17800 Oophorectomy

Overview

An oophorectomy (say: oh-off-uh-REK-tuh-mee) is an operation to remove one or both ovaries. The ovaries are two small, almond-shaped organs in the lower belly, one on each side of the womb. They store and release eggs and make the hormones oestrogen and progesterone. Removing one ovary is called a unilateral oophorectomy. Removing both is called a bilateral oophorectomy. Sometimes the ovary is taken out together with its fallopian tube (the tube that carries eggs to the womb), and this is called a salpingo-oophorectomy. The surgery can be done through small cuts in the belly using a camera (keyhole surgery), or through a larger cut in the lower belly (open surgery).

Yes. Surgery on the ovaries is one of the more common operations in gynaecology (women's health care). Every year many thousands of people around the world have one or both ovaries removed.

Anyone who has ovaries can need this surgery. It is most often done in people in their 40s, 50s and 60s, but it can also be needed in younger adults, teenagers and, rarely, in children — for example if an ovary twists or a large cyst develops. People with a strong family history of ovarian or breast cancer, or who carry certain gene changes, may be offered surgery to lower their risk.

Symptoms

Common symptoms

• Pelvic pain or a dull ache low in the belly that does not go away
• Bloating or a swollen feeling in the tummy
• A lump or mass in the pelvis that was found on a scan or during an exam
• Period changes, such as irregular or heavy bleeding
• Feeling full quickly when eating, or losing appetite
• Pain during sex
• After surgery: mild pain, tiredness, and some vaginal spotting or discharge for a short time

Symptoms in children

• Ovarian problems are rare in children, but a twisted ovary can happen at any age
• Sudden severe belly pain, often with vomiting, which can come and go
• A swelling or lump in the lower belly
• Early puberty signs, which can sometimes be linked to certain ovarian growths

Symptoms in older adults

• Bleeding after the menopause — this should always be checked by a doctor
• Bloating, tummy swelling or feeling full quickly
• Changes in bowel or bladder habits, such as needing to pass urine more often
• Recovery after surgery can take a little longer, and it is important to think about bone and heart health after both ovaries are removed

Causes

Main causes

• An ovarian cyst that is large, painful, or not going away on its own
• A twisted ovary (ovarian torsion) — the ovary turns on its blood supply and needs urgent surgery to save it
• Suspected or confirmed ovarian cancer
• Endometriosis or ongoing pelvic pain that has not improved with other treatments
• An infection or abscess in the pelvis that does not clear up
• Inherited gene changes (such as BRCA1 or BRCA2) that raise the risk of ovarian and breast cancer, where surgery is chosen to lower risk
• Being done at the same time as another pelvic operation, such as a hysterectomy

Risk factors

• A family history of ovarian, breast or bowel cancer
• Carrying an inherited gene change linked to cancer risk
• Getting older — ovarian problems and ovarian cancer are more common after age 50
• Endometriosis or repeated ovarian cysts
• Never having been pregnant
• Smoking and obesity, which are linked to a slightly higher risk of some ovarian problems

When to see a doctor

See a doctor urgently if:

• Sudden severe pelvic or belly pain
• Bleeding after the menopause
• A new lump or swelling in your lower belly
• Fever with pelvic pain, or unusual smelly discharge
• Any symptom after surgery that is getting worse rather than better

Book a routine appointment if:

• Pelvic pain or bloating that lasts more than two or three weeks
• Periods that have become much heavier, longer or more painful
• Pain during sex that keeps happening
• You are worried about your family history of ovarian or breast cancer
• You want to talk about whether surgery is right for you

Diagnosis

Your doctor will start by asking about your symptoms, your periods, your general health and your family history. They will usually do an internal (pelvic) examination to feel the size and shape of your ovaries. From there, a scan and sometimes blood tests help build a clear picture. If cancer is a possibility, you may be referred to a specialist team who will talk you through the next steps, including whether surgery is needed. Deciding to have an oophorectomy is a shared decision — your doctor should explain the benefits, the risks and the alternatives so you can choose what is right for you.

Tests that may be done

• Pelvic ultrasound — a painless scan that uses sound waves to look at the ovaries
• Blood tests to check your general health and hormone levels
• A blood test called CA-125, which can be raised in ovarian cancer but can also be raised for other reasons
• CT or MRI scans if more detail is needed
• A pregnancy test before surgery, if there is any chance you could be pregnant
• Genetic counselling and testing if there is a strong family history

What to expect at your appointment

You will usually meet the surgeon before the operation to talk about what will be removed, how it will be done, and what it means for your hormones and fertility. You will be asked to stop eating and drinking for a set time before surgery. Most people have a general anaesthetic, so you will be asleep throughout and will not feel anything.

Treatment

An oophorectomy is itself a treatment — it is an operation rather than a medicine. The type of surgery depends on why it is being done. If one ovary is healthy and can be left, surgeons often leave it in place, especially if you are younger, because it keeps making hormones. If cancer is suspected, both ovaries and tubes are usually removed. Surgery can be done by keyhole (small cuts and a camera) or by open surgery (a larger cut), and your surgeon will explain which is safer and more suitable for you.

Self-care at home

• Follow your surgeon's advice about lifting, driving, bathing and returning to work — this is usually around two to six weeks depending on the type of surgery
• Keep the wound clean and dry, and pat it dry gently after washing
• Take short walks each day to help your circulation and lower the risk of blood clots
• Eat plenty of fibre and drink enough water to avoid constipation, which is common after surgery
• Ask your care team which pain relief is safe for you, and take it as advised so you can move around comfortably
• Do pelvic floor exercises once your doctor says it is okay
• Write down your questions before appointments so you do not forget them

Medical treatments

Treatment around surgery is tailored to you. If both ovaries are removed before your natural menopause, you may be offered hormone therapy to ease symptoms such as hot flushes and to help protect your bones — your doctor will discuss whether this is suitable for you. If cancer is found, you may be referred to a specialist cancer team who will talk through further treatment options. If you have pain or an infection, your care team will advise on the right approach. Always ask your doctor or pharmacist before starting any medicine, including over-the-counter ones and supplements.

When is surgery considered?

Surgery is usually recommended when an ovary is twisted and needs saving quickly, when a cyst is large or suspicious, when cancer is found or strongly suspected, when pain from endometriosis or cysts has not improved with other treatments, or when someone at high genetic risk chooses risk-reducing surgery. Your doctor should always explain the alternatives, including watching and waiting, so the decision is yours.

Living with this condition

Most people are back to their usual routines within four to six weeks, though tiredness can linger a little longer. If both ovaries were removed and you had not yet reached the menopause, you may notice hot flushes, night sweats, trouble sleeping, mood changes and vaginal dryness quite soon after surgery. These are common and there is a lot that can help — tell your doctor or nurse how you are feeling rather than putting up with it. If only one ovary was removed, your hormones usually carry on much as before.

Lifestyle tips

• Build gentle activity back into your day — short walks first, then build up as you feel able
• Keep up weight-bearing exercise such as walking or dancing to help keep bones strong
• Include calcium-rich foods in your diet, such as milk, yoghurt, leafy greens and fortified plant milks
• Get some sunlight safely and ask your doctor whether a vitamin D supplement is right for you
• Limit alcohol and avoid smoking, as both affect bone and heart health
• Look after your pelvic floor with regular exercises
• Give yourself time — healing is not a race

Diet and exercise

A balanced diet with plenty of vegetables, fruit, wholegrains, beans and lean protein helps your body recover and supports bone health. Drink enough water, and eat fibre to keep your bowels comfortable. Once you are healing well, aim for about 150 minutes of moderate activity a week — anything that makes you a little warm and slightly out of breath counts. Start slowly and build up. If you had both ovaries removed, staying active and eating well matters even more for your bones and heart.

Mental health and emotional wellbeing

It is completely normal to feel a mix of emotions. Some people feel relieved that a problem is being dealt with; others feel sad, worried, or grieve the loss of fertility or of their ovaries. Hormone changes after surgery can also affect mood and sleep, which can make difficult feelings feel bigger. These feelings usually ease, but if low mood, anxiety or poor sleep lasts more than a couple of weeks or starts to affect your daily life, please tell your doctor — support is available and it helps. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line straight away.

Prevention

Most ovarian problems that lead to this surgery cannot be prevented. You cannot stop a cyst or a twisted ovary from happening. However, some things do lower risk: not smoking, keeping to a healthy weight, and — for people with a strong family history or an inherited gene change — talking to a specialist about risk-reducing options. If you are at higher risk, genetic counselling can help you understand your choices well before any decision about surgery.

Screening programmes

There is no reliable routine screening test for ovarian cancer for people at average risk, and scans are not recommended for people without symptoms. If you have a strong family history or a known gene change, your specialist team may offer regular check-ups, scans or blood tests. If you have symptoms that worry you, do not wait for a screening programme — see your doctor.

Complications

If left untreated

• A twisted ovary can lose its blood supply and be permanently damaged within hours
• A large cyst can burst, causing sudden pain and internal bleeding
• Ovarian cancer may grow and spread if not treated
• Long-standing endometriosis or pelvic infection can cause ongoing pain and scarring
• Some ovarian growths can become cancerous over time

Long-term outlook

For most people, the outlook after an oophorectomy is good. Benign cysts and twisted ovaries are cured by surgery, and many people feel much better once the problem is gone. If cancer is found, treatment has improved a great deal and specialist teams now offer many options — your team will talk honestly with you about what to expect. Living with one ovary usually means normal hormones and a normal life. If both ovaries are removed, the main long-term things to look after are your bones, your heart and your wellbeing, and your doctor can help you with all of these.

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