Oophorectomy

Oophorectomy, the surgical removal of the ovaries, is a significant intervention that fundamentally impacts a woman’s health. This decision is typically based on complex medical conditions, cancer risks, or severe gynecological disorders. In our clinic, we approach the oophorectomy process not merely as an operation, but as comprehensive treatment planning. We carefully consider our patients’ quality of life, future health status, and personal priorities. Our expert team utilizes the latest technological advancements to determine the safest and most effective surgical approach for you.

This surgical procedure may involve the removal of one or both ovaries. Regardless of the decision, this process will have distinct effects on hormonal balance, fertility, and overall health.

What Is Oophorectomy and Why Is It Necessary?

Oophorectomy is the surgical procedure to remove one (unilateral oophorectomy) or both (bilateral oophorectomy) ovaries from the body. The ovaries are the cornerstones of the female reproductive system. They house the egg cells and also produce the primary female hormones, estrogen and progesterone. Consequently, the decision to remove these organs must be based on very serious grounds.

Sometimes this procedure is combined with the removal of the fallopian tubes, which is a salpingectomy. The removal of both ovaries and fallopian tubes is known as a bilateral salpingo-oophorectomy, a method we frequently use today, especially in risk-reducing surgeries.

Our reasons for resorting to this surgery are diverse. In some cases, it plays a life-saving role, while in others, it may be the only option to resolve conditions that diminish quality of life, such as chronic pain. We primarily evaluate the need for oophorectomy in two main categories: cancer-related conditions and benign (non-cancerous) gynecological problems.

Cancer treatment or prevention is among the most serious justifications for oophorectomy. Ovarian cancer is an insidious disease that becomes difficult to treat when diagnosed at an advanced stage. We perform oophorectomy as part of the treatment. Similarly, this intervention may be necessary in the treatment of other gynecological cancers, such as uterine or cervical cancer.

Benign conditions, on the other hand, usually relate to problems that severely impact quality of life. When these conditions cannot be resolved with non-surgical methods, oophorectomy becomes a viable option.

• Severe Endometriosis This is a condition where uterine lining tissue grows outside the uterus. When this tissue implants on the ovaries (forming endometriomas or chocolate cysts) and causes severe pain unresponsive to medication, we may consider oophorectomy after other treatment options are exhausted.
• Benign Ovarian Cysts or Tumors Surgery is required for large cysts that cause persistent pain, carry a risk of torsion (twisting), or appear suspicious.
• Ovarian Torsion This is an emergency situation where the ovary twists around its own blood vessels, cutting off its blood supply. If blood flow cannot be restored, the ovary usually must be removed.
• Severe Abscesses Following Pelvic Inflammatory Disease (PID) In cases of severe infection-related abscesses involving the ovaries and tubes (tubo-ovarian abscess) that are resistant to treatment, removing the organs may be necessary.

Oophorectomy and Fertility

One of the greatest concerns regarding the decision for oophorectomy is the future of fertility. Our approach to this issue varies depending on the type of surgery performed.

If a unilateral oophorectomy (removal of one ovary) is performed and the other ovary and uterus are healthy, your fertility continues. The single remaining ovary typically takes over the function of both, and you continue to menstruate and ovulate regularly. Your chance of conceiving naturally in the future is largely preserved.

However, if a bilateral oophorectomy (removal of both ovaries) is necessary, the situation is different. When both ovaries are removed, your egg reserve is completely eliminated. This means your ability to conceive naturally permanently ends. If this surgery becomes mandatory for a patient who has not yet had children or wishes to preserve fertility, we will have a detailed discussion with you about fertility preservation options (such as egg freezing) before the surgery.

Why is an Oophorectomy Performed?

• To remove ovarian cysts or benign tumors that cause pain or carry risk of complications
• To treat or prevent ovarian cancer, especially in high-risk cancer syndrome patients
• To manage severe endometriosis, removal of the ovary may become necessary when the disease extensively involves ovarian tissue and preservation is no longer feasible.

About the uterus and ovaries

The uterus is a pear-shaped muscular structure about the size of a fist in the lower pelvic region. It is part of the female reproductive system and is the place where a growing fetus develops.

The uterus has three primary layers: the endometrium (inner layer), myometrium (middle layer), and serosa (outer layer).

The uterus connects on either side to the ovaries via the fallopian tubes. Ovaries are the sites of egg development. Ovulation is the release of an egg cell from the ovary into the fallopian tube midway during the menstrual cycle. In the absence of pregnancy, a woman releases about 400 to 500 eggs during her reproductive life. The key hormones produced by the ovaries are estrogen and progesterone. 

n the first 14 days of the menstrual cycle, enables the egg to mature. It also plays a role in thickening the lining of the uterus and promotes breast development along with an increase in bone and cartilage density. Progesterone prepares the endometrium between the 14^th and 28^th days of the menstrual cycle to allow the implantation of a fertilized egg (zygote) inside the uterus. If fertilization does not occur, the levels of progesterone fall, and the endometrium is shed during monthly periods.

What are the indications for oophorectomy?

Your healthcare provider may recommend the removal of one or both ovaries for the following reasons:

• endometriosis
• non-cancerous cyst formation
• preventive surgery (prophylactic oophorectomy) for those with a high risk of breast and ovarian cancer
• ovarian cancer
• necrotic ovary undergoing torsion or twisting around the blood vessels
• pelvic inflammatory disease (PID) or tubo-ovarian abscess (TOA)
• cryopreservation of ovarian tissue

How do surgeons perform oophorectomy?

There are several ways to perform an oophorectomy with each having its own sets of risks and recovery times. Your surgeon should discuss these procedures and their associated risks with you beforehand.

Laparotomy or abdominal incision

In this procedure, the surgeon makes a vertical or horizontal cut across the abdomen. Then pulls apart the abdominal muscles to get a better view of the ovaries and ties the blood vessels to prevent bleeding. Then staples or stitches the cut. Laparotomy often requires a longer recovery time and presents a higher risk of complications.

Laparoscopy

This is a minimally invasive surgical approach in which the surgeon inserts a camera into the abdomen via a small cut near the navel. This camera relays the video feed to an external monitor. The surgeon makes other cuts to insert special tools to cut and tie the blood vessels and detach the ovaries. Then removes them usually through the larger port in the belly button. Since the cuts on the skin are small, they leave less scarring and heal more quickly.

Vaginal removal

Sometimes, a surgeon may remove the ovaries via the vagina in a minimally invasive approach. They generally do this when they also perform hysterectomy along with oophorectomy and when vaginal removal of the uterus is feasible. This causes almost no abdominal scarring and carries a smaller risk of infection and faster recovery.

How can oophorectomy help treat endometriosis?

There is currently no cure for endometriosis. Hysterectomy and oophorectomy should be the last resort when all other treatment options, including laparoscopic excision surgery, fail and the patient is sure she does not want to preserve her fertility. It is important to note that while the removal of the ovaries can help reduce symptoms such as pain, there is still a risk the symptoms will recur. 

The risk of developing ovarian cancer is one in 80 in the general population. However, that risk is marginally greater in those with endometriosis (approximately 2% to 3%). In the presence of known or suspected ovarian cancer, a specialist gynecologic surgeon will make an informed treatment decision with the patient, which will usually include an oophorectomy. 

Oophorectomy for the purpose of risk-reducing surgery may be warranted in cases of familial cancer or the like. However, it should not be routine in women with endometriosis. 

Oophorectomy, as the last resort treatment for a patient with endometriosis, may aid in the alleviation of pain by completely stopping menstrual cycles, causing “surgical menopause”. If endometriosis lesions or scar tissue remain in the pelvis without surgical removal, there is a chance that pain caused by endometriosis continues even after oophorectomy, especially if hormone replacement therapy is used. This is the reason why the decision to pursue an oophorectomy should be a well-thought-out discussion between the patient and the surgeon. 

Oophorectomy recovery time

The recovery time after an oophorectomy typically ranges from a few weeks to a couple of months. Most people can resume light activities within a week but should avoid strenuous exercise for about six weeks.

The length of recovery depends on factors like the type of surgery, overall health, and any complications. Pain and swelling are common right after surgery but usually subside within a few days. Following your doctor’s advice and attending follow-up appointments are essential to ensure a smooth recovery process.

What are the risks of oophorectomy?

Though oophorectomy is a relatively low-risk surgery, it does present a few risks depending on the type of procedure. These include:

• large blood vessel injury. This is rare and typically occurs in 0.1% to 0.64% of cases.
• genitourinary tract injury (ureter). This may occur in 1% to 2% of gynecological surgical interventions.
• neuropathies (nerve injuries). This occurs in about 2% of cases depending on whether the patient is over or underweight and has pre-existing mobility issues. 

Other risks during surgery include infection, excess bleeding, pain, blood clot formation, scarring, and reaction to anesthesia. 

How long does the procedure take?

A typical oophorectomy procedure can take between one to four hours. You will be moved to a recovery area and the excised ovaries sent for clinical examination. 

Does oophorectomy lead to infertility?

Unilateral oophorectomy i.e., removal of a single ovary will not greatly affect fertility if the remaining ovary and fallopian tube are healthy.

Bilateral oophorectomy will lead to loss of fertility, so discuss all available options for fertility preservation (such as egg freezing) with your healthcare provider first before committing to the procedure.

What are some of the menopausal symptoms after oophorectomy?

Bilateral oophorectomy will result in immediate surgical menopause. Early menopause can lead to symptoms such as hot flashes, vaginal dryness, depression and anxiety, loss of sex drive, cognitive changes, sleep disturbance, and osteoporosis.

What are some of the post-procedure steps to follow?

After the surgery, your healthcare team will monitor your progress. They may instruct you to sit up and walk a short distance and wear special socks or boots to prevent blood clots. 

At home, do not push yourself, lift heavy loads, or have sexual intercourse for a few weeks until your doctor gives the go-ahead. If you experience emotional changes due to surgery-induced menopause, consider contacting local support groups for support.

Is hormone therapy necessary after oophorectomy? 

There is still no consensus on whether post-menopausal hormone therapy should be indicated for women who are in natural menopause. Younger women who undergo surgery-induced menopause may need low-dose hormone therapy at least up to the age of 51 for cardiovascular protection and for bone health.

Oophorectomy after menopause

An oophorectomy after menopause involves the removal of one or both ovaries in individuals who have already stopped menstruating. Since the ovaries no longer produce eggs or significant hormones after menopause, the procedure may have fewer immediate effects on hormone levels.

However, removing the ovaries can still lead to sudden hormonal changes, including an increased risk of osteoporosis or heart disease.

Frequently Asked Questions

Our approach

At Seckin Endometriosis Center, we avoid oophorectomy unless absolutely necessary.

We always discuss all available options with our patients before going ahead with any procedure and fertility preservation is of utmost importance whenever feasible.