A salpingo-oophorectomy is surgery to remove one or both ovaries along with the attached fallopian tubes. When one side is removed, it’s called a unilateral salpingo-oophorectomy. When both sides are removed, it’s a bilateral salpingo-oophorectomy. The procedure is performed for a range of reasons, from treating ovarian cysts and endometriosis to reducing the risk of ovarian and breast cancer in people with certain genetic mutations.
Unilateral vs. Bilateral: What Gets Removed
The distinction matters because the two versions of this surgery have very different consequences for your body. A unilateral procedure removes one ovary and its connected fallopian tube, leaving the other ovary intact. Because the remaining ovary continues producing hormones, you won’t go through menopause and may still be able to become pregnant.
A bilateral salpingo-oophorectomy removes both ovaries and both fallopian tubes. This permanently ends ovarian hormone production and fertility. In premenopausal people, it triggers immediate surgical menopause. The surgery is sometimes done at the same time as a hysterectomy (removal of the uterus), but it can also be performed on its own.
Why the Surgery Is Performed
There are several reasons a surgeon might recommend this procedure. Ovarian cysts, tumors, or abscesses that don’t respond to other treatments can require removal of the affected ovary and tube. Endometriosis that causes severe pain or hasn’t improved with medication is another common reason. Ovarian torsion, where the ovary twists and cuts off its own blood supply, sometimes requires emergency removal.
One of the most well-known reasons is cancer risk reduction. People who carry BRCA1 or BRCA2 gene mutations face a significantly elevated lifetime risk of ovarian and breast cancer. A risk-reducing bilateral salpingo-oophorectomy (sometimes abbreviated RRSO) can dramatically lower those odds. For people already diagnosed with ovarian, fallopian tube, or certain uterine cancers, the surgery is part of treatment and staging.
Surgical Approaches
There are three main ways this surgery is performed, and the approach your surgeon chooses depends on the size of whatever is being removed, whether cancer is suspected, and your overall health.
- Laparoscopic (minimally invasive): The surgeon works through a few small incisions using a camera and thin instruments. This approach is appropriate when the risk of cancer is low and any mass is relatively small. It results in less blood loss, a shorter hospital stay, and faster recovery.
- Open abdominal (laparotomy): A larger incision is made in the abdomen. This gives the surgeon better visibility and room to work, which is important when cancer staging is needed or a large mass is present. The tradeoff is more postoperative pain and a longer recovery.
- Vaginal approach: This is the least common method and is only used when a salpingo-oophorectomy is being done at the same time as a vaginal hysterectomy.
Robotic-assisted laparoscopic surgery is also an option at many centers. It uses the same small-incision concept but gives the surgeon enhanced precision through robotic instruments.
What Recovery Looks Like
Recovery time depends largely on which surgical approach was used. After laparoscopic or vaginal surgery, most people go home the same day or after an overnight stay. An open abdominal procedure typically requires up to three days in the hospital.
Regardless of the approach, you can expect three to six weeks of restricted activities. During this time, you’ll generally be advised to avoid heavy lifting, strenuous exercise, and sexual intercourse. Walking is usually encouraged early on to reduce the risk of blood clots. Your surgeon will set a follow-up appointment to check healing and let you know when it’s safe to return to your normal routine. Most people who have laparoscopic surgery feel noticeably better within two weeks, though full recovery takes longer.
Surgical Menopause After Bilateral Removal
If you haven’t already gone through menopause and both ovaries are removed, your body loses its primary source of estrogen, progesterone, and a significant share of its androgens (like testosterone) overnight. Unlike natural menopause, which unfolds gradually over years as hormone levels taper, surgical menopause is abrupt. That sudden drop often makes symptoms more intense.
Common symptoms include hot flashes, night sweats, vaginal dryness, mood changes, difficulty with memory and concentration, sleep disruption, and decreased sex drive. The impact on libido can be especially pronounced compared to natural menopause because the ovaries normally continue producing androgens even after they stop releasing eggs. Some research suggests that losing this androgen production through surgery has a measurable effect on sexual function.
Beyond day-to-day symptoms, the sudden loss of estrogen carries longer-term health consequences. Premenopausal people who undergo bilateral removal face increased rates of cardiovascular disease, accelerated bone density loss (raising the risk of osteoporosis and fractures), cognitive changes, and recurrent urinary tract infections. These risks are most significant for people who have the surgery well before the typical age of natural menopause, roughly 45 to 55.
Hormone Therapy After Surgery
For people who undergo bilateral salpingo-oophorectomy before age 40, current clinical guidelines are clear: hormone therapy is recommended until the typical age of menopause (around 50 to 51) to reduce the risk of the cardiovascular, bone, and cognitive problems described above. This recommendation holds even if you aren’t experiencing noticeable symptoms, because the protective effects of estrogen matter regardless of whether you feel its absence day to day.
The picture gets more nuanced for people who had the surgery because of cancer. If the cancer was hormone-sensitive, such as certain ovarian or uterine tumors, hormone therapy is generally avoided. But for cancers that aren’t driven by hormones, like squamous cell cervical cancer, hormone therapy is considered safe and is recommended. People with BRCA1 or BRCA2 mutations who had a risk-reducing surgery but have no personal history of breast cancer can also use hormone therapy. The decision always involves weighing individual risk factors, so the conversation with your care team matters.
Importantly, guidelines emphasize that people should be fully informed about the hormonal consequences of losing both ovaries before the surgery takes place, not after. Understanding what surgical menopause involves, and what hormone therapy can and cannot do, helps you plan ahead for recovery and long-term health.