Oophorectomy (ovary removal surgery)

What is an oophorectomy?

Oophorectomy, also called ovary removal surgery, is an operation to remove one or both of your ovaries, the organs that store eggs and produce hormones controlling your periods. It's sometimes combined with removing your fallopian tubes (salpingo-oophorectomy) or your womb (hysterectomy) at the same time.

What conditions does it treat?

An oophorectomy may be recommended for a number of reasons, including:

• ovarian cysts or other growths on the ovary
• endometriosis affecting the ovary
• ovarian torsion, where an ovary twists around its own blood supply, causing severe pain
• an infection of the ovary or surrounding area, such as pelvic inflammatory disease or a tubo-ovarian abscess, though antibiotics are usually tried first
• ovarian cancer, or a growth that might be cancerous
• a high genetic risk of ovarian or breast cancer, such as a BRCA gene mutation, which can raise the lifetime risk of ovarian cancer to around 65% with BRCA1 or around 25% with BRCA2

What are the benefits?

Removing an ovary treats or eases the underlying problem, whether that's a cyst, endometriosis or an infection that hasn't responded to other treatment. If cancer is suspected, it's also the most reliable way to find out whether a growth is benign, borderline, or cancerous.

For women at high genetic risk of ovarian or breast cancer, removing the ovaries and tubes significantly reduces future cancer risk. Where keyhole surgery is possible, it also brings a lower infection risk and a faster recovery than open surgery, and removing a single ovary, with the other working normally, usually leaves your hormone levels and fertility unaffected.

Are there different types or surgical approaches?

There are several forms this surgery can take, depending on what needs to be removed:

• unilateral oophorectomy: removing one ovary
• bilateral oophorectomy: removing both ovaries
• salpingo-oophorectomy: removing one ovary and its fallopian tube
• bilateral salpingo-oophorectomy (BSO): removing both ovaries and both fallopian tubes
• combined with a hysterectomy: removing the womb, and sometimes the cervix, at the same time

The operation itself can be done by keyhole surgery (laparoscopic, sometimes robot-assisted), through the vagina (often alongside vaginal removal of the womb), or through open surgery (laparotomy) using a single larger cut. Keyhole and vaginal approaches carry a lower infection risk and faster recovery; open surgery is used when a mass is large, cancer is suspected, or keyhole surgery isn't safely possible, and occasionally a keyhole operation needs to be converted to open surgery partway through.

Sometimes only part of an ovary, or a cyst, is removed rather than the whole ovary, which preserves fertility better, though the remaining tissue can occasionally fail earlier than it otherwise would. If both ovaries are being removed electively alongside a hysterectomy for a non-cancerous condition, this deserves careful thought: research suggests it reduces future ovarian and breast cancer risk, but is also linked with a higher rate of death from any cause and a higher risk of heart disease and lung cancer in women having this done at 65 or younger, without a matching improvement in overall survival. Because of this, the right age, if any, to remove healthy ovaries alongside a hysterectomy remains genuinely debated, and it's worth discussing your own risk factors in detail with your gynaecologist.

What happens before the procedure?

You'll have a pre-operative assessment to check you're fit for surgery, usually including blood tests, a urine test, an ECG (heart tracing) and an ultrasound; an MRI or genetic testing may also be arranged if there's a family history of ovarian or breast cancer. You'll be told when to stop eating and drinking beforehand and which regular medicines to take on the day, so bring a full list of what you take.

If both ovaries are being removed, it's worth discussing fertility preservation, such as egg freezing, with a fertility specialist beforehand if having children in the future matters to you. It's also worth arranging practical support for afterwards, since you'll need someone to drive you home and help with household tasks for a while, and support is available if you'd like to stop smoking before your operation.

What happens during the procedure?

1. You're given a general anaesthetic, so you're asleep and feel nothing, though occasionally a regional or local anaesthetic is used instead.
2. Once asleep, a catheter is passed into your bladder to drain urine during the operation.
3. For keyhole surgery, the surgeon makes a small cut at or near your belly button, fills your abdomen with gas to improve the view, and inserts a thin telescope (laparoscope), along with two or three further small cuts for instruments.
4. The blood vessels supplying the ovary are carefully sealed, and the ovary, and fallopian tube if included, is freed from surrounding tissue.
5. The ovary is removed, whole or in pieces inside a retrieval bag, through one of the small cuts; occasionally a cut needs to be made larger to complete the procedure.
6. The cuts are closed with glue or dissolvable stitches and covered with simple dressings, and the tissue removed is sent to a laboratory for testing.

The whole operation typically takes 1 to 2 hours.

What does recovery look like?

In hospital

You're monitored closely in a recovery area, with checks on your blood pressure, pulse, breathing, temperature and wounds, and staff will also check for any vaginal bleeding. You're encouraged to start moving about and doing gentle leg and breathing exercises as soon as possible, which helps your circulation and reduces the chance of a chest infection.

Feeling sick is a common side effect of general anaesthetic, and anti-sickness medicine can help. You'll wear support stockings and have blood-thinning injections to help prevent blood clots, sometimes continuing these injections at home for up to 28 days if you've had open surgery; a drip and urinary catheter are removed once you're eating, drinking and passing urine normally.

Keyhole or vaginal surgery often allows you home the same day, sometimes with one night in hospital, while open surgery usually means a stay of up to about 3 days. Your doctor will see you before you leave to discuss how the surgery went and what happens next.

At home

Tummy discomfort is common for a few days. You may also get shoulder tip pain from the gas used during keyhole surgery pressing on a nerve pathway, which usually lasts 48 to 72 hours; painkillers and peppermint tea can both help.

Mild constipation for the first few days is common and temporary, and laxatives can be prescribed if needed. Light vaginal bleeding or discharge, similar to a light period, can last up to around 10 days.

Expect roughly 2 to 6 weeks of restricted activity depending on the type of surgery you had, generally shorter after keyhole surgery and longer after open surgery. During this time, avoid heavy lifting, strenuous exercise (walking is fine), sex, baths, hot tubs and swimming (use showers and sanitary pads instead of tampons until healed), and don't drive until you can perform an emergency stop comfortably and aren't drowsy from painkillers; let your car insurer know you've had surgery.

If both ovaries are removed and you hadn't already gone through menopause, menopause begins immediately, with symptoms such as hot flushes, night sweats and vaginal dryness, and a raised long-term risk of thinning bones (osteoporosis). Hormone replacement therapy may be offered depending on your age and diagnosis.

A follow-up appointment roughly 3 weeks after surgery checks your recovery and reviews any lab results. Contact your medical team sooner if you notice swelling, redness or leaking from your wounds, worsening pelvic pain, a fever, painful urination, or swelling and pain in a leg.

What are the risks and complications?

As with any operation, an oophorectomy carries some risks:

• wound infection or delayed healing: common, usually minor
• bruising around the cuts: common
• a urine infection, or difficulty or frequency passing urine: possible
• bleeding more than expected, or a build-up of blood internally: uncommon
• damage to nearby organs such as the bladder, ureter or bowel: uncommon, reported in around 1-2% of gynaecological keyhole operations for the urinary tract, and often not noticed until after surgery
• a blood clot in the leg (deep vein thrombosis) or lung (pulmonary embolism): uncommon, and the risk is reduced by moving around soon after surgery and wearing compression stockings
• injury to a major blood vessel: rare, around 0.1-0.64% of gynaecological keyhole procedures
• nerve problems from positioning during surgery: affects around 2% of major gynaecological operations, usually improving over time
• a severe allergic reaction to the anaesthetic: rare
• needing to convert from keyhole to open surgery partway through: uncommon
• if cancer is present, a small risk that a growth ruptures during surgery, potentially spreading cancer cells: rare, and surgeons take precautions to avoid this
• ongoing pain from ovarian tissue left behind (ovarian remnant syndrome): rare
• permanent loss of fertility, if both ovaries and tubes are removed.