Introduction

If a medical professional has recommended an oophorectomy (removal of ovaries) for you, or someone you know, then this article is for you. The goal here is to outline what this procedure entails and provide the necessary information to make an informed decision regarding surgery.  

Understanding oophorectomy 

An oophorectomy is the surgical removal of one or both ovaries.¹ 

The ovaries are the reproductive glands of people of the female reproductive sex. They are important in producing hormones, oestrogen and progesterone, and play an important role in fertility through ovulation, follicle (egg) development and hormonal feedback. They ensure that the female reproductive system functions as it should.

Medical conditions requiring oophorectomy 

An oophorectomy may be undertaken to manage imbalances in hormones, alleviate symptoms of benign (non-cancerous) ovarian conditions or reduce the risks of cancer development.^2,3 These include: 

• Treatment of ovarian cancer: If you have ovarian cancer, you may be recommended an oophorectomy to remove the cancerous tissue and minimise the chances of the disease spreading
• Prevention of ovarian cancer: An oophorectomy can be undertaken if you are found to have a high risk of developing ovarian cancer, such as mutations in the BRCA1 or BRCA2 gene to minimise your risk of developing cancer
• Treatment of benign ovarian conditions: Symptoms of non-cancerous ovarian conditions, such as endometriosis, benign tumours or ovarian cysts may be managed with an oophorectomy
• Hormonal management: For conditions such as severe endometriosis and hormone-sensitive cancers, that involve hormonal imbalances, oophorectomy may be recommended to reduce hormone production and reduce the symptoms experienced
• Risk reduction in hereditary conditions: If there is a family history of ovarian cancer then an oophorectomy can be recommended to reduce the risk of cancer development 
• As part of a hysterectomy: A hysterectomy is the surgical removal of the womb (uterus). This can be necessary in some cases of cancer, benign conditions or in cases of heavy periods. It may also be performed as part of gender affirmation surgery  

The decision to have an oophorectomy will be discussed with a healthcare provider considering your medical history, risk factors and treatment goals. 

Surgical procedure

There are two main types of oophorectomy; the recommended type will depend on your medical needs.¹ They are distinguished by how much ovarian tissue is removed during the surgery. They are either: 

• Unilateral oophorectomy: This procedure involves the removal of one ovary, leaving one intact. This may be performed in instances where only one ovary is affected by ovarian cancer or a benign condition, such as a cyst or non-cancerous tumour
• Bilateral oophorectomy: A bilateral oophorectomy involves the removal of both ovaries. This surgery may be undertaken in instances of ovarian cancer that affects both ovaries, ovarian cancer prevention, severe endometriosis, or gender-affirming surgery

The surgery may be carried out in the following approaches:^1,4

• Laparoscopically:  This approach involves a series of small incisions in the abdomen. It is associated with quicker recovery time and is minimally invasive
• Vaginally: The removal of the ovaries through the vagina 
• Laparotomy: Making a large incision in the abdomen, which may be necessary in some patients. This can be planned or may be necessary if laparoscopic surgery is not working. Recovery time is slightly longer than for laparoscopic surgery

How an oophorectomy is carried out can be discussed with a surgeon.^5,6 

Recovery and aftercare

Recovery and aftercare after an oophorectomy are important to manage symptoms, promote healing and support recovery. 

Following an oophorectomy, the length of hospitalisation can vary, depending on the patient's health and the type of surgery. Some may require an overnight stay whilst others can be discharged the same day as the surgery. It is important to follow medical guidance following surgery as to how long hospitalisation is necessary as this ensures optimum recovery. 

Many people experience pain or discomfort following surgery. This can be managed using over-the-counter pain relief and prescription medication. Furthermore, wound care following surgery is important to prevent infection. It is important to keep the incision clean and dry and follow medical guidance on how often dressings should be changed. Signs of infection should be reported to a healthcare provider, these include redness, swelling or drainage from the wound. 

Hormone replacement therapy 

Individuals who undergo bilateral oophorectomy may be offered hormone replacement therapy. (HRT). HRT intends to replace the hormones that are produced by the ovaries as the loss of the ovaries following oophorectomy results in sudden menopause (when your periods stop because of lower hormone levels).^7,8 

People who have an oophorectomy may choose to take HRT to alleviate the symptoms of menopause. These symptoms include: 

• Hot flushes 
• Night sweats
• Sleep problems 
• Mood swings 
• Anxiety and low mood 
• Vaginal dryness

HRT is not suitable for everyone. It is not recommended for people with high blood pressure, those with a history of blood clots or liver disease and people with a history of breast, ovarian or uterine cancer. There are alternative ways to manage the symptoms of menopause if you are unable to take HRT. 

Whether you are eligible for HRT following an oophorectomy will be discussed with a healthcare provider. They will consider your symptoms and medical history to decide if this treatment is appropriate. 

Fertility

The impact of oophorectomy on fertility depends on whether both ovaries are removed. 

If only one ovary is removed, through unilateral surgery, then the ovary that remains can still produce hormones and it is still possible to get pregnant. Other factors can still impact fertility, so this is not guaranteed. 

If both ovaries have been removed, through bilateral surgery, then it is not possible to get pregnant via sexual intercourse. Methods such as in vitro fertilisation (IVF) remain an option. It may be possible to freeze your eggs before the oophorectomy. 

Fertility options following oophorectomy can be discussed with your healthcare provider as this is a personal matter that depends on each individual's circumstances. 

Emotional and psychological impact 

Undergoing an oophorectomy can have a significant and emotional impact. This can be significant, and it is important to understand that some common psychological effects can include: 

• A feeling of loss of grief: Many individuals can feel a sense of loss at the removal of their reproductive organs
• Body image and self-esteem: Changes in hormone levels, menopausal symptoms, difficult recovery, and scars can contribute to low self-esteem or negative body image
• Sexuality and Intimacy: A change in hormone levels can have an impact on one’s desire for sexual activity. Some individuals experience discomfort during sexual activity, vaginal dryness or decreased arousal 
• Fertility concerns: Undergoing a bilateral oophorectomy means that you are no longer able to conceive via natural fertility. This can be emotionally challenging for individuals who wish to have children
• Hormonal changes: The removal of ovaries results in menopause, the symptoms of which can impact quality of life
• Coping with a cancer diagnosis: For those undergoing an oophorectomy as part of a cancer diagnosis, coping with worries of recurrence, treatment and mortality can be difficult 

It is necessary to know the potential emotional and psychological impact of an oophorectomy before undergoing one as this can allow you to make an informed decision whether to have the surgery and put into place the necessary support resources for yourself. Such resources include online forums or support groups, counselling or therapy or hospital-provided support. Preparing yourself for how an oophorectomy may impact you or someone you know having the surgery can make you more aware of recognising these feelings if they arise. 

Summary

In conclusion, an oophorectomy is the removal of one or both ovaries in the incidence of health concerns, such as cancer, or benign conditions or as a preventative measure. 

It is important when considering an oophorectomy that you fully understand what the surgery involves, why this is a good or necessary option and the risks associated with the surgery and recovery, both physical and psychological. For many, this is a difficult decision and requires a strong support system, from both a medical team and friends or family. Many support groups can be found online that can help navigate this surgery. 

Although oophorectomy carries risks, it can enhance the quality of life for individuals who undergo the procedure. Having a comprehensive understanding of the surgery allows you to engage in informed discussion with a healthcare professional when considering this as an option for you.