Oophorectomy 101: Everything You Need to Know About Ovary Removal

Note: Oophorectomies can be given as part of gender-affirming care. The following article specifically delves into ovary removal surgery as it relates to cisgender women. 

Some people might assume that, when you have your uterus removed via hysterectomy, the surgeon also takes out your ovaries. While that can happen depending on medical necessity, ovary removal goes by a different name—and it often happens on its own, sans hysterectomy.

Enter: the oophorectomy. 

This mouthful of a name refers to removing one (unilateral) or both (bilateral) ovaries. Here, we’ll get into why women receive oophorectomies and what to expect, surgery and recovery wise, for the more common type of ovary removal.

A Somewhat Quick Dive Into Oophorectomy Risk 

We have to talk about something major first: Doctors typically try to avoid unnecessarily removing ovaries in premenopausal women due to increased risk of health problems. For these women, removing both ovaries means surgical menopause, which is exactly what it sounds like: menopause stemming from removal of your ovaries. There’s an “immediate cessation of ovarian production of estrogen, progesterone and testosterone,” describes a 69-year trend report of oophorectomies in a specific area of the United States.

The data about this risk, on paper, is convincing—though still emerging.

For example, a small 2023 study published in the journal Menopause found that women who underwent bilateral oophorectomies when they were premenopausal and younger than 46 had increased risk of arthritis, bone fractures, obstructive sleep apnea and asthma compared to women who didn’t receive that procedure. Older research links premenopausal bilateral oophorectomies to cardiovascular disease, neurological issues and disorders and mental health concerns. 

To add to this, Dr. Louise Perkins King, a gynecologic surgeon from Brigham and Women’s Hospital’s Division of Minimally Invasive Gynecology Surgery, tells Flow Space, “Surgical menopause is associated with increased risk of cardiovascular disease, bone loss and early-onset dementia.” For those reasons, when she sees patients in their reproductive years—including women experiencing perimenopause—she aims to save their ovaries if possible.

Dr. Caitlin Waters, a clinical assistant professor and minimally invasive gynecologic surgeon at Stony Brook Medicine, has the same ovary-preserving objective. “In general, we try to really save the ovaries until the age of menopause,” she says.

That’s especially true for benign (AKA, noncancerous) cases.

For instance, if doctors find ovarian growths they suspect are not cancer, they’ll typically start by just removing the growths, Waters explains. The estrogen and progesterone that your ovaries produce are helpful for heart and bone health, she says. And even though taking out one ovary—if only one is impacted—wouldn’t result in a super significant hormonal drop, doctors should first try removing the growth as opposed to the whole ovary, Waters explains. 

What’s more, because your ovaries may produce low amounts of estrogen even after you’ve reached menopause, Waters and King agree that there could be some continued risk in removing your ovaries.

Reasons Someone Would Need an Oophorectomy

All this said, there are times when oophorectomies are necessary.

They’re done, for example, as part of ovarian or uterine cancer treatment and as a preventative procedure for folks with BRCA mutations who have an increased risk of cancers like ovarian and breast cancer, saysKing. 

People with severe endometriosis who haven’t responded to other treatment options may choose to remove their ovaries, especially while getting a hysterectomy. Getting a bilateral oophorectomy can help with painful endometriosis flareups caused by the hormonal fluctuations of a “normal” period, says Waters. Going on hormone replacement therapy (HRT) after an oophorectomy can keep hormone levels more consistent instead, she explains.

Additionally, an oophorectomy will be recommended to remove a twisted ovary (ovarian torsion) whose tissue dies from lack of blood flow, Waters explains. The same goes for ovaries impacted by an infection called a “tubo-ovarian abscess,” she says. You don’t always need to get an oophorectomy to treat this infection, but it’s sometimes necessary when you aren’t responding well to antibiotics or doctors can’t drain the area properly, she notes.

Lastly, oophorectomies are still an option for anyone who has benign ovarian cysts that are persistent, large and/or painful, says King.

What to Expect From the Surgery 

If you’re removing one or both ovaries for something benign, the surgery itself isn’t terribly complicated, especially if you’re getting a minimally invasive procedure. King says this type of oophorectomy is done laparoscopically.

With a minimally invasive oophorectomy, your surgeon would make a very small incision in your belly button area, where they’d place a camera. Next, they’d “make between two and four other small incisions in a halo around the body [so they can] operate with long instruments in the pelvis,” King explains. 

“We would separate the ovaries from their blood supply, and then put them into a bag within the abdomen to keep them contained. Then, we would bring the bag out through [one of those incisions],” King describes, noting that she usually uses the belly button site. Stitches are typically dissolvable, she adds. 

Surgeons will sometimes pull out the corresponding fallopian tubes. In that case, the specific procedure would be referred to as a salpingo-oophorectomy, says King.

The incision is usually bigger if they’re extracting your ovaries while also removing cancer of the uterus, King notes. Same goes with ovarian cancer. “Frequently, ovarian cancer is hard to detect, and by the time we find it, it’s fairly advanced, which requires more of an open surgery,” she explains. This “open” oophorectomy is referred to as a laparotomy. 

Ovaries can be removed vaginally too, but that seems to be less common, according to the experts Flow Space spoke with.

Oophorectomy Recovery Details

If the procedure is minimally invasive, most people go home the same day, and recovery takes around two weeks, King notes. Waters agrees, noting that she’s seen people recover in two to four weeks. (By comparison, an oophorectomy that’s done with an “open” approach and wider incision would have a longer recovery time of about six weeks, says Waters.)

While you shouldn’t lift anything heavy for about a month to decrease your hernia risk, walking around is encouraged to avoid blood clots, says King. For incision site pain, she will give her patients a very short course of opiates and then tell them, if needed, to take over-the-counter pain relievers.

Once you’re cleared by your surgeon, these experts say that further followup appointments depend on why you needed an oophorectomy in the first place and your pathology results. (You might go to your PCP, your general gynecologist and/or an oncologist.)  

Let’s Talk About Surgical Menopause

It’s one thing to deal with a healing incision site; it’s another to be thrust into the throes of surgical menopause. Women who get both their ovaries removed before reaching natural menopause could deal with symptoms like night sweats and hot flashes.

That said, the severity differs per person, says King.

“For the patients [who] have severe symptoms, it’s abrupt. And in that sense, I think it’s probably harder than the gradual onset of menopause,” King says. Waters agrees. The mere fact that menopause symptoms come on so rapidly might make them feel more significant, she notes. 

If these menopausal symptoms are difficult to manage, King says that hormone therapy can help, but she cautions against starting it right away. She suggests patients wait to implement hormone therapy until at least two weeks post-surgery since it can increase blood clot risk. 

Waters, on the other hand, says that because doses of hormones can be fairly low—and also because blood clot risk is minimal for people who can easily walk around post-surgery—it may be safe to start HRT right after an oophorectomy. So, it’s a mixed bag (read: check with your provider).

The good news is that women who have one ovary left will not go through surgical menopause—and their period usually won’t be impacted, both doctors say. 

Surgical menopause definitely isn’t ideal, but a key takeaway is that some women don’t have a choice.

“We don’t want to remove any more organs than we have to remove,” says Waters, “but if that is recommended because of concern for cancer, [for example,] please take that recommendation into consideration.”