An oophorectomy is a surgical procedure to remove one or both ovaries. It may be done to treat ovarian cysts, cancer, endometriosis, or infections, or as a preventive measure for people at high genetic risk of ovarian or breast cancer. When both ovaries are removed in a premenopausal person, it immediately triggers surgical menopause.
Types of Oophorectomy
There are several variations of this surgery, and the terminology can be confusing. A unilateral oophorectomy removes one ovary, leaving the other intact. Because one ovary continues producing hormones and releasing eggs, this version preserves fertility and does not cause menopause. A bilateral oophorectomy removes both ovaries, ending the body’s primary source of estrogen and progesterone.
In many cases, the fallopian tubes are removed along with the ovaries. This combined procedure is called a salpingo-oophorectomy. It can also be unilateral or bilateral. Bilateral salpingo-oophorectomy (often abbreviated BSO) is frequently performed alongside a hysterectomy, since the surgical access is already in place.
Why It’s Done
The most common reasons for oophorectomy fall into a few broad categories.
Ovarian masses and cysts. Simple ovarian cysts smaller than 10 cm that aren’t causing symptoms can often be monitored without surgery. But complex masses, large cysts with a risk of twisting (torsion), or masses suspected of being cancerous typically require removal. If a mass is found during pregnancy, surgery is ideally done in the second trimester when it’s safest.
Ovarian torsion. When an ovary twists on its blood supply, surgeons usually try to untwist it and save the organ. Oophorectomy is reserved for cases where the tissue has already died and can’t be salvaged.
Endometriosis. Tissue similar to the uterine lining can grow on or around the ovaries, forming cysts called endometriomas. When these don’t respond to other treatments, removing the affected ovary may be recommended.
Cancer treatment. Ovarian cancer that has already developed is a clear indication for surgery. Oophorectomy may also be part of treatment plans for hormone-sensitive breast cancers, since removing the ovaries eliminates a major source of estrogen that can fuel tumor growth.
Cancer risk reduction. For people carrying BRCA gene mutations, which dramatically increase the lifetime risk of ovarian and breast cancer, preventive bilateral salpingo-oophorectomy can be life-saving. Data from a large National Cancer Institute study illustrates the difference: among BRCA carriers who didn’t have the surgery, about 3.5% died from ovarian cancer during the study period, compared with roughly 0.25% of those who did. Breast cancer deaths dropped from about 2% to 1%.
Infection. Oophorectomy for pelvic inflammatory disease or tubo-ovarian abscess is rarely needed, since antibiotics remain the first-line treatment.
How the Surgery Is Performed
There are three main surgical approaches. Minimally invasive surgery (laparoscopic or robot-assisted) uses several small incisions and a camera to guide the procedure. This approach is associated with less surgical trauma, shorter hospital stays, and lower overall healthcare costs. It’s the preferred method for most benign conditions.
Open surgery (laparotomy) uses a larger abdominal incision and is more common when cancer is suspected or confirmed, since it gives the surgeon better visibility and access. A middle-ground option, mini-laparotomy, uses a smaller incision of about 5 to 7 cm and aims to combine the benefits of both approaches.
Overall complication rates are low. One study of risk-reducing surgeries found intraoperative complications in about 3% of cases and postoperative complications in about 4.5%.
Surgical Menopause After Bilateral Oophorectomy
When both ovaries are removed before natural menopause, the body loses its main source of estrogen almost overnight. Unlike natural menopause, which unfolds gradually over years, surgical menopause is abrupt, and the symptoms tend to be more severe as a result.
Common symptoms include hot flashes, night sweats, insomnia, vaginal dryness, mood changes including depression, difficulty concentrating, and skin thinning. Sexual health is also affected: studies report decreased libido, difficulty with arousal, and a threefold increase in the risk of not being able to reach orgasm. These effects are most pronounced in people who don’t receive hormone replacement after surgery.
Long-Term Health Risks
The sudden drop in estrogen doesn’t just cause symptoms. It raises the risk of several serious conditions over time.
Bone loss. The skeleton depends on estrogen to maintain its density. After bilateral oophorectomy, bone loss can reach up to 20% in the first 18 months alone. One study measured an 8.5% decline in spine bone density and a 5.7% decline at the hip over just 18 months. More than 75% of the bone mass lost in the first 20 years after menopause is driven by estrogen deficiency rather than aging itself, making this a particular concern for younger patients.
Cardiovascular disease. Without estrogen’s protective effects, levels of harmful cholesterol rise, accelerating the buildup of plaque in arteries. The younger a person is at the time of surgery, the greater the cumulative cardiovascular risk over their lifetime.
Cognitive decline. Earlier age at oophorectomy has been linked to increased risk of cognitive decline and Alzheimer’s disease. Small trials have shown that starting estrogen therapy promptly after surgery can improve verbal memory in the short term.
Hormone Therapy After Surgery
For premenopausal people who have both ovaries removed, hormone therapy is recommended regardless of whether symptoms are present, because it addresses the long-term health risks of estrogen loss. Current guidelines advise continuing hormone therapy at least until the average age of natural menopause (around 50 to 51) to help prevent osteoporosis and heart disease.
Hormone therapy provides the greatest benefit when started soon after surgery rather than years later. There is no universally recommended cutoff for how long to continue it. As long as the lowest effective dose is used and the person has regular follow-up, there’s no need to impose an arbitrary time limit. The decision is individualized based on each person’s risk profile, particularly whether they have a history of hormone-sensitive cancer that might make estrogen replacement inappropriate.
Fertility Preservation Before Surgery
If you’re facing a bilateral oophorectomy and want the option of biological children in the future, fertility preservation should be discussed before the procedure. Several options exist.
- Egg freezing (oocyte cryopreservation) involves stimulating the ovaries with hormones, then surgically retrieving mature eggs to freeze. This doesn’t require a partner or donor sperm, making it the most flexible option for many people.
- Embryo freezing follows the same stimulation and retrieval process, but the eggs are fertilized before freezing. This requires sperm from a partner or donor and generally offers good success rates depending on the number and quality of embryos stored.
- Ovarian tissue cryopreservation involves removing and freezing small fragments of ovarian tissue, which can potentially preserve thousands of follicles in a single procedure. This approach is still considered experimental but may be the only option when there isn’t time for ovarian stimulation.
- Immature egg retrieval collects eggs during surgery that are then matured in a lab and frozen. This is another option when stimulation isn’t feasible.
Of these, egg and embryo freezing remain the most established methods and the most likely to result in a future pregnancy.
Recovery Timeline
Recovery depends heavily on the surgical approach. Minimally invasive procedures generally allow a faster return to normal activities than open surgery. Most people who have laparoscopic oophorectomy can expect to return to light daily activities within one to two weeks. Open surgery typically requires a longer recovery, often four to six weeks before resuming full activity including exercise and heavy lifting. Your surgical team will give you specific restrictions based on your procedure, but in general, driving, lifting anything heavy, and sexual activity are off limits for the first few weeks regardless of approach.