Prophylactic Ovary Removal: What to Expect
Prophylactic ovary removal is usually performed by a gynecologist or a gynecologic oncologist. A gynecologic oncologist is trained to diagnose and treat cancers that affect women’s reproductive organs. There have been some cases in which early ovarian cancer has been found during prophylactic ovary removal. For this reason, many high-risk women choose to have their ovary removal done by a gynecologic oncologist.
Once you choose a surgeon, you will work together to decide how the ovaries and fallopian tubes will be removed. In many cases, the surgery can be done laparoscopically, meaning that the ovaries and fallopian tubes are removed through small incisions in the pelvic region.
Before prophylactic ovary removal
As you plan for prophylactic ovary removal, your doctor will perform tests to make sure the ovaries are healthy before surgery. These may include:
a CA125 blood test to check for a protein that is sometimes elevated when ovarian cancer is present
transvaginal ultrasound, a test used to create images of the ovaries
CT scan or another type of imaging test
For more information about preoperative testing, meeting with an anesthesiologist, and other surgery preparations, please see What to Expect With Any Surgery.
In the hospital on the day of surgery, you’ll change into a hospital gown and wait in a preoperative holding area. Then, you’ll be taken into the anesthesia room, where a nurse will insert an intravenous infusion (IV) line into your hand or arm and tape it into place. Soon after this, you’ll be given relaxing medication through the IV line.
During prophylactic ovary removal
What happens during prophylactic ovary removal depends on the kind of surgery you have: laparoscopic ovary removal or abdominal ovary removal.
Laparoscopic ovary removal is usually performed in the hospital or outpatient surgical center under general anesthesia. In some cases, the surgery can be done using local anesthesia, which numbs only the area to be operated on. This allows you to stay awake. Laparoscopic ovary removal typically lasts about an hour to 90 minutes.
Laparoscopic ovary removal is technically called “laparoscopic bilateral salpingo-oophorectomy (BSO),” which means “removal of the ovaries and fallopian tubes on both sides.” The surgeon makes several small incisions in the abdominal wall and then uses a special device called a laparoscope to perform the procedure:
First, a tube is inserted through the navel, or “belly button,” to inflate the pelvis with carbon dioxide gas. Inflating the pelvis gives the surgeon better access to the ovaries and fallopian tubes.
Then the surgeon will insert a lighted camera that allows for viewing of the internal organs on a television monitor.
The surgeon will use special surgical instruments to remove the ovaries and fallopian tubes through the small incisions. If these organs and the surrounding tissue appear healthy, there is no need for the surgeon to go any further.
The surgeon will send the tissue to a laboratory for close examination under a microscope, just to be certain that no early-stage cancer is present.
If ovarian cancer is present, more extensive surgery is needed to remove all of the cancer. A gynecologic oncologist can perform this more extensive surgery right away. If your ovary removal is being performed by a gynecologist, he or she should call in a gynecologic oncologist if cancer is found, or refer you to a gynecologic oncologist for more complete surgery at a later date.
Abdominal ovary removal is performed under general anesthesia and generally lasts about 1-2 hours. It may last longer if the surgeon needs to do some further exploration.
Abdominal ovary removal requires making a larger incision to remove the ovaries and fallopian tubes. Typically, the surgeon will use a bikini incision, a horizontal incision just above the pubic bone. This procedure is technically called “abdominal bilateral salpingo-oophorectomy (BSO).”
The larger incision may be needed if the surgeon cannot access the ovaries and fallopian tubes through the smaller incisions used for laparoscopy. Abdominal ovary removal is often a better choice than laparoscopic ovary removal when:
You have scar tissue (technically known as adhesions) from previous abdominal or pelvic surgeries.
You have a condition such as endometriosis, in which the tissue that normally lines the uterus is growing outside of the uterus.
You are excessively overweight.
You’re having a hysterectomy, or removal of the uterus and/or cervix, due to some other health issue or concern. (Hysterectomy does not further reduce breast and ovarian cancer risk, but it does prevent cancers of the uterus and cervix.)
Depending on your unique situation, the surgeon may attempt the less invasive laparoscopic ovary removal first, making the larger incision only if it’s needed. In other cases, the surgeon may decide up front that the surgery requires the larger abdominal incision.
The surgeon also will make a longer vertical incision up and down the abdomen if there is anything unusual that suggests cancer may be present. The surgeon will inspect the area thoroughly and send any suspicious tissue for immediate examination by a pathologist. This process is known as a “frozen section.” If the tissue is healthy, no further surgery is needed.
If ovarian cancer is present, more extensive surgery is required to remove all of the cancer. A gynecologic oncologist can perform this more extensive surgery right away. If your ovary removal is being performed by a gynecologist, he or she should call in a gynecologic oncologist if cancer is found, or refer you to a gynecologic oncologist for more complete surgery at a later date.
After prophylactic ovary removal
If you had laparoscopic surgery, you will go home from the hospital the same day or the very next day. Abdominal surgery requires you to spend 1-2 nights in the hospital.
After surgery, your doctor will monitor you for any signs of infection, such as a fever or unusual redness and drainage from your incision(s). You may be given pain reliever in a pump that you control, giving yourself doses through an intravenous (IV) line as needed. As you recover, you also will take some pain medications by mouth, immediately and for a few weeks after your surgery.
The same day or the very next day, your doctor or nurse will have you get up and walk around. Although walking may be painful at first, it can help prevent the formation of blood clots in the legs, strengthen the abdominal muscles, and get your digestive system working again.
Both the surgery itself and the pain medications can slow down your intestines, which play a key role in digesting your food and removing waste from the body. At first, you may not be allowed to take any food or drink by mouth, instead taking your nutrients through an intravenous (IV) line. After that, you’ll probably be restricted to a diet of fluids or soft foods until your doctor is sure that your intestines are working normally again.
At-home recovery after prophylactic ovary removal
Once you’re home from the hospital, you will need to limit physical activities such as driving, exercise, and heavy lifting for 2-6 weeks, depending on the type of surgery. For laparoscopic surgery, it may be 3 or more weeks before you have all your energy back and for abdominal surgery, about 4-6 weeks. As much as possible, try to delegate your responsibilities at work and at home to coworkers, family, and friends. This is especially important if you care for young children or an ill parent or spouse, or you have a job that requires you to be physically active.
In addition to feeling tired, you may experience some side effects:
Pain: You may feel pain at the site of the incision(s) after laparoscopic or abdominal surgery. The inflation of your pelvis and abdomen for laparoscopic surgery can cause some pain that may radiate as far as your shoulder. Your doctor will likely tell you to take pain medication during the first week or two after surgery.
Changes in your digestive system: You may find that you have a smaller-than-usual appetite in the days after surgery. Some women find it helpful to eat more frequent, smaller meals instead of 3 large meals. You may have less frequent bowel movements until your gastrointestinal system gets back to normal. Your doctor may recommend a stool softener.
Surgical menopause: Within days or even hours of surgery, you will begin to experience side effects related to the loss of estrogen. Unlike natural menopause, which happens gradually, surgical menopause causes a sudden drop in your body’s estrogen level. These effects are likely to be more intense if you had not yet started the process of natural menopause. Side effects can include hot flashes, fatigue, mood swings, and vaginal dryness and irritation. You can learn about how to ease these side effects in the Menopause section.
Call your doctor if you experience any of the following symptoms, which could be a sign of infection:
a temperature over 100.4 degrees Fahrenheit; for at least a couple of weeks, you should take your temperature in the morning and evening
increase in swelling or redness at your incision(s)
any blood or fluid draining from your incision(s)
pain not relieved by your pain medicine
vaginal discharge with itching or a bad-smelling odor
nausea or vomiting
any difficulty with urinating, such as pain, burning, urinating often, or being unable to reach the bathroom in time
Your surgeon will see you for an office visit at about 2 weeks and again at about 4-6 weeks after surgery. The surgeon will check to make sure your incision(s) is healing properly.
For some women, the symptoms of surgical menopause can continue for many months. You might plan on seeing your regular doctor or gynecologist more frequently during the first year after surgery, or for as long as it takes your body to adjust.
Some women choose to take short-term hormone replacement therapy (HRT) for relief from hot flashes, vaginal dryness, and sexual side effects. Although HRT has been found to increase breast cancer risk, research also has shown that short-term HRT is safe for high-risk women who undergo ovary removal. In other words, if you take HRT to help with the symptoms of surgical menopause, this does not “wipe out” the reduction in breast cancer risk that comes from having the ovaries removed. The general recommendation is to use the lowest dose needed for the shortest time possible.
Still, individual doctors may have different opinions about whether or not you should take HRT after ovary removal. You can work with your doctor to weigh the risks and benefits and determine what is right for you.
After surgery is a good time to ask your doctor about making plans for maintaining your health over the long term. If you had your ovaries removed before natural menopause, you are at increased risk of osteoporosis (thinning of the bones) and possibly cardiovascular disease. Ask your doctor what tests you should have to evaluate your bone and heart health. Your doctor may recommend lifestyle changes to lower your risk.
— Last updated on January 21, 2022, 9:23 PM