Oophorectomy

Introduction

If your doctor has recommended an oophorectomy — the surgical removal of one or both ovaries — you likely have many questions. The ovaries are small but important organs. They produce eggs and they release the hormones estrogen and progesterone, which influence the menstrual cycle, bone strength, heart health, sexual function, and overall well-being. Removing one or both of them is not a small decision, and the right choice depends on why the surgery is being considered, your age, whether you hope to have children in the future, and your personal and family medical history.

This guide is written for people who have already been told that oophorectomy is a possibility or a plan. It walks through what the procedure involves, why it is performed, the surgical approaches available, what recovery looks like, and what life after surgery typically involves — including the hormonal and fertility considerations that often weigh most heavily on patients.

What Is an Oophorectomy?

An oophorectomy is the surgical removal of one or both ovaries. The word comes from “oophoron,” the Greek term for ovary, and “ectomy,” meaning removal. Depending on the situation, the operation can involve:

• Unilateral oophorectomy — removal of one ovary, with the other ovary left in place.
• Bilateral oophorectomy — removal of both ovaries.
• Salpingo-oophorectomy — removal of the ovary together with its fallopian tube. This may be done on one side (unilateral salpingo-oophorectomy) or on both (bilateral salpingo-oophorectomy, often shortened to BSO).
• Risk-reducing salpingo-oophorectomy (RRSO) — the same operation, performed in people at high genetic risk of ovarian or fallopian-tube cancer to reduce that risk.

The ovaries do two important jobs. They release eggs each month during the reproductive years, and they make hormones — mainly estrogen and progesterone, with smaller amounts of testosterone. Because of this dual role, the decision to remove them carefully balances treating or preventing disease against the long-term effects of losing ovarian hormone production. The balance is different at age 25 than at age 55, and different again after natural menopause has already occurred.

Why Is an Oophorectomy Performed?

Oophorectomy is recommended for a range of conditions and risks. The reason for surgery shapes almost every other decision — which ovary or ovaries are removed, which surgical approach is used, and what follow-up will look like.

Ovarian Cysts and Tumours

Most ovarian cysts are harmless and resolve on their own. Surgery is considered when a cyst is large, persistent, growing, painful, or has features on ultrasound that raise concern for cancer. In many of these cases, doctors first try to remove the cyst while preserving the ovary (a procedure called cystectomy). Oophorectomy is considered when the ovary itself is too damaged, when the mass is suspicious, or when cysts keep recurring.

Ovarian Cancer or Suspicion of Cancer

When ovarian cancer is confirmed or strongly suspected, removal of the affected ovary (and often the other ovary, the fallopian tubes, the uterus, and surrounding tissue) is a central part of treatment. The exact extent of surgery is guided by a gynaecologic oncologist and depends on cancer type and stage.

Ovarian Torsion

Ovarian torsion happens when the ovary twists on its blood supply, cutting off circulation. It causes sudden, severe pelvic pain and is a surgical emergency. If the ovary can be untwisted quickly and is still healthy, doctors try to save it. If the tissue has been damaged beyond recovery, oophorectomy may be necessary.

Severe Endometriosis

Endometriosis can involve the ovaries, forming cysts called endometriomas. When endometriosis is severe, repeatedly recurs after conservative surgery, or causes pain that has not responded to medical treatment, oophorectomy — sometimes alongside hysterectomy — may be discussed. Major societies generally favour preserving ovaries in younger people when possible, even when endometriosis is severe.

Pelvic Inflammatory Disease and Tubo-Ovarian Abscess

A serious pelvic infection that has formed an abscess involving the ovary and tube, and that does not respond to antibiotics and drainage, may require surgical removal of the affected structures.

Risk-Reducing Surgery in High-Risk Individuals

People who carry certain inherited gene changes — most commonly BRCA1 and BRCA2, and to a lesser extent genes in the Lynch syndrome group — have a significantly higher lifetime risk of ovarian and fallopian-tube cancer. For these individuals, removing both ovaries and fallopian tubes (risk-reducing salpingo-oophorectomy) is one of the most effective measures known to reduce that risk. National Comprehensive Cancer Network (NCCN) guidance describes risk-reducing salpingo-oophorectomy as a recommended option for BRCA carriers, typically discussed between ages 35 and 40 for BRCA1 and 40 to 45 for BRCA2, after childbearing is complete. The timing is individualised through genetic counselling.

As Part of Other Operations

Oophorectomy may also be performed alongside hysterectomy in some situations — for example, certain cancers, severe endometriosis, or when the ovaries themselves are diseased. In recent years, many societies, including the American College of Obstetricians and Gynecologists (ACOG), have moved away from routinely removing healthy ovaries during hysterectomy in people who have not yet reached menopause, because keeping the ovaries has long-term health benefits.

Who Is a Candidate?

Whether oophorectomy is appropriate is a clinical decision that brings together several factors:

• The underlying diagnosis or risk. Cancer, suspected cancer, severe pain, torsion, and high genetic risk all weigh strongly toward surgery.
• Age and menopausal status. The hormonal consequences of removing both ovaries are very different before and after natural menopause.
• Fertility goals. If pregnancy is desired in the future, doctors generally aim to preserve at least one ovary whenever it is medically safe to do so.
• General health. Other medical conditions, the risks of anaesthesia, and the ability to recover from surgery are all assessed.
• Personal values. Some decisions — particularly risk-reducing surgery — involve trade-offs that only the patient can weigh, with support from genetic counsellors and gynaecologists.

Where the situation allows, doctors often recommend trying ovary-preserving options first — medications, hormonal therapy, cystectomy, or observation. Oophorectomy is generally reserved for situations where these are not suitable, have not worked, or where the risks of leaving the ovary in place outweigh the benefits.

Alternatives to Oophorectomy

Depending on the reason for surgery, alternatives may include:

Watchful Waiting

Many simple ovarian cysts — particularly in people who are still having menstrual cycles — resolve on their own. A common approach is to repeat the ultrasound in a few weeks or months and operate only if the cyst persists, grows, or causes symptoms.

Medical Therapy

Hormonal medications — including combined oral contraceptive pills, progestin-only options, GnRH analogues, and others — can shrink endometriomas, reduce pain, and help manage related symptoms. For pelvic infections, antibiotics are the first treatment. For pain syndromes, pain-management strategies and physiotherapy may be tried.

Ovarian Cystectomy

This is removal of the cyst alone, with the ovary itself preserved. Cystectomy is often considered for benign-appearing cysts in people who want to preserve ovarian function or future fertility. It can be done laparoscopically in most cases.

Salpingectomy Alone

Removing only the fallopian tubes (without the ovaries) is increasingly discussed as a risk-reduction strategy. This is because many ovarian cancers are now thought to originate in the fallopian tube. For some people at moderately increased risk, or for those who want to delay losing ovarian hormones, professional societies are exploring this option. Whether it is appropriate is highly individual and is a decision made with a specialist.

Hormonal Suppression for Endometriosis

For endometriosis, long-term hormonal suppression can sometimes control symptoms without removing the ovaries.

None of these alternatives suits every situation. The choice depends on the diagnosis, the level of risk, and the patient’s goals.

Surgical Approaches

Laparoscopic Oophorectomy

Laparoscopy is the most common approach for benign conditions. The surgeon makes a few small cuts (usually 0.5 to 1 cm) in the abdomen. A thin camera (laparoscope) and slim instruments are passed through these openings. The abdomen is gently inflated with carbon dioxide gas to create space to work. The ovary (and, where appropriate, the fallopian tube) is carefully separated from surrounding tissue, the blood vessels supplying it are sealed, and the ovary is removed through one of the small openings, often inside a sterile retrieval bag to avoid spilling tissue. Laparoscopic surgery is generally associated with less pain, smaller scars, a shorter hospital stay, and quicker return to normal activities than open surgery.

Robotic-Assisted Oophorectomy

Robotic surgery is a form of laparoscopy in which the surgeon controls instruments through a robotic system from a console next to the operating table. The instruments offer fine, precise movements and a magnified three-dimensional view. Robotic oophorectomy is used for both benign and cancer-related surgery and is particularly helpful in complex pelvic anatomy or when other operations are being done at the same time. From the patient’s perspective, recovery is broadly similar to standard laparoscopy.

Vaginal Oophorectomy

In some cases — usually as part of a vaginal hysterectomy — the ovaries can be removed through the vagina, without any abdominal incision. This is feasible in selected situations and depends on factors such as the size of the ovaries, prior surgery, and pelvic anatomy. When possible, it avoids abdominal scars entirely.

Open (Abdominal) Oophorectomy

Open surgery uses a single larger cut in the lower abdomen, either horizontal (near the bikini line) or vertical (from the navel downward). It is generally considered for large ovarian masses, suspected or confirmed ovarian cancer (where full surgical staging is needed), severe scarring from previous surgery, or emergencies where speed is important. Recovery is longer than with laparoscopic surgery, but for some situations — particularly cancer surgery — the open approach allows the most thorough operation.

Your surgeon will discuss which approach is most suitable in your case. Sometimes a planned laparoscopic operation needs to be converted to open surgery during the procedure if unexpected findings make that safer; this is uncommon but worth knowing about in advance.

Preparing for Oophorectomy

Preparation usually begins several days to weeks before surgery, depending on whether the operation is planned or urgent.

Pre-Operative Tests and Assessment

• Blood tests to check blood count, kidney and liver function, blood sugar, and clotting.
• Imaging — usually pelvic ultrasound, with MRI or CT in selected cases to evaluate the ovary and surrounding structures.
• Tumour markers such as CA-125 may be checked when an ovarian mass is being investigated. These are interpreted in context and are not a diagnosis on their own.
• Heart and lung assessment in older patients or those with existing conditions.
• An anaesthesia review, where the anaesthetist discusses your medical history, medications, allergies, and any prior reactions to anaesthesia.

Discussion of Fertility and Hormones

If you are pre-menopausal and have not completed childbearing, fertility-preservation options are best discussed before surgery whenever possible. These may include egg freezing or embryo freezing, depending on your situation and timing. For those undergoing bilateral oophorectomy before natural menopause, the doctor will also discuss the likelihood of surgical menopause and whether hormone therapy after surgery may be appropriate.

Medication and Lifestyle Adjustments

• Blood-thinning medications (including aspirin and certain supplements such as fish oil, vitamin E, and some herbal preparations) may need to be paused. Tell your team about everything you take, including supplements.
• Smoking increases surgical risk and slows healing. Stopping — even a few weeks before surgery — helps.
• You will usually be asked not to eat or drink for several hours before surgery, as directed by your team.
• Arrange for help at home for the first week or two, especially if you have young children.

What Happens During Oophorectomy

The day of surgery typically follows this pattern:

1. Admission and check-in. You change into a hospital gown, an intravenous (IV) line is placed, and you meet the surgical and anaesthesia team.
2. Anaesthesia. Oophorectomy is almost always done under general anaesthesia, meaning you are fully asleep during the procedure.
3. Positioning and preparation. You are positioned on the operating table, the abdomen is cleaned with antiseptic, and sterile drapes are placed.
4. The surgery itself. The surgeon accesses the abdomen through the chosen approach, identifies the ovary and its blood supply, carefully separates it from surrounding tissue, and seals the blood vessels before removing the ovary (and tube, if included). The removed tissue is sent to a pathologist for examination.
5. Closure. Incisions are closed with stitches, surgical glue, or staples, depending on the approach.
6. Recovery room. You wake up in a recovery area where nurses monitor your breathing, blood pressure, pain, and any bleeding.

In Hospital

After laparoscopic or robotic surgery, many people go home the same day or after one night in hospital. After open surgery, the stay is usually two to four days. Common experiences in the first day or two include:

• Soreness around the incisions, controlled with pain medication.
• Some shoulder-tip pain after laparoscopic surgery, caused by residual gas under the diaphragm. This usually settles within a few days.
• Mild nausea from anaesthesia.
• Encouragement to walk gently as soon as possible to reduce the risk of blood clots and help bowel function return.

The First Two Weeks

At home, expect:

• Tiredness, which gradually improves.
• Mild abdominal discomfort, especially when getting up from sitting or coughing.
• Some light vaginal bleeding or discharge, particularly if combined with hysterectomy or vaginal surgery.
• A gradual return of appetite and bowel function. Constipation is common in the first week; gentle movement, fluids, and fibre help.

Return to Activity

• Light activities and short walks: from a few days after surgery.
• Driving: usually once you can perform an emergency stop without pain and are off strong painkillers — often around one to two weeks for laparoscopic surgery and longer for open surgery.
• Desk-based work: often two to three weeks after laparoscopic surgery.
• Physical work, heavy lifting, intense exercise, and swimming: usually delayed until four to six weeks, sometimes longer after open surgery.
• Sexual activity: timing depends on whether other surgery was done at the same time; your surgeon will advise.

Follow-Up

You will typically have a follow-up appointment two to six weeks after surgery to check healing, review pathology results, and discuss next steps — including, where relevant, the plan for hormone therapy or further cancer treatment.

Risks and Complications

Oophorectomy is generally a safe operation in experienced hands, but, like any surgery, it carries risks. These include:

Short-Term Risks

• Bleeding during or after surgery, occasionally requiring transfusion.
• Infection — of the wound, the urinary tract, or inside the pelvis.
• Injury to nearby organs such as the bladder, ureters, or bowel. These are uncommon but possible, particularly when scar tissue or endometriosis is present.
• Blood clots in the legs or lungs. Compression stockings, early walking, and sometimes blood-thinning injections are used to reduce this risk.
• Reaction to anaesthesia, which is uncommon but possible.
• Conversion to open surgery if laparoscopic surgery becomes difficult or unsafe.

Longer-Term Considerations

The longer-term effects depend on whether one or both ovaries are removed and on age:

• After unilateral oophorectomy in a pre-menopausal person, the remaining ovary usually continues to produce hormones and release eggs. Periods generally continue, and natural pregnancy may still be possible.
• After bilateral oophorectomy before natural menopause, the body suddenly loses most of its estrogen and progesterone. This is called surgical menopause and is discussed in detail below.
• Emotional impact. Losing fertility, going through sudden menopause, or facing a cancer diagnosis are significant life events, and many people benefit from psychological support during and after this process.

Life After Oophorectomy

What life looks like after surgery depends most on whether one or both ovaries were removed, and on your age at the time of surgery.

After Removal of One Ovary

With one healthy ovary remaining, hormone production and ovulation typically continue. Menstrual cycles usually carry on as before, although they may be slightly less regular. Natural pregnancy is often still possible, though it may take longer. Menopause occurs around the usual age, though sometimes slightly earlier.

After Removal of Both Ovaries Before Menopause: Surgical Menopause

When both ovaries are removed before natural menopause, hormone levels drop suddenly rather than gradually. This is called surgical menopause. Symptoms can come on quickly and may include:

• Hot flushes and night sweats
• Sleep disturbance
• Vaginal dryness and discomfort during intercourse
• Mood changes
• Reduced libido
• Changes in skin, hair, and body composition

Beyond symptoms, the long-term loss of estrogen before the natural age of menopause is associated with an increased risk of osteoporosis (thinning of the bones), heart disease, and possibly cognitive changes. Because of this, major societies generally recommend that pre-menopausal people who undergo bilateral oophorectomy for non-cancer reasons be offered menopausal hormone therapy (HRT) at least until the typical age of natural menopause — around 50 to 51 — unless there are specific reasons not to. Whether hormone therapy is appropriate after surgery for hormone-sensitive cancers or in BRCA carriers is a more nuanced discussion and depends on personal medical history.

After Removal of Both Ovaries After Menopause

If natural menopause has already occurred, the hormonal changes from surgery are smaller, because the ovaries had already largely stopped producing estrogen. Recovery focuses on the surgical healing itself.

Bone, Heart, and Long-Term Health

After bilateral oophorectomy — especially before natural menopause — long-term care often includes:

• Bone-density monitoring (DEXA scans) and attention to calcium, vitamin D, and weight-bearing exercise.
• Periodic checks of blood pressure, cholesterol, and blood sugar.
• Discussion of hormone therapy where appropriate.
• Awareness of mood and cognitive well-being, with mental-health support if needed.

Sexual Health and Relationships

Changes in libido and vaginal comfort are common after surgical menopause but are usually treatable. Vaginal moisturisers, local estrogen preparations, lubricants, and pelvic-floor physiotherapy can all help. Open conversation with a partner, and with your doctor, makes a real difference. Many people return to a satisfying sexual life after recovery.

Emotional Well-Being

Even when surgery has clear medical benefit, it can bring grief — about fertility, about the body changing, or about a cancer diagnosis. Counselling, peer-support groups, and time all help. There is no “right” way to feel.

Fertility After Oophorectomy

Fertility considerations sit at the heart of many oophorectomy decisions, particularly for younger patients.

• After unilateral oophorectomy, natural conception is often still possible because the remaining ovary continues to release eggs.
• After bilateral oophorectomy, natural conception is no longer possible because there are no longer any ovaries to release eggs. The uterus, if still present, can still carry a pregnancy with donor eggs or with previously frozen eggs or embryos, depending on local laws and clinical suitability.

• Egg freezing — eggs are collected, frozen, and stored for future use.
• Embryo freezing — eggs are fertilised (usually with a partner’s or donor sperm) and the resulting embryos are frozen.
• Ovarian tissue freezing — an emerging option that may be considered in selected cases, particularly when there is no time for egg collection.

A reproductive medicine specialist can advise on which option, if any, fits the situation, the urgency of surgery, and individual circumstances.

Oophorectomy in Adolescents and Young Adults

Oophorectomy is rare in adolescents and young adults but does happen — most often for ovarian torsion, large or persistent cysts, certain benign tumours, or, less commonly, ovarian cancer. In this age group, doctors place strong emphasis on ovary-preserving surgery whenever it is safe. Even an ovary that looks badly damaged after torsion is often left in place, because tissue can recover, and the long-term hormonal effects of losing both ovaries in adolescence are significant.

When oophorectomy is unavoidable in a young person, care includes:

• Discussion with paediatric or adolescent gynaecology specialists.
• Genetic counselling if a hereditary cancer syndrome is suspected.
• Consideration of fertility-preservation options before surgery, where time and circumstances allow.
• Long-term planning for hormone replacement when both ovaries are removed, often until the typical age of natural menopause.
• Psychological support, including for parents and family.

Frequently Asked Questions

Will I go into menopause after oophorectomy?

Only if both ovaries are removed and you have not already gone through natural menopause. If one ovary is left in place, it usually continues to produce hormones, and your periods generally carry on.

Will I gain weight after oophorectomy?

Some people notice changes in body composition, particularly after surgical menopause — an increase in abdominal fat, and sometimes weight gain. This is influenced by hormones, age, activity level, and diet. Regular activity, a balanced diet, and, where appropriate, hormone therapy can help.

Can I still have a normal sex life?

Yes, most people return to a satisfying sex life after recovery. Some experience vaginal dryness or reduced libido after surgical menopause, but these symptoms are often manageable with local treatments, lubricants, hormone therapy, and open conversation with your partner and doctor.

How long does it take to recover fully?

Most people feel substantially better within two to three weeks after laparoscopic or robotic surgery, with full recovery by four to six weeks. Recovery from open surgery typically takes six to eight weeks or more.

Will my voice or appearance change?

No. Removing the ovaries does not cause voice changes or major changes in appearance. Skin and hair texture can shift gradually after menopause, but this is part of the broader hormonal transition and is not a sudden or dramatic change.

If I have a BRCA gene change, do I have to have both ovaries removed?

Risk-reducing salpingo-oophorectomy is one of the most studied ways to reduce ovarian cancer risk in BRCA carriers, and NCCN guidance describes it as a recommended option. Whether and when to have surgery is an individual decision, shaped by genetic counselling, family history, age, childbearing plans, and personal values. Salpingectomy alone, and intensive screening, are sometimes discussed as alternatives or interim steps.

Will I need hormone therapy after surgery?

If both ovaries are removed before natural menopause and there is no specific reason to avoid it, hormone therapy is often discussed — commonly continued until around the typical age of menopause. After cancer surgery, in BRCA carriers, or where there is a history of certain conditions, the decision is more individual.

Can I still have children after surgery?

If one ovary is preserved, natural pregnancy may still be possible. If both ovaries are removed, natural pregnancy is no longer possible, but if the uterus remains, pregnancy with previously frozen eggs or embryos, or with donor eggs, may be possible depending on the situation and local regulations.

Conclusion

Oophorectomy is a well-established gynaecological operation with a clear role — treating ovarian disease, addressing emergencies like torsion, and reducing cancer risk in high-risk individuals. For some patients it is life-saving; for others it relieves symptoms that have weighed on daily life for years; for others still it is a planned, preventive step taken with care.

The decisions surrounding oophorectomy — one ovary or both, surgical approach, fertility preservation, hormone therapy — are best made in conversation with a gynaecologist (and, where relevant, a gynaecologic oncologist, genetic counsellor, or reproductive medicine specialist). Understanding what the surgery involves, what recovery looks like, and what life afterwards may bring helps you take part in those conversations with clarity and confidence.