Oophorectomy

September 20, 2011

Oophorectomy, also called ovariectomy, is the surgical removal of one or both ovaries. According to the Centers for Disease Control and Prevention (CDC), 491,000 oophorectomies and salpingo-oophorectomies (surgical removal of the fallopian tubes along with the ovaries) were performed in the United States in the year 1998. Removal of the ovaries is often done along with a hysterectomy (removal of the uterus). The ovaries produce ova (reproductive egg cells) and the sex hormones androgens, estrogens, and progesterones. Excision of both ovaries (bilateral oophorectomy) causes a surgical menopause, with the cessation of menses and fertility.

Between the years 1988 and 1993, approximately 50% of women in the United States undergoing hysterectomy also had both ovaries removed. During these years, the proportion of women having oophorectomy along with hysterectomy increased. Oophorectomy was done more frequently when the surgical approach was abdominal—63% for abdominal hysterectomy versus 18% for vaginal hysterectomy. Approximately two thirds of women with a diagnosis of cancer or endometrial hyperplasia had an oophorectomy along with their hysterectomy. Younger women are less likely to have oophorectomy accompanying hysterectomy— the incidence is 18% in the 18to 24-year-old age group, 76% in those 45-54 years old, and 62% in women 55 years or older.

Oophorectomies are performed for a variety of reasons. With cancer of the ovary or ovaries, both ovaries are removed. In the past, prophylactic oophorectomy was often performed in women who were nearing menopause and undergoing hysterectomy in order to prevent future ovarian cancer. Since ovarian tissue can also grow elsewhere in the abdomen, oophorectomy does not always protect against the future development of ovarian cancer. Ovarian cancer, when caught early, has excellent 5-year cure rates. However, early detection is not common due to the lack of early signs and symptoms. Some high-risk women choose prophylactic oophorectomy to prevent ovarian and even breast cancer. Studies have shown significant risk reduction of both of these cancer types with the surgery, but the procedure is still somewhat controversial and the optimal timing for such intervention is not clear.

Prophylactic oophorectomy may also be performed in young women who have already developed breast cancer. Since some breast cancers grow larger in response to estrogen or progesterone, the removal of the ovaries can cut the supply of these hormones to the tumor. Other indications for oophorectomy are the excision of large ovarian cysts, removal of ovarian abscess, and treatment of endometriosis.

Obstetrician/gynecologists are the surgical specialists who perform oophorectomies. Oophorectomy may be carried out through an abdominal surgical incision— either horizontal or vertical. The surgery can also be done through the vagina, which speeds recovery. Another option with a relatively quick recovery time is laparoscopic surgery. With an abdominal incision, recovery typically takes up to 8 weeks while women who have vaginal and laparoscopic surgeries usually recover within 2-4 weeks. Surgery to remove ovarian cancer requires an abdominal incision.

Following bilateral oophorectomy, a woman usually receives treatment with female hormones, such as estrogen (if the uterus is also removed) or combination therapy of estrogen and progesterone if the uterus is left intact. Use of selective estrogen receptor modulators (SERMs) and testosterone replacement are two other options. If only one ovary is resected, the remaining ovary typically makes enough estrogen to negate the need for hormone replacement therapy postsurgically.

Women who have undergone bilateral oophorectomy and who do not take hormones may experience the usual signs and symptoms of menopause including hot flashes, sleep disturbance, vaginal atrophy, and decreased vaginal lubrication. A surgical menopause such as this causes an abrupt loss of ovarian secretion of androgens, estrogens, and progesterone. Potential psychological reactions include grief over the loss of the ability to become pregnant and/or depressive symptoms. Women who have experienced depression during times of significant hormonal shifts, such as during pregnancy or in the postpartum period, are more likely to experience depression following oophorectomy. Overall, the abrupt change in hormonal levels tends to produce more severe and pronounced symptoms than a natural menopause with its more gradual decrease in hormone production.

SEE ALSO: Hormone replacement therapy, Hysterectomy, Menopause

Suggested Reading

  • Kornstein, S. G., & Clayton, A. H. (Eds.). (2002). Women’s mental health: A comprehensive textbook. New York: Guilford Press.
  • Krasnoff, R. D. (1994). In P. B. Doress-Worters & D. Laskin Siegal (Eds.), The new ourselves, growing older: Women aging with knowledge and power (pp. 315-332). New York: Simon & Schuster.

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