rate is 93%. For advanced stages, survival rates are lower but still improving with new treatments.

Of course, every woman’s situation is unique. Your individual life expectancy depends on factors like cancer stage and grade, age, overall health, and genetics. Your doctor can give you a better idea of what to expect based on your personal circumstances.

Even if you haven’t been diagnosed with ovarian cancer, oophorectomy might impact your lifespan. One study found that women who had both ovaries removed before age 45 had a 67% higher risk of all-cause mortality than those who kept their ovaries, unless they used HRT. Additional research found a link between oophorectomy and increased risk of heart disease, especially for those under 35 at the time of surgery.

These studies underscore the importance of preserving ovaries when possible and carefully weighing the benefits and risks of oophorectomy. Adjusting to life after this surgery can be challenging, both physically and emotionally. But with time, self-compassion, and the right support, many women find a renewed sense of strength, resilience, and purpose. 

Remember that healing is not a linear process. There may be good days and hard days, triumphs and setbacks. Be patient with yourself and celebrate each milestone along the way. And know that there is a vibrant community of survivors, advocates, and healthcare professionals ready to uplift and encourage you. You have the power within you to thrive after oophorectomy, and a world of resources to help you do just that.

Making Decisions About Oophorectomy Surgery

If you’re considering oophorectomy, it’s essential to have an in-depth conversation with your doctor about your options. Some key questions to ask include:

  • What are the potential benefits of oophorectomy for me?
  • What are the risks and potential complications?
  • Will I need one or both ovaries removed?
  • Is there a strong indication for removing my fallopian tubes too?
  • Should I consider having my uterus removed at the same time?
  • Am I a candidate for minimally invasive surgery?
  • How will oophorectomy impact my fertility, menstrual cycle, and sexual function?
  • What are my options for managing surgical menopause symptoms?
  • How can I maintain my bone, heart, and brain health after surgery?
  • What will my recovery timeline look like?
  • How often will I need follow-up visits and screening tests after surgery?

If you’re at high risk of ovarian cancer but haven’t been diagnosed, you may wonder about alternatives to oophorectomy. While surgery is the most effective risk-reduction strategy, other options might include:

  • Regular pelvic exams and ultrasounds
  • Blood tests for tumor markers 
  • Birth control pills (which may lower ovarian cancer risk)
  • Lifestyle modifications (like maintaining a healthy weight and avoiding long-term hormone therapy)

Oophorectomy is a complex and consequential surgery with the potential to impact many aspects of your physical, emotional, and reproductive health. Whether you’re facing ovarian cancer, an inherited risk, or another gynecologic condition, it’s crucial to understand your options, trust your instincts, seek a second opinion, and advocate for your needs. Ultimately, the decision to have an oophorectomy is deeply personal. It’s important to weigh the potential benefits and risks in the context of your unique situation.

Remember, too, that you don’t have to navigate this journey alone. Lean on your personal support system and connect with others who understand what you’re going through. Organizations like Not These Ovaries offer a number of resources, support groups, and opportunities to get involved in the fight against ovarian cancer.

At Not These Ovaries, we’re committed to advancing ovarian cancer research and improving outcomes for all those affected by this disease. We know that behind every diagnosis is a unique story and a person deserving of the best possible care. That’s why we’re working tirelessly to fund innovative studies and clinical trials, educate the public about ovarian cancer, and support patients and families. Because we believe that no one should have to face ovarian cancer alone, and that together, we can create a world where no one has to.