Oophorectomy

Overview  

An oophorectomy is a surgical procedure that involves the removal of one or both ovaries, which are almond-shaped organs located on either side of the uterus in the pelvis. These ovaries play a crucial role in reproductive health by producing hormones that regulate the menstrual cycle and contribute to overall bone and heart health. They also contain eggs necessary for pregnancy. 

When both ovaries are removed, the procedure is referred to as a bilateral oophorectomy. If only one ovary is removed, it’s known as a unilateral oophorectomy. In some cases, the surgery may also include the removal of the fallopian tubes, in which case it is called a salpingo-oophorectomy. 

Oophorectomy can be performed as part of a hysterectomy, which is a surgery to remove the uterus, though not all hysterectomies involve the removal of the ovaries. This procedure is often done to treat diseases or to lower the risk of certain cancers.  

Types  

There are various types of oophorectomies, and your surgeon will suggest the most suitable one based on your medical history and symptoms:  

• Unilateral oophorectomy: Involves the removal of one ovary (one side)  
• Bilateral oophorectomy: Involves the removal of both ovaries (both sides)  
• Salpingo-oophorectomy: Involves the removal of one ovary and one fallopian tube (use to transports eggs from your ovary to your uterus).  
• Bilateral salpingo-oophorectomy: Involves the removal of both fallopian tubes and ovaries.  

An oophorectomy may be performed alongside a hysterectomy, which is a procedure to remove the uterus. However, not all hysterectomy procedures include the removal of the ovaries. 

• Hysterectomy with salpingo-oophorectomy: Involves the removal of the uterus along with one fallopian tube and one ovary.  
• Total hysterectomy with bilateral salpingo-oophorectomy: Involves the simultaneous removal of the uterus, cervix, both fallopian tubes, and both ovaries.  

Reasons for undergoing the procedure  

An oophorectomy may be performed to treat or prevent certain health issues such as:   

• A tubo-ovarian abscess: An infection of the ovary or the surrounding area, also referred to as pelvic inflammatory disease (PID) or a tubo-ovarian abscess (TOA). This is a pus-filled pocket involving a fallopian tube and an ovary.   
• Endometriosis: This condition occurs when tissue resembling the lining of the uterus grows outside of the uterus. It can lead to the formation of cysts on the ovaries known as endometriomas.  
• Noncancerous ovarian tumors or cysts: Small tumors or cysts can develop on the ovaries, which may burst and cause pain and other complications. These problems can be avoided by removing the ovaries.  
• Ovarian cancer: Oophorectomy may be utilized as a treatment for ovarian cancer.  
• Ovarian torsion: Occurs when an ovary becomes twisted.  
• Reduce the cancer risk: Oophorectomy may be recommended for individuals at high risk of breast or ovarian cancer. This procedure lowers the risk of both types of cancer. Research indicates that some ovarian cancers originate in the fallopian tubes. Therefore, during an oophorectomy aimed at cancer risk reduction, the fallopian tubes may also be removed. This combined procedure is known as a salpingo-oophorectomy.  

If both ovaries and fallopian tubes are removed, natural pregnancy becomes impossible. However, if your uterus is preserved, assisted reproductive technologies such as IVF (in vitro fertilization) can enable pregnancy. These considerations are crucial if you desire children.  

Preserving fertility before the procedure is possible; for instance, egg freezing may be an option. Consultation with a fertility specialist recommended by your healthcare provider can help explore these choices. 

Risk 

An oophorectomy is generally considered a safe procedure. However, like any surgery, there are potential risks, including:  

• Bleeding.  
• Blood clots. 
• Inability to get pregnant if both ovaries are removed.  
• Infection.  
• Injury to the nearby organs such as bladder or bowel.  
• Ovarian remnant syndrome or the remaining ovary cells continue to cause symptoms of period, like pelvic pain.  
• Reaction to anesthesia.  
• Rupture of a malignant tumor, which can spread cancer cells.  

Early menopausal syndrome may be more likely if an oophorectomy is performed before the age of 45. It’s important to talk to your healthcare provider about these potential risks. 

After surgery and up until about age 50, taking low dosages of hormone replacement therapy can help reduce these side effects. Hormone replacement treatment, however, is not without risk. It is recommended to go over your alternatives in detail with your healthcare provider. 

Before the procedure 

In preparation for an oophorectomy, you may need to:   

• Inform your healthcare team about any medications, vitamins, or supplements you are taking, as certain substances could potentially interfere with the surgery.  
• Discontinue aspirin or other blood-thinning medications. Your healthcare provider will advise you on when to stop these medications. In some cases, an alternative blood-thinning medication may be prescribed around the time of surgery.  
• Refrain from eating before surgery. You will receive specific instructions such as, stop eating several hours beforehand. You might be allowed to drink liquids up to a specified time before surgery. Follow the guidance from your healthcare team.  
• Undergo necessary testing such as imaging test (like ultrasound) and blood tests may be required to help the surgeon plan for the procedure.  
  

If you’ve had an oophorectomy and are considering starting a family, it’s important to consult with your healthcare provider to understand how the surgery might impact your plans. They can discuss various options for achieving pregnancy and connect you with a fertility specialist who can explore potential avenues based on your individual situation.  

You will receive information from your healthcare team about the timing and location of your oophorectomy. The process may involve moving between different areas before the surgery, depending on the preparations needed. Typically, patients are discharged on the same day for procedures often performed on an outpatient basis.  

During the procedure  

An oophorectomy typically requires general anesthesia to ensure you are unconscious throughout the procedure. The surgeon accesses the ovaries by making an incision in the abdominal area. 

The placement of the incision varies depending on the specific type and purpose of the oophorectomy surgery:  

• Laparoscopic approach: Described as a minimally invasive technique, laparoscopic surgery involves using a small camera to view inside the abdomen. Additional 1-2 cm incisions are made on the skin to facilitate ovary removal. This approach typically carries a reduced risk of infection and generally leads to faster recovery times. In certain instances, the robotic-assisted minimally invasive surgery involves the use of a surgical robot. During this procedure, the surgeon sits at a console and utilizes controllers to operate the instruments.  
• Vaginal: This method is also classified as minimally invasive, offering a reduced risk of infection and quicker recovery. Vaginal removal of ovaries typically occurs simultaneously with uterine removal through the vagina. 
• Laparotomy: At times, the surgeon may decide that a larger opening, termed a laparotomy, is necessary to complete the procedure. This involves making an incision into the abdomen. Laparotomies, which require larger openings, typically lead to longer recovery times and a slightly higher risk of complications, although these risks are generally low.  
  

The surgical approach chosen by your surgeon depends on your specific circumstances. Patients undergoing minimally invasive surgery generally experience faster recovery, reduced pain, and shorter hospital stays. However, minimally invasive surgery may not be suitable for everyone. In some cases, a procedure initially planned as minimally invasive may need to transition to an open surgery. 

After making the incision(s) in the abdomen, the surgeon proceeds to remove the ovaries. Depending on the surgical plan, one or both ovaries are detached from their blood supply and surrounding tissue. Subsequently, they are extracted from the abdomen through the incision. If part of the surgical plan includes it, the fallopian tubes or uterus may also be removed during this procedure. 

After surgery, the incision is closed with dissolvable stitches. Laparoscopic and vaginal surgeries usually require an overnight hospital stay but are often outpatient procedures, allowing you to go home a few hours after. A laparotomy may mean up to three days in the hospital. Recovery varies but expect three to six weeks of restricted activities.  

After the procedure  

The effects on your body after oophorectomy depend on the type of procedure you undergo. If you haven’t reached menopause and both ovaries are removed, you’ll enter menopause right away. It’s important to discuss with your healthcare provider before surgery how to prepare for these hormonal changes.  

After undergoing an oophorectomy, your recovery process typically involves several steps:  

• Initially, you’ll spend time in a recovery room until the effects of anesthesia wear off.  
• You’ll then be transferred to a hospital room where you can continue to recover.  
• It’s encouraged to start moving around as soon as you’re able, which aids in your recovery process.  
  

For many individuals, oophorectomy surgery is outpatient, meaning they can return home the same day without needing to stay overnight in the hospital.  

Outcome  

People who have particular diseases or conditions or who are at a higher risk of developing ovarian cancer can benefit from an oophorectomy. As a preventive step against ovarian cancer in high-risk patients, this approach can successfully treat or reduce symptoms associated with these medical conditions. 

Recovery times vary, but typically you should plan for at least two weeks of restricted activities after surgery. For a laparotomy, it may take up to six weeks before you can return to your usual routine.  

Typically, most individuals can resume full activities within 2 to 4 weeks following surgery. It’s advisable to discuss your specific recovery timeline and expectations with your healthcare team. 

After an oophorectomy, it’s important to monitor for these potential signs:  

• Fever or chills.  
• Foul-smelling or itchy vaginal discharge.  
• Leakage of fluid or pus from the incision.  
• Nausea or vomiting.  
• Painful urination.  
• Pelvic pain.  
• Swelling or pain in the legs (indicating possible blood clots).  
• Swelling or redness around the incision site.  

If you notice any of these symptoms, it’s crucial to contact your healthcare provider promptly for evaluation and appropriate management.