Can You Get Ovarian Cancer After a Hysterectomy or Other Prophylactic Surgeries?

If you’ve had a hysterectomy or you’re considering one, you’ve probably wondered: can you get ovarian cancer after a hysterectomy or other prophylactic surgeries? 

The short answer is: yes. Your risk is significantly reduced, but surgery alone doesn’t close the door completely. The good news is, knowing what to watch for puts you ahead of most.

Whether ovarian cancer is still possible after a hysterectomy depends almost entirely on which type of hysterectomy you had and what was removed along with your uterus. And even when both ovaries are taken out, there’s still a small but real risk that something very much like ovarian cancer can develop.

First, What Kind of Hysterectomy Did You Have?

Not all hysterectomies are the same. The procedure covers a range of surgeries, each removing different structures:

• Partial (supracervical) hysterectomy removes the upper uterus and leaves the cervix. Your ovaries stay in place.
• Total hysterectomy removes the uterus and cervix. Your ovaries stay in place.
• Radical hysterectomy removes the uterus, cervix, upper vagina, and surrounding tissue. This is often used for cervical cancer. Ovaries may or may not be removed.
• Total hysterectomy with bilateral salpingo-oophorectomy (BSO) removes the uterus, cervix, both fallopian tubes, and both ovaries.

That last one is the most relevant when it comes to ovarian cancer risk reduction. But even a BSO doesn’t bring your risk down to zero.

Read more: “Oophorectomy vs Hysterectomy: What’s the Difference?”

If Your Ovaries Were Left In, Your Risk Is Still There

If you had a partial or total hysterectomy without removing your ovaries, your ovarian cancer risk is essentially unchanged, or reduced only modestly.

One study tracking more than 22,000 women found that those who had a hysterectomy with at least one ovary conserved developed ovarian cancer at a rate of 0.27 per 1,000 person-years, compared to 0.34 per 1,000 in the general population: a reduction, but not elimination.  

The American Cancer Society notes that having a hysterectomy even with ovaries intact may reduce ovarian cancer risk by roughly one-third, but your ovaries are still present and capable of developing cancer.  

What About Bilateral Salpingo-Oophorectomy (BSO)?

Removing both ovaries and fallopian tubes during a hysterectomy — what’s called a bilateral salpingo-oophorectomy — does significantly lower ovarian cancer risk. 

A major study of 56,692 women found that those who had a hysterectomy with BSO had an ovarian cancer rate of just 1.7 per 100,000 person-years, compared to 26.2 per 100,000 for those who had a hysterectomy alone. 

That’s a dramatic difference. But your risk doesn’t drop to zero.

Even after both ovaries are removed, a rare type of cancer called primary peritoneal cancer can still develop. It originates in the peritoneum, a thin layer of tissue lining the inside of the abdomen. During development, the peritoneum, ovaries, and fallopian tubes all form from the same type of cells. That’s why peritoneal cancer behaves almost identically to ovarian cancer, and is treated the same way.

What Does the Research Say About Hysterectomy and Ovarian Cancer Risk Overall?

The picture is more nuanced than many people expect.

A large population-based study followed nearly 838,000 women over 27 years. Researchers found that, after accounting for age, parity, and tubal ligation, hysterectomy without oophorectomy was not associated with a meaningful reduction in ovarian cancer risk overall (HR = 0.98). 

However, for women who had a hysterectomy specifically because of endometriosis or fibroids, the reduction was substantial. 

Why the difference? Endometriosis and fibroids are themselves associated with increased ovarian cancer risk, particularly for endometrioid and clear cell subtypes. Removing those conditions through hysterectomy may be what’s actually driving the risk reduction.

The takeaway: if you had a hysterectomy for fibroids or endometriosis, you may have more protection than someone who had one for an unrelated reason. But it’s not a universal guarantee across the board.

What About Other Prophylactic (Preventive) Surgeries?

Hysterectomy isn’t the only surgery that can affect ovarian cancer risk. Here’s what the evidence says about other procedures:

Bilateral salpingo-oophorectomy (BSO) alone: For women at high genetic risk — particularly those who carry BRCA1 or BRCA2 mutations — having both ovaries and fallopian tubes removed is the most effective surgical option available. 

Multiple prospective and retrospective studies have demonstrated that it reduces ovarian cancer risk by 75–96%, and lowers breast cancer risk by roughly 50% in BRCA mutation carriers. 

That said, the benefits aren’t identical across mutation types. Emerging research suggests that most of the ovarian cancer risk reduction from BSO is driven primarily by BRCA1 carriers. And when it comes to breast cancer protection specifically, recent data indicates the benefit is stronger for BRCA2 carriers than BRCA1.

Timing matters, too. Because BRCA1-associated cancers tend to develop earlier, guidelines generally recommend completing BSO by age 40 for BRCA1 carriers. For BRCA2 carriers, whose cancer risk peaks a decade later, there may be more flexibility, though that decision should always be made with a specialist.

This is not a decision to take lightly. BSO triggers surgical menopause, which carries its own risks, including effects on cardiovascular health, bone density, and quality of life. Those trade-offs are real and deserve a full conversation with your care team.

Opportunistic salpingectomy: Growing evidence suggests that many ovarian cancers — particularly the high-grade serous type — actually originate in the fallopian tubes, not the ovaries themselves. 

This has led to a new approach: removing the fallopian tubes during other gynecological surgeries (like a hysterectomy or sterilization procedure), even when there’s no known genetic risk. This is called opportunistic salpingectomy.

Research suggests it could reduce ovarian cancer incidence by 20 to 40% over the following two decades. Importantly, when done carefully, salpingectomy does not appear to significantly disrupt ovarian function or hormone levels.

Tubal ligation: Commonly known as “getting your tubes tied,” tubal ligation has been associated with meaningful ovarian cancer risk reduction, though the degree of protection varies significantly depending on the cancer subtype. 

Research shows up to 50% reduction for endometrioid and clear cell cancers, while the effect on high-grade serous cancer is more modest at around 20%. Mucinous ovarian cancer sees little to no benefit.

That variation makes sense given what we now know about how different subtypes develop. Endometrioid and clear cell cancers are linked to endometriosis and retrograde menstruation, both of which tubal ligation can help interrupt. 

High-grade serous cancers, on the other hand, are now thought to originate in the fimbriae at the tip of the fallopian tube, which tubal ligation blocks but doesn’t remove, explaining the weaker protective effect.

It’s also worth noting that researchers have found no association between tubal ligation and reduced risk of borderline ovarian cancer specifically.

Read more: “Tubal Ligation and Ovarian Cancer: Understanding Your Risk Reduction Options”

The Complexity of Elective Oophorectomy

Removing healthy ovaries is not a decision to make lightly. For women at average risk, the potential downsides deserve serious consideration.

Elective bilateral oophorectomy — removing both ovaries when they’re otherwise healthy — has been linked to increased risks of coronary heart disease, osteoporosis, and cognitive decline, particularly when performed before age 50. Research found that EO performed before age 65 was associated with more all-cause deaths than it prevented from ovarian cancer, largely due to cardiovascular disease. 

Estrogen therapy can help offset some of these effects, but it introduces its own considerations.

For women with BRCA mutations or a strong family history, the calculus is different. The elevated cancer risk may well outweigh the risks of surgical menopause. The Society of Gynecologic Oncologists generally recommends risk-reducing salpingo-oophorectomy for BRCA carriers after age 40 or once childbearing is complete.

So What Should You Watch For After Any of These Surgeries?

There is currently no reliable screening test for ovarian cancer recommended for the general population. That makes awareness of ovarian cancer symptoms essential, regardless of what surgery you’ve had.

These symptoms are often vague, which is part of what makes ovarian cancer so difficult to catch early. If you experience any of them and they stick around for two weeks or more, tell your doctor. Don’t wait it out.

Life After Prophylactic Surgery: What to Keep in Mind

Hysterectomy and other prophylactic surgeries can meaningfully reduce your ovarian cancer risk. But none of them eliminates it entirely. 

The type of surgery you had matters. So does your genetic background, your reason for having surgery, and whether your fallopian tubes were removed along the way. Stay informed, know your symptoms, and keep up with regular gynecologic care. That vigilance is part of your protection, too.