Why a gynae onc might suggest removing your ovaries

13 Oct 2020

It can be a daunting time when you find out you are high-risk for any kind of cancer. It can carry implications for you, your partner and your family, and there is often so much information being thrown at you that it’s hard to keep up.

So, we thought we’d look at one of the surgical options that a gynaecological oncological might suggest, an oophorectomy, and break it down so it’s easier to understand. It's just one of the options that you might come across on your health journey with high-risk cancer.

What is an Oophorectomy?
An oophorectomy is a surgery to remove one or both of your ovaries. To remove one ovary, it’s referred to as unilateral oophorectomy and if it’s both, it’s a bilateral oophorectomy. Often this surgery is extended to remove not only the ovary but also the fallopian tube as well. Then it’s known as a salpingo-oophorectomy.

Why would you have one?
This kind of surgery can be used to treat a number of problems related to a women’s reproductive organs, including ovarian cysts, abscesses, endometriosis, ovarian cancer, and prevention of ovarian and/or fallopian tube cancer. Women who are identified to have an increased hereditary risk of these cancers due to a mutation in the BRCA1 or BRCA2 gene, for example, may wish to consider surgical removal to reduce their risk.  In addition, some women diagnosed with oestrogen-responsive breast cancers prior to menopause may wish to consider an oophorectomy to reduce the risk of breast cancers stimulated by estrogen levels, as this procedure can reduce the oestrogen being produced.

How effective is an oophorectomy at reducing the risk of cancer?
Having your ovaries removed may reduce the risk of both breast and ovarian cancer in women who carry a hereditary predisposition, particularly if they haven’t experienced menopause yet. As for how effective it is, a study by Dr. Timothy Rebbeck, of the University of Pennsylvania found that women with either of the gene mutations, who had both ovaries and fallopian tubes removed, reduced their risk of ovarian cancer by 96% and their risk of breast cancer by 53%.

What are the potential risks and side effects?
This surgery is generally considered safe, but like all surgeries carries some potential risks and side effects, which include bleeding, blood clots, infection, and damage to nearby organs. In some cases, this surgery can also increase a patient’s risk of depression, reduce their sex drive and induce menopause if both ovaries are removed. If performed prior to menopause, women may also experience systemic symptoms of menopause such as hot flushes, night sweats, and difficulty sleeping.

What happens in the surgery?
There are two ways this surgery is generally performed, open surgery and minimally invasive surgery. In open surgery, called a laparotomy, an incision is made in the lower abdomen to access the ovaries and/ or the fallopian tubes and uterus (for a hysterectomy). This surgery requires more recovery time in the hospital. In laparoscopic surgery, small ‘keyhole’ incisions are made in the abdomen using a camera to perform the operation. This is less taxing on the patient, requires much less time recovering, and may reduce some of the risk of the operation. Your surgeon should be able to tell you which is the most appropriate way for you.

Does an Oophorectomy stop periods?
If you have had one ovary removed, you will still have regular periods and may still be fertile. If you have had both ovaries removed, you may no longer get your period.

What can you expect after the surgery?
The surgery takes anywhere between 1-4 hours and patients are given a general anesthetic. You should expect to be in hospital for 1-5 days, depending on which surgery was performed. Recovery can take as little as 2-3 weeks, and up to six weeks, but heavy lifting, sex and strenuous exercise should be avoided until you’ve been given the all-clear. It is always best to discuss postoperative instructions with your treating physician.
The information in this article is correct at the time of printing and has been fact-checked by Clinical Associate Professor Trevor Tejada-Berges from Chris O'Brien Lifehouse.