Oophorectomy: Everything You Need to Know

Oophorectomy involves the removal of one or both ovaries. This operation may be done to treat a number of ovarian diseases, including endometriosis and benign or cancerous ovarian masses. Oophorectomy may also be performed as a preventive surgery in women at high risk for developing ovarian cancer.

What Is an Oophorectomy?

Ovaries are almond-shaped glands located on either side of the uterus. Oophorectomy is surgery to remove one or both of these glands. Sometimes, an oophorectomy is combined with another surgery.

The different types of oophorectomy and combination procedures are as follows:

• Unilateral oophorectomy: Removal of one ovary
• Bilateral oophorectomy: Removal of both ovaries
• Salpingo-oophorectomy: Removal of an ovary and its attached Fallopian tube (carries the released egg from the ovary to the uterus)
• Bilateral salpingo-oophorectomy: Removal of both Fallopian tubes and ovaries
• Hysterectomy with salpingo-oophorectomy: Removal of the uterus (hysterectomy) with one or both Fallopian tubes and ovaries

An oophorectomy is typically performed under general anesthesia by an obstetrician-gynecologist (OB/GYN).

The surgery may be scheduled or performed emergently, depending on the reason why it's being done.

Surgical Approaches

The three surgical approaches that may be used to perform an oophorectomy include:

• Laparoscopic surgery: With this minimally invasive approach, the surgeon makes small incisions in the skin of the abdomen. Long, thin instruments (one that has a camera attached to it for visualization purposes) are inserted through these small incisions to remove the ovary or ovaries. In some instances, the surgeon uses a robotic arm (controlled with a computer) to perform the surgery.
• Laparotomy (open surgery): With this approach, one or more of the ovaries is removed through a single large incision made across the abdomen.
• Vaginal surgery: With this minimally invasive approach, the ovary or ovaries are removed through a woman's vagina. This approach may be used when a woman is undergoing a hysterectomy with bilateral salpingo-oophorectomy.

Laparoscopic oophorectomy has a smaller risk of infection, pain, and postoperative complications and is associated with a shorter hospital stay. That said, a laparotomy is generally preferred if the ovary is large or there is suspicion for cancer.

Contraindications

There are no absolute contraindications to an oophorectomy.

One exception is that a bilateral prophylactic (preventive) oophorectomy is contraindicated in premenopausal women who have an average risk for ovarian cancer.

In a study in Mayo Clinic Proceedings, women younger than 46 years who had a preventive oophorectomy were at an increased risk for developing severe chronic conditions (e.g., depression, chronic obstructive pulmonary disease, heart disease, and osteoporosis, to name a few).

Potential Risks

Besides storing and protecting the eggs a woman is born with, the ovaries release an egg every month for possible fertilization. They also produce hormones that control a woman's menstrual cycle.

As such, surgical removal of one ovary (unilateral oophorectomy) can cause fertility problems.

Beyond this, oophorectomy comes with general surgical risks, like bleeding and infection, and those related to the administration of anesthesia.

Risks specific to oophorectomy include:

• Injury to the bladder or intestines
• Scar tissue (adhesion) formation
• Rupture of a malignant ovarian tumor, which may lead to the unintended spread of cancer cells
• Ovarian remnant syndrome (when premenopausal patients experience symptoms like bleeding or pain related to a piece of the ovary accidentally being left behind)

Purpose of Oophorectomy

The purpose of an oophorectomy is to treat a cancerous or diseased/damaged ovary or to reduce the symptoms of a benign ovarian condition.

Oophorectomy may also be performed to prevent ovarian cancer in select high-risk patients.

The various ovarian conditions that may warrant an oophorectomy include:

• Benign ovarian tumors or cysts that cannot be treated with a less invasive surgery/procedure (e.g., cystectomy)
• Ovarian torsion (when the ovary twists around the ligaments that hold it in place)
• Ovarian cancer
• Cancer that has spread (metastasized) to the ovary
• An ovarian abscess (collection of pus)
• Endometriosis

If it's determined that you need an oophorectomy, various tests for medical and anesthesia clearance will be ordered.

Such tests include:

• Blood tests like a complete blood count (CBC) and a coagulation panel (to check for bleeding disorders)
• Chest X-ray
• Electrocardiogram (ECG)

If you have been diagnosed with ovarian cancer, a colonoscopy, chest X-ray, and/or PET scan may be performed to determine if the cancer has spread. Your healthcare provider will also draw a CA-125 blood test before you undergo surgery (or any other cancer treatment).

How to Prepare

Once you are scheduled for an oophorectomy, your surgeon will give you instructions on how to best prepare.

Location

Your operation will take place in a hospital or surgical center.

If your surgery is in a hospital, you may be admitted the night before (depending on the timing of your operation and your surgeon's preference).

If your surgery is being done as an outpatient, or you are not being admitted the night before, confirm the time of arrival for your operation with your surgeon. They usually like patients to arrive a couple of hours early.

Food and Drink

You may be advised to eat a light, low-fat dinner the night before your surgery.

You may be instructed to stop eating solid foods after midnight. In most cases, you will be allowed to drink clear liquids and chew gum up to eight hours before surgery.

If you drink alcohol, do not do so after 8:00 pm the night before your surgery (though refraining sooner is better).

Medications

You may be advised to stop taking certain medications for a designated period of time. For instance, most surgeons advise patients to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) a week before surgery.

Tell your surgeon if you are taking aspirin or another blood thinner like Coumadin (warfarin). Blood thinners may or may not need to be discontinued prior to surgery, depending on the reason you are taking them.

Lastly, your surgeon may advise you to take laxatives to clear your bowels prior to surgery. If your surgeon is recommending a bowel prep, clarify the precise regimen so you don't inadvertently over- or underdo it.

What to Wear and Bring

You may be asked to shower the night before surgery with a special antibacterial soap. This will help prevent infection. After you shower and on the morning of your surgery, do not apply any lotion, perfume, or deodorant.

Since you will change into a hospital gown upon arrival at the hospital or surgical center, it's a good idea to wear loose-fitting clothes that are easy to remove. Leave all jewelry and body piercings at home and bring a small amount of cash or a credit card to pay for small items (if needed) during your hospital stay.

Make sure you bring your driver's license, insurance card, and a list of your medications. Leave your bottles of pills at home, unless instructed otherwise.

If you are staying overnight in the hospital, be sure to pack the following items in your bag or suitcase:

• Any medical devices you use (e.g., asthma inhaler, CPAP machine, or hearing aids)
• Comfortable and loose-fitting clothes (especially pants) to go home in
• Slip-on shoes or non-skid-slippers to walk around in
• Small personal or comfort items (e.g., cell phone and charger, lab top, hand cream, or sleep mask)

Pre-Op Lifestyle Changes

Getting regular aerobic exercise, like swimming or biking, before surgery can help you recover faster and easier. Check with your surgeon to see if this is appropriate for you.

Be sure to have an honest talk with your surgeon about what and how much you drink, if you consume alcohol.

While the sooner you quit smoking the better, quitting even a few days before your surgery can help prevent complications, like poor wound healing or adverse anesthesia effects. If desired, your surgeon can refer you to a smoking cessation program for support and guidance.

Fertility Preservation

If you want to have children, talk with your healthcare provider about your options. There may be ways to preserve your ability to become pregnant after having an oophorectomy, depending on your particular situation. Ask your practitioner to refer you to a fertility doctor who can review your options with you.

For example, you can potentially freeze your eggs beforehand (assuming the surgery isn't urgent). You may then be able to get pregnant after surgery through in vitro fertilization—unless your uterus is also removed, in which case surrogacy is an option.

What to Expect on the Day of Surgery

On the day of your oophorectomy, you will arrive at the hospital and check-in at the front desk.

Before the Surgery

After checking in, you may be taken to a pre-operative room where you will change out of your clothes into a hospital gown. A nurse will then review your medication list, record your vitals, and place an intravenous (IV) line for administering fluids and medications into a vein in your hand or arm.

Your surgeon will come to greet you and briefly review the operation with you. You may need to sign a consent form at this time, mostly pertaining to the risks associated with the surgery. Your anesthesiologist will also come to say hello and review the anesthesia process and potential risks involved.

From there, you will be walked or wheeled on a gurney into the operating room.

During the Surgery

Upon entering the operating room, the surgical team will transfer you onto a table.

If you are receiving general anesthesia, the anesthesiologist will administer inhaled or intravenous medication to put you to sleep. You will not remember anything that occurs during the procedure after this point.

Next, a breathing tube called an endotracheal tube will be inserted into your windpipe. This tube is connected to a ventilator that takes control of your breathing during the operation.

If you are having a vaginal hysterectomy with bilateral salpingo-oophorectomy, you may instead undergo regional anesthesia. If this is the case, the surgeon will inject a numbing medication into your spine. You may feel a stinging sensation as the medication is being injected. You will also be given a sedative to help you fall asleep during the surgery.

Once you are asleep from the anesthesia or sedation, a surgical assistant will insert a Foley catheter to drain urine during the operation. Inflatable compression devices may also be placed on your legs to help prevent post-operative blood clots.

While the precise flow of your surgery will vary depending on the surgical approach used, and whether other surgeries are also being performed, you can generally expect the following:

• Incision(s): The surgeon will make one or more incisions over the abdomen. The size and number of incisions depend on whether the surgery is open (larger) or laparoscopic/robotic (smaller). With a vaginal approach, an incision is made within the top part of the vagina.
• Visualization: The ovaries will be visualized through the incision sites. Carbon dioxide gas may be pumped into the abdomen to help make it easier for the surgeon to see everything.
• Peritoneal washing: In some instances (to check for the spread of cancer cells or to help stage ovarian cancer, if relevant), the surgeon will obtain a peritoneal washing. This procedure entails instilling a sterile solution into different areas within the patient's pelvis and abdomen. The fluid is then collected and sent off to a pathologist after the surgery is done.
• Biopsy: A biopsy or tissue sample may be taken if there are any suspicions of cancer (for example, an enlarged lymph node or nodule).
• Ovary removal: Using surgical instruments (e.g., a surgical clamp or forceps), the surgeon will remove the ovary by separating/detaching it from its blood supply and ligaments. With a laparoscopic approach, the ovary is placed in a pouch that is then pulled out through one of the small incisions. With a vaginal approach, the ovary is removed through the vaginal incision.
• Closure: The incision(s) will be closed with dissolvable stitches. The abdominal incision(s) will be covered with adhesive strips or surgical glue.
• Prep for recovery: If you were given general anesthesia, it will be stopped. The breathing tube will be removed, and you will then be taken to a recovery room.

After the Surgery

In the recovery room, you will slowly wake up from anesthesia or sedation. A nurse will monitor your vital signs and help you manage common post-operative symptoms like pain and nausea.

Once you are fully awake and alert, you will be discharged home (if an outpatient surgery) or wheeled to a hospital room (if an inpatient surgery).

Most patients who are admitted after undergoing an oophorectomy stay in the hospital for two to three nights.

Pain medication will be given through your IV at first; you will be switched over to an oral drug before you leave the hospital. Your Foley catheter will also be removed before going home.

In terms of eating after surgery, you will be advised to slowly advance your diet, starting with ice chips and proceeding to liquids and solids, as tolerated.

Recovery

As you recover, you can expect the following:

• Abdominal/pelvic pain is common after surgery but should start to improve within a few days. Continue to use your prescribed pain medication as recommended.
• Constipation is common after surgery. Your surgeon may recommend stool softeners and increasing the fiber in your diet.
• Your surgeon will ask you to walk as much as you can to prevent complications like blood clots or pneumonia.

Wound Care

You should be able to shower 24 hours after your operation. Your surgeon will advise you to gently wash your incision site(s) and pat them dry with a clean towel afterward.

Your adhesives strips/surgical glue should come off on their own within 10 days after surgery. If they have not, you should be able to gently remove them on your own (get approval from your surgeon first, however).

Activity

You may have specific activity guidelines to follow after surgery, such as:

• Avoid brisk exercise and lifting more than 10 pounds for four to six weeks.
• Avoid swimming or taking baths until your surgeon says it's OK.
• Avoid driving for two to four weeks (or longer if you are still on pain medication).
• Return to work two to six weeks after surgery.
• Avoid sex for six weeks (this may vary by the surgical approach used).

Long-Term Care

You can expect to follow up with your surgeon about two weeks after you are discharged.

During this appointment, your surgeon will do the following:

• Evaluate your incision site(s) to ensure proper healing and remove any glue/strips, if present
• Monitor you for any postoperative complications

Menopause and Hormone Replacement Therapy

If you are premenopausal and had both of your ovaries removed, expect to enter menopause immediately after surgery.

Symptoms of medical or induced menopause (e.g., hot flashes, vaginal dryness, etc.) are the same as natural menopause, but they tend to be more severe and prolonged due to the abrupt loss of ovarian function.

The sudden estrogen depletion of an oophorectomy is also associated with more severe health consequences than natural menopause, such as an increased risk of coronary artery disease, stroke, cognitive problems, mood disorders, osteoporosis, sexual dysfunction, and early death.

As a result, hormone replacement therapy (HRT) is generally recommended right after surgery until the typical age of natural menopause (around 51).

In addition to easing the symptoms of surgical menopause, HRT reduces the risk of developing the long-term health conditions associated with early menopause.

That said, there are some risks associated with taking HRT and not everyone is a candidate. It's best to talk with your surgeon about HRT prior to your operation, if possible.

Keep in mind, if you decide to take HRT, you will need regular follow-up with your gynecologist to have your hormone levels checked.

Possible Future Surgeries/Therapies

With a diagnosis of ovarian cancer, you may require additional therapies like chemotherapy or targeted therapy. In some cases, radiation is recommended. Another surgery may be needed if the cancer recurs and/or spreads.

Coping

If you underwent an oophorectomy, especially for cancer or another serious diagnosis, it's normal to experience a whirlwind of emotions. You may feel down, worried, fearful, angry, or irritable.

Try to be kind to yourself in the weeks and months following your surgery and reach out to loved ones for support.

A Word From Verywell

Undergoing an oophorectomy tends to be more involved than perhaps other abdominal operations because of the surgery's potential implications—immediate menopause, infertility, managing a cancer diagnosis, etc.

Continue to remain proactive about learning as much as you can about this surgery. Don't forget to reach out to your surgical team with any questions or concerns. They are there to help you and ensure that your operation goes as smoothly as possible.