Having surgery on your ovaries or uterus often leads women to wonder if they can or should keep their ovaries afterwards. This is an important decision that requires weighing the risks and benefits. There are a few key factors to consider when deciding whether to remove your ovaries or keep them during gynecologic surgery.
Why Would Ovaries Be Removed During Surgery?
There are a few common reasons ovaries may be recommended for removal during surgery:
- Ovarian cancer – Removal of the ovaries and fallopian tubes (salpingo-oophorectomy) is often recommended for treating ovarian cancer. This helps ensure all of the cancerous tissue is removed.
- Uterine cancer – Sometimes removal of the ovaries is recommended with a hysterectomy for uterine or endometrial cancer, even if the ovaries themselves are not cancerous. This is because estrogen produced by the ovaries can stimulate growth of uterine cancer cells.
- Breast cancer – Women at high risk of breast cancer may elect to have their ovaries removed as a preventative measure, as estrogen produced by the ovaries is linked to increased breast cancer risk.
- Endometriosis – Severe endometriosis may be treated with removal of the ovaries and uterus (hysterectomy with bilateral salpingo-oophorectomy).
- Genetic mutations – Women who test positive for genetic mutations like BRCA1 or BRCA2 that increase ovarian cancer risk may choose to have their ovaries removed preventatively.
- Pelvic pain – Sometimes removal of the ovaries is recommended to treat chronic pelvic pain that doesn’t respond to other treatments.
In these situations, the potential benefits of ovarian removal may be determined to outweigh the risks.
Benefits of Keeping Ovaries
Although ovarian removal is sometimes clearly beneficial, there are advantages to keeping your ovaries when possible:
- Avoid surgical menopause – Keeping your ovaries means you avoid suddenly going into menopause after surgery. This allows a more natural transition.
- Reduce menopausal symptoms – Keeping your ovaries can prevent severe hot flashes, mood changes, vaginal dryness, and other menopausal symptoms caused by the abrupt drop in estrogen.
- Lower heart disease risk – Removal of the ovaries is linked to higher risks of cardiovascular disease. Ovarian estrogen production helps protect heart health.
- Stronger bones – Estrogen helps maintain bone density. Ovary removal increases the risk of osteoporosis.
- Improved quality of life – Avoiding surgical menopause can help maintain energy levels, sleep, sex drive, and overall quality of life.
For women who are premenopausal, keeping the ovaries can prevent or reduce many of the challenging symptoms and health effects of menopause.
Risks of Keeping Ovaries
However, there are some potential downsides to keeping your ovaries in certain situations:
- Cancer recurrence – For ovarian or uterine cancers, leaving the ovaries means there is still a chance of cancer cells being left behind which could lead to recurrence.
- New ovarian cancer – Although rare before menopause, there is always a small risk of developing a new ovarian cancer later on.
- Cysts – Ovarian cysts may still develop and sometimes require additional surgery.
- Continued pelvic pain – For some gynecologic conditions causing pelvic pain, the ovaries may be involved, in which case leaving them could mean ongoing pain.
For women at high cancer risk, the benefits of ovary removal often outweigh these risks. But for others, keeping the ovaries may be safer if cancer is not a concern.
Surgical Menopause Symptoms
Understanding the potential symptoms and health impacts of surgical menopause can help inform the decision of whether or not to remove the ovaries:
| Menopausal Symptom | Description |
|---|---|
| Hot flashes | Sudden sensations of intense heat and sweating, lasting 1-5 minutes |
| Night sweats | Severe hot flashes at night causing sweating and sleep disruption |
| Vaginal dryness | Thinning and dryness of the vaginal lining leading to painful intercourse |
| Mood changes | Irritability, anxiety, depression |
| Difficulty concentrating | Reduced ability to focus and multitask (“brain fog”) |
| Bone loss | Accelerated osteoporosis leading to fractures and reduced height |
| Cardiovascular disease | Increased risk of heart attack and stroke |
| Loss of sex drive | Reduced libido and sexual functioning |
These effects can significantly reduce quality of life but are often less severe when the ovaries are retained compared to full surgical menopause.
Surgical Options to Keep Ovaries
There are a few different surgical approaches that may allow the ovaries to be retained:
- Oophorectomy – Only one ovary is removed, while the remaining ovary is left to continue functioning.
- Tubal ligation – The fallopian tubes are removed in a tubal ligation or salpingectomy, but the ovaries remain.
- Partial hysterectomy – A partial hysterectomy removes just the uterus while leaving the ovaries and cervix intact.
- Radical trachelectomy – For cervical cancer, the cervix is removed while preserving the uterus and ovaries.
In some cases, one ovary may be removed due to a cyst or other issue, but leaving at least one intact can preserve ovarian function.
Oophorectomy Considerations
Some factors to weigh when considering removing just one ovary (oophorectomy) include:
- The remaining ovary may still allow normal hormone function.
- But over time, the lone ovary may deteriorate more rapidly.
- There is no guarantee the remaining ovary will fully compensate.
- May be adequate for women close to natural menopause age.
- Less optimal for younger women further from menopause.
Menopause After Ovary Removal
For women having both ovaries removed, surgical menopause begins immediately. The timing of menopause after an oophorectomy depends on age:
| Age at Oophorectomy | Menopause Onset |
|---|---|
| Younger than 45 | Immediate surgical menopause |
| 45-50 years old | Perimenopause followed by menopause within 2 years |
| Over 50 years old | Menopause typically occurs within 5 years |
Having just one ovary removed before natural menopausal age will usually delay menopause slightly but not induce immediate menopause.
Hormone Therapy Options
For women who have their ovaries removed, hormone therapy can help manage surgical menopause symptoms. Options may include:
- Estrogen therapy – Estrogen alone is given to women who have had a hysterectomy.
- Estrogen plus progesterone – Progesterone is given along with estrogen for women with an intact uterus to prevent uterine cancer.
- Extended-cycle regimens – Hormones are taken continuously without breaks to prevent monthly withdrawal bleeding.
- Lower hormone doses – Low-dose treatment helps minimize risks from prolonged exposure.
- Custom compounded hormones – Compounded bioidentical hormones are chemically identical to the body’s own hormones.
- Tibolone – A synthetic steroid hormone that has estrogen, progesterone, and testosterone effects.
- SERMs – Selective estrogen receptor modulators like ospemifene (Osphena) target vaginal tissue.
The best choice depends on the individual situation. Your doctor can help determine the most appropriate hormone therapy if your ovaries are removed.
Long-Term Effects of Ovary Removal Before Menopause
Some long-term health consequences can occur from ovary removal before natural menopause:
- Increased mortality – Women who have both ovaries removed before age 45 have a higher overall mortality risk.
- Cardiovascular disease – Risk of heart attack, stroke, and cardiovascular death increases without ovarian estrogen.
- Parkinson’s disease – Estrogen deficiency is linked to higher chances of developing Parkinson’s.
- Cognitive impairment – Surgical menopause may negatively impact memory and thinking skills.
- Bone loss – Osteoporosis and fracture risk is higher when the ovaries are removed.
- Sexual dysfunction – Lower estrogen levels can cause vaginal dryness, pain, and reduced libido.
- Bladder issues – Urinary control problems and incontinence become more common after ovary removal.
Hormone therapy and lifestyle approaches can help reduce some of these risks. But keeping the ovaries when possible is ideal.
Conclusion
Deciding whether or not to keep your ovaries during gynecologic surgery is an important choice that should balance your individual cancer risks against the risks of surgical menopause. For women at average ovarian cancer risk having hysterectomy for benign conditions, retaining healthy ovaries is often recommended. But if cancer is a major concern, preventative ovary removal may be the safest option. Discussing your unique situation with both a gynecologist and menopause specialist is key to making the best decision about your ovaries.