What Is a Salpingo-Oophorectomy? Procedure Explained

A salpingo-oophorectomy is a surgical procedure that removes one or both ovaries along with the attached fallopian tubes. When both sides are removed, it is called a bilateral salpingo-oophorectomy (BSO); when only one side is removed, it is a unilateral salpingo-oophorectomy. The surgery is performed for a range of reasons, from treating ovarian cancer and endometriosis to preventing cancer in people who carry high-risk gene mutations. Because the ovaries are the body’s main source of estrogen and progesterone, removing them has consequences that extend well beyond the pelvis, affecting the heart, bones, brain, and sexual health in ways that deserve careful consideration before surgery.

Why the Surgery Is Performed

The reasons for a salpingo-oophorectomy generally fall into two camps: treating an existing problem or preventing a future one. On the treatment side, common indications include ovarian cancer, large or suspicious ovarian cysts, severe endometriosis, ovarian torsion (when the ovary twists on its blood supply), and tubo-ovarian abscesses that do not respond to antibiotics. The procedure is also part of the standard surgical staging for ovarian cancer, which typically includes a total hysterectomy alongside removal of both tubes and ovaries.

On the prevention side, what doctors call a “risk-reducing” salpingo-oophorectomy (RRBSO) is offered to people with BRCA1 or BRCA2 gene mutations, whose lifetime risk of ovarian cancer is dramatically higher than the general population’s. For context, the lifetime risk of ovarian cancer in people without these mutations is only about 1.4 to 1.8%.¹ That relatively low baseline risk is one reason the decision to remove healthy ovaries at the time of a hysterectomy for benign conditions has become more controversial in recent years. Historically, surgeons routinely recommended BSO alongside hysterectomy for anyone over 40 or 45, assuming the ovaries had outlived their usefulness. That thinking has shifted as research revealed the long-term health costs of losing ovarian hormones early.²

How Effective Is It at Preventing Cancer?

For BRCA mutation carriers, the cancer-prevention numbers are striking. Risk-reducing salpingo-oophorectomy performed before age 35 to 45 reduces the risk of ovarian and peritoneal cancer by roughly 95%.³ The procedure also cuts breast cancer risk by about half to two-thirds, since the ovaries produce hormones that fuel many breast cancers.⁴ On top of that, when the removed tissue is carefully examined by pathologists, occult (hidden) cancers that had not yet caused symptoms are found in a meaningful percentage of cases, sometimes picked up only through detailed sectioning of every bit of tube and ovarian tissue.

In one prospective study of BRCA1/2 carriers undergoing risk-reducing surgery, about 18% of the occult cancers discovered originated in the fallopian tube rather than the ovary itself, reinforcing why modern guidelines insist on removing the tubes along with the ovaries and examining all tissue thoroughly.⁵ A separate study found that when a detailed pathology protocol was followed, seven occult cancers were uncovered from 41 specimens, four of them in the fallopian tubes. All seven were found only when the tissue was sectioned according to protocol; standard examination would have missed them.⁶

One important caveat: the surgery does not eliminate cancer risk entirely. A small residual risk of primary peritoneal cancer remains, because the lining of the abdomen (the peritoneum) shares a developmental origin with the ovary’s surface. That said, research at specialist centers suggests the residual risk is very low, far below what would be expected without surgery.³

Laparoscopic Versus Open Surgery

The procedure can be done through small incisions using a camera (laparoscopically) or through a larger abdominal incision (open surgery, also called laparotomy). In practice, most salpingo-oophorectomies today are performed laparoscopically or with robotic assistance unless the clinical situation demands an open approach, such as large pelvic masses or advanced cancer where the surgeon needs direct access.

The advantages of the laparoscopic route are well documented. Compared with open surgery, laparoscopic salpingo-oophorectomy leads to a shorter hospital stay, less pain medication use, and a faster return to full activity.⁷ One study comparing the two approaches found a 25% rate of postoperative complications in the open-surgery group compared with 0% in the laparoscopic group, along with shorter hospital stays and an earlier return to work with laparoscopy.⁸ The trade-off used to be higher hospital charges for laparoscopy due to specialized equipment costs, though that gap has narrowed as the technique has become standard.

What Recovery Looks Like

For laparoscopic procedures, recovery is quicker than many people expect. In a study of patients undergoing prophylactic surgery in an ambulatory (same-day) hospital setting, the average stay was about seven hours, and nearly four out of five patients felt well enough to go home at discharge. No one required readmission. On average, patients returned to full-time work in about 16 days, though the range was wide, from as little as one day to nearly eight weeks.⁹

The complication rate is generally low. A retrospective study of 246 women undergoing risk-reducing surgery found that about 6% experienced complications. The majority were minor, such as pain or superficial infection not needing antibiotics, while the rest were infections that did require antibiotics. No serious surgical complications (organ injury, hemorrhage requiring reoperation, or death) occurred.¹⁰

One finding worth noting: roughly 43% of patients in the ambulatory study felt they were not well informed about what to expect after surgery, even though they had received preoperative counseling.⁹ That gap between what people are told and what they actually experience, particularly regarding menopausal symptoms and emotional adjustment, is a recurring theme in the research and something to ask your surgical team about in advance.

Surgical Menopause and Its Immediate Effects

When both ovaries are removed in someone who has not yet reached natural menopause, the result is surgical menopause, an abrupt drop in estrogen and progesterone. This is not the same as natural menopause, where hormone levels taper gradually over five to ten years. After bilateral oophorectomy, estrogen deficiency appears suddenly and is permanent.¹¹ For many people, the intensity of symptoms, including hot flashes, night sweats, mood changes, sleep disruption, and vaginal dryness, is more severe than what occurs during a natural transition precisely because of that sudden hormonal cliff.

The consequences extend beyond the classic menopausal symptoms. The early loss of ovarian hormones affects multiple body systems, including the cardiovascular, neurological, skeletal, and connective tissue systems, and can compromise quality of life through vasomotor symptoms, mood disturbance, sleep problems, and sexual function changes.¹² This is why the age at which the ovaries are removed matters so much: the younger you are, the more years of estrogen exposure you lose, and the greater the potential downstream impact.

Cardiovascular Risks After Ovary Removal

Heart disease is one of the most serious long-term concerns. Women who undergo bilateral oophorectomy before age 45 face a higher rate of death from cardiovascular disease compared with women who keep their ovaries. In the Mayo Clinic Cohort Study, the risk was nearly doubled in those who did not receive estrogen therapy after surgery.¹³ Estrogen therapy appeared to erase much of that excess risk: women who started estrogen at the time of surgery and continued at least until the typical age of natural menopause did not show the same increased mortality.

A large study of premenopausal Chinese women echoed these findings, reporting that hysterectomy with bilateral oophorectomy was associated with a 19% higher risk of cardiovascular disease, with younger age at surgery amplifying the relative risk.¹⁴ A Danish nationwide cohort study also found that women under 45 who had BSO at the time of benign hysterectomy had a measurably higher ten-year risk of being hospitalized for cardiovascular disease.¹⁵

Taken together, the pattern is clear: removing the ovaries before natural menopause carries a cardiovascular penalty, and the penalty grows the younger the surgery is performed. Estrogen therapy can offset much of that risk, which is why hormone management after surgery is a critical part of the conversation.

Bone Loss After Surgery

Estrogen plays a central role in maintaining bone density. When the ovaries are removed before menopause, bone loss accelerates rapidly. In premenopausal women who underwent prophylactic BSO, bone density at the lumbar spine dropped by roughly 3.5% per year, with the femoral neck and total hip losing about 2 to 3% per year.¹⁶ Another study of high-risk women found an 8.5% decline in lumbar spine density and about a 5.7% decline at both hips over just 18 months of observation without treatment.¹⁷

That speed of loss is alarming enough to warrant baseline bone density scans before or shortly after surgery, along with discussions about calcium, vitamin D, weight-bearing exercise, and, if appropriate, hormone replacement or other medications to slow bone breakdown. It is worth noting that one older study suggested the surgical procedure itself is not the main driver of eventual bone loss so much as the patient’s age and the total duration of menopause.¹⁸ In practical terms, though, the earlier the surgery, the longer the cumulative exposure to low estrogen, and the greater the risk of osteoporosis and fractures if no intervention is provided.

Cognitive and Neurological Concerns

The relationship between early ovary removal and brain health has received growing attention. A large study from the Mayo Clinic found that premenopausal bilateral oophorectomy before age 46 was associated with more than double the odds of being diagnosed with mild cognitive impairment later in life, along with measurable declines in global cognition and attention.¹⁹ Separate research has suggested that memory decline may begin within six months of oophorectomy in middle-aged women, particularly for working memory, and that estradiol therapy may help preserve this ability.²⁰

The data from the Mayo Clinic’s broader cohort work on oophorectomy and aging puts the risk increase for cognitive impairment at about 60% and for parkinsonism at about 80%, with even greater risks when surgery occurs before age 45.²¹ Again, estrogen therapy initiated at the time of surgery and maintained until the age of natural menopause appears to substantially reduce these neurological risks. The recurring message across systems is that hormone replacement is not an optional add-on but a core part of managing the downstream effects of early ovary removal.

Sexual Function and Emotional Impact

The effect on sexual health is one of the most underappreciated aspects of the surgery. The ovaries produce not just estrogen but also testosterone and other androgens that contribute to sex drive. A prospective controlled study found that two years after risk-reducing surgery, sexual dysfunction had risen from 19% to 42% in the surgical group, compared with a much smaller increase in a comparison group. Desire, arousal, lubrication, and satisfaction all declined significantly, and sexual distress nearly quadrupled.²² Sexual pain and discomfort also increased meaningfully in the surgical group.

These findings align with a cross-sectional study from China, which reported sexual dysfunction in about 46% of patients after risk-reducing salpingo-oophorectomy. Despite these quality-of-life impacts, roughly 90% of participants in the same study expressed complete satisfaction with having had the surgery, and only about 6% reported persistent psychological stress.²² The paradox of high satisfaction alongside significant sexual dysfunction captures the reality that for people at very high cancer risk, the trade-off still feels worth it, even when the side effects are real and lasting. Preoperative counseling that honestly addresses sexual changes, rather than glossing over them, helps people prepare for and manage these effects.

Hormone Therapy After Surgery

For premenopausal people who undergo bilateral salpingo-oophorectomy, the question of hormone replacement therapy (HRT) is not really whether to use it but rather the specific formulation and duration. The Mayo Clinic cohort data show that starting estrogen at the time of surgery and continuing until the average age of natural menopause (around 51 to 52) significantly reduces most of the increased risks associated with early ovary removal, including cardiovascular disease, cognitive decline, and bone loss.²¹

A common worry for BRCA mutation carriers is that taking hormones after surgery might undo the breast cancer protection the procedure provides. The evidence on this point is reassuring. Observational data suggest that short-term HRT use of about three to five years following risk-reducing surgery does not increase breast cancer risk in BRCA carriers.²³ This is a relief for the many people who undergo the surgery in their 30s or early 40s and face the prospect of decades without ovarian hormones if they avoid HRT.

Fertility Preservation and Unilateral Surgery

For younger patients facing ovarian cancer, the tension between cancer treatment and fertility is acute. The standard surgical approach calls for bilateral salpingo-oophorectomy, but in carefully selected cases, such as early-stage epithelial ovarian cancer or borderline tumors, fertility-sparing surgery is an option. This means removing the affected ovary and tube while preserving the uterus and at least part of the other ovary.²⁴ This approach requires close ongoing surveillance but allows the possibility of future pregnancy.

For people who are not facing cancer but may eventually need bilateral surgery (for instance, BRCA carriers who have not yet completed their families), the timing of risk-reducing surgery becomes a personal calculation. Guidelines generally recommend RRBSO for BRCA1 carriers by age 35 to 40 and for BRCA2 carriers by 40 to 45, but individual circumstances like family history, whether childbearing is complete, and personal comfort with ongoing screening all factor in. Egg or embryo freezing before surgery is another option that can decouple the cancer-prevention decision from the fertility timeline.

When Ovaries Are Removed During Hysterectomy for Benign Conditions

Perhaps the most consequential shift in surgical thinking involves people who are having a hysterectomy for a non-cancerous reason, such as fibroids or heavy bleeding, and whose surgeon raises the question of removing the ovaries at the same time. Historically, the logic was straightforward: the ovaries are right there, ovarian cancer is hard to detect, so take them out. But the lifetime risk of ovarian cancer in the general population is low, while the health penalties of losing ovarian hormones early are now well documented across the cardiovascular, skeletal, neurological, and sexual domains.¹

Current thinking favors ovarian conservation in most premenopausal patients undergoing hysterectomy for benign disease, unless there is a specific indication for removal such as a known genetic mutation or strong family history. For someone without elevated cancer risk, the math usually favors keeping the ovaries. The protection they offer for the heart, bones, and brain over the years to come generally outweighs the small cancer-prevention benefit of removal. That said, the decision is ultimately individual, and a good surgeon will walk through the trade-offs rather than defaulting to automatic removal.

What Pathologists Look for in Removed Tissue

After the ovaries and tubes come out, the tissue goes to pathology for examination. In risk-reducing procedures, this is not a formality. A specialized protocol known as SEE-FIM (Sectioning and Extensively Examining the FIMbriated end of the fallopian tube) involves cutting the entire tube and ovary into thin sections and examining every piece under a microscope. The fimbriated end of the tube, the finger-like projections closest to the ovary, is where many early cancers originate.

The importance of this thorough approach was underscored by a study that found all seven occult malignancies in BRCA carriers were discovered only in tissue that had been processed according to the detailed sectioning protocol. Standard pathology processing missed them.⁶ If you are undergoing risk-reducing surgery, it is worth confirming that your surgical and pathology teams follow this protocol.

Salpingectomy Alone as an Alternative

An emerging strategy, particularly for people at average ovarian cancer risk, is removing only the fallopian tubes (salpingectomy) while leaving the ovaries in place. This approach is based on the growing understanding that many ovarian cancers actually start in the fallopian tubes. By removing the tubes at the time of a hysterectomy or other pelvic surgery, you may capture much of the cancer-prevention benefit while preserving the ovaries’ hormonal function. This is sometimes called “opportunistic salpingectomy.” For BRCA carriers, salpingectomy alone is not yet considered an adequate substitute for full RRBSO, though clinical trials are investigating whether a two-stage approach (tubes first, ovaries later) might allow carriers to delay surgical menopause while still reducing risk. The research here is ongoing, and the answer is not yet settled.