Ovary Removal Surgery: Procedure, Benefits, Risks, Recovery and Alternatives

Ovary removal surgery—known medically as oophorectomy—remains a critical procedure in gynecology, performed for reasons ranging from cancer prevention to treatment of specific ovarian diseases. With advances in surgical techniques and our understanding of ovarian function, the decision to remove one or both ovaries is more nuanced than ever. This article provides a comprehensive, evidence-based overview to help patients and clinicians navigate the many considerations surrounding ovary removal, including its procedure, benefits, risks, recovery, and alternatives.

Ovary Removal Surgery: The Procedure

Ovary removal surgery can sound daunting, but understanding the process can help ease anxiety and empower informed decision-making. The procedure itself varies based on the underlying condition, surgical approach, and the patient’s medical history. Let’s explore how ovary removal is performed and what patients can expect before, during, and after surgery.

Approach	Description	Indications	Source(s)
Laparoscopy	Minimally invasive, small incisions, faster recovery	Benign cysts, fertility preservation, cancer risk	2 3 4 5 22
Laparotomy	Open surgery, larger incision, for complex/malignant cases	Advanced cancer, large masses	1 13 14
vNOTES	Transvaginal endoscopic, no abdominal scars	Benign ovarian cysts	2
Partial/Total	Removal of part or all ovary (unilateral/bilateral)	Disease location, risk profile	8 10

Table 1: Common Surgical Approaches to Ovary Removal

Surgical Techniques and Approaches

The primary surgical options for ovary removal include traditional open surgery (laparotomy), minimally invasive laparoscopy, and novel approaches like transvaginal natural orifice transluminal endoscopic surgery (vNOTES).

• Laparoscopy: This is now the gold standard for benign conditions and fertility-preserving procedures. It uses small incisions and a camera for precise removal, resulting in faster recovery, less pain, and fewer complications compared to open surgery. It's also the preferred method for harvesting ovarian tissue for cryopreservation in cancer patients 3 4 5 22.
• Laparotomy: Reserved for complex cases, such as advanced ovarian cancer, where extensive exploration and tumor reduction are needed. The approach allows for optimal visualization and the ability to remove larger tumors or perform cytoreductive surgery 1 13 14.
• vNOTES: This innovative approach accesses the ovaries through the vaginal wall, leaving no visible scars and offering excellent cosmetic results for benign conditions. However, it's still considered novel and requires further study 2.

Types of Ovary Removal

• Unilateral oophorectomy: Only one ovary is removed, typically when disease is confined to one side.
• Bilateral oophorectomy: Both ovaries are removed, which is sometimes performed alongside a hysterectomy for cancer risk reduction, severe endometriosis, or other indications 8 10.

What to Expect Before, During, and After

• Preoperative preparation: Includes lab tests, imaging, and counseling about fertility and hormonal changes.
• During surgery: Patients are under general anesthesia. The duration depends on the complexity and approach.
• After surgery: Most minimally invasive procedures allow for same-day or next-day discharge, while open surgeries require a longer hospital stay 2 5 22.

Benefits and Effectiveness of Ovary Removal Surgery

Ovary removal can be life-saving or dramatically improve quality of life for some women. The benefits, however, depend on the underlying medical reason for surgery and the patient’s age and health.

Benefit	Description	Patient Populations	Source(s)
Cancer Risk Reduction	Lowers risk of ovarian and related cancers	High-risk, BRCA mutation, postmenopausal	6 8 9 10
Symptom Relief	Resolves pain, cysts, endometriosis symptoms	Chronic benign disease	2 22
Fertility Preservation	Ovarian tissue cryopreservation and reimplant	Cancer patients	3 4 5
Improved Outcomes	Tumor-reductive surgery improves survival in cancer	Ovarian cancer patients	1 13

Table 2: Key Benefits and Effectiveness of Ovary Removal Surgery

Cancer Risk Reduction

For women with a strong family history or genetic predisposition (e.g., BRCA mutations), bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes) significantly reduces the risk of ovarian and breast cancer. Recent studies suggest that many ovarian cancers originate in the fallopian tubes, and salpingectomy alone (removal of tubes) also lowers cancer risk—even in women without genetic mutations 6 8 9.

Symptom Relief and Disease Management

Ovary removal is highly effective for treating persistent pain from benign ovarian cysts, endometriosis, or severe pelvic adhesions when conservative management fails. In cases of ovarian torsion, oophorectomy may be necessary if the ovary cannot be salvaged, though conservative detorsion is increasingly favored in children and young adults 7 22.

Fertility Preservation Strategies

For women requiring cancer treatment, laparoscopic removal and cryopreservation of ovarian tissue can preserve fertility. This tissue can be transplanted back after treatment, with good rates of resumed menstruation, hormonal activity, and even pregnancies 3 4 5.

Improved Survival in Cancer

In ovarian cancer, aggressive surgical removal of tumor masses (cytoreductive surgery) before chemotherapy has been shown to improve outcomes and survival rates 1 13.

Risks and Side Effects of Ovary Removal Surgery

While ovary removal can be beneficial in specific scenarios, it also carries short- and long-term risks. Understanding these is vital for making an informed choice.

Risk/Consequence	Description	Impact Level	Source(s)
Surgical Complications	Bleeding, infection, injury to nearby organs	Short-term	5 13 14 22
Early Menopause	Sudden loss of ovarian hormones	Long-term	8 9 10
Cardiovascular Disease	Increased risk post-oophorectomy	Long-term	8 10 12
Bone Loss/Osteoporosis	Lower estrogen leads to bone thinning	Long-term	10
Cognitive & Mood Effects	Memory, mood, sexual dysfunction	Long-term	9 10

Table 3: Main Risks and Side Effects of Ovary Removal Surgery

Surgical and Immediate Risks

• General surgical risks: Bleeding, infection, and injury to adjacent organs are possible, though rare with minimally invasive techniques 5 13 14 22.
• Extended or complex surgeries: Longer procedures and advanced age increase the risk of severe postoperative complications 14.

Long-term Health Impacts

• Early Menopause: Removal of both ovaries in premenopausal women leads to immediate menopause, with symptoms like hot flashes, vaginal dryness, and mood swings 8 10.
• Cardiovascular Disease: Studies consistently show increased rates of heart disease, hypertension, and metabolic issues after bilateral oophorectomy, especially in women under 50 8 10 12.
• Bone Health: Loss of estrogen accelerates bone thinning, increasing the risk of osteoporosis and hip fractures 10.
• Cognitive and Sexual Health: Increased risk of memory impairment, sexual dysfunction, and declines in psychological well-being have been linked to surgical menopause 9 10.

Cancer Risk—A Double-Edged Sword

While risk of ovarian cancer is eliminated, overall mortality may rise due to increased risk of other cancers and heart disease, particularly in women with average risk of ovarian cancer 8 10.

Recovery and Aftercare of Ovary Removal Surgery

Recovery from ovary removal surgery varies depending on the surgical approach, underlying health, and whether the procedure was done for benign or malignant reasons. Supportive care, both physical and emotional, is crucial for optimal recovery.

Recovery Aspect	Typical Timeline/Action	Notes/Strategies	Source(s)
Hospital Stay	1–2 days for laparoscopy; longer for open surgery	Faster with minimally invasive	2 5 17 18 22
Return to Activities	1–2 weeks (laparoscopy), up to 6 weeks (open)	ERAS protocols speed recovery	17 18
Pain Management	Short-term use of analgesics	Enhanced with humanistic care	17 18
Emotional Support	Counseling, support groups	Important for QOL	18

Table 4: Recovery and Aftercare Milestones

Hospital Stay and Physical Recovery

• Laparoscopic/vNOTES procedures: Most patients go home within 24–30 hours, with minimal pain and quick return to daily activities 2 5 22.
• Open surgery: Recovery is slower, with hospital stays of 5–10 days and several weeks before resuming normal activities 17.

Enhanced Recovery Programs

Enhanced recovery after surgery (ERAS) protocols—multidisciplinary approaches to perioperative care—have demonstrated shorter hospital stays, reduced readmission rates, and faster return to normal life, even after complex cancer surgeries 17.

Pain and Stress Management

• Pain: Managed with oral or injectable medications. Humanistic and patient-centered care models improve pain control, decrease anxiety, and enhance satisfaction 18.
• Emotional support: Postoperative counseling and support groups are crucial, as the abrupt loss of ovarian hormones can impact mood, sexual health, and quality of life 18.

Monitoring and Follow-Up

• Surveillance: Follow-up visits assess wound healing, manage menopausal symptoms, and monitor for complications.
• Hormone therapy: May be recommended for younger women to mitigate menopausal symptoms and protect bone and heart health 8 10.

Alternatives of Ovary Removal Surgery

Ovary removal isn’t always the only—or best—option. Many benign conditions can be managed with less invasive treatments that preserve ovarian function and hormonal balance.

Alternative	Description	Key Benefits	Source(s)
Ovarian Cystectomy	Removal of cyst, preserving ovary	Maintains fertility, hormones	2 22
Salpingectomy	Removal of fallopian tubes only	Reduces cancer risk, preserves ovaries	6 16 21
Medical Therapy	Hormonal or non-hormonal medications	Symptom control	11 12
Ovarian Tissue Preservation	Cryopreservation and later reimplantation	Fertility in cancer patients	3 4 5
Conservative Management	Watchful waiting with surveillance	Avoids surgery, preserves function	11 20

Table 5: Main Alternatives to Ovary Removal Surgery

Ovarian Cystectomy and Organ-Sparing Surgery

Removing only the cyst (cystectomy) rather than the entire ovary is often possible, especially with benign masses. This approach is fertility-sparing and maintains hormonal function 2 22.

Salpingectomy

Recent evidence highlights the benefit of removing only the fallopian tubes (salpingectomy) to lower ovarian cancer risk, preserving the ovaries and their hormonal function 6 16 21.

Medical and Conservative Management

• Hormonal therapy: Birth control pills or hormonal intrauterine devices can manage symptoms of endometriosis or benign cysts without surgery.
• Active surveillance: For small endometriomas or cysts, especially before IVF, conservative management is often preferred to avoid unnecessary loss of ovarian reserve 11 20.

Fertility Preservation Techniques

For patients undergoing cancer treatment, removal and cryopreservation of ovarian tissue, with later transplantation, is increasingly standard and carries a low complication rate 3 4 5.

Conclusion

Ovary removal surgery is a complex decision that balances immediate health needs against long-term wellbeing. Here are the key takeaways:

• Multiple surgical options: From minimally invasive laparoscopy and vNOTES to open surgery, the approach is tailored to the patient and indication 2 3 4 5 22.
• Benefits: Includes cancer risk reduction, symptom relief, and improved survival in certain cancers, with fertility preservation possible for selected patients 1 2 3 4 5 6 8 9 10 13 22.
• Risks: Range from surgical complications to long-term health effects like cardiovascular disease, bone loss, and cognitive changes, especially with bilateral removal in premenopausal women 8 9 10 12.
• Recovery: Enhanced by minimally invasive techniques and ERAS protocols; emotional support is vital for quality of life 2 5 17 18.
• Alternatives: Ovarian-sparing surgery, salpingectomy, medical therapy, and tissue preservation can often avoid or delay ovary removal 2 3 4 5 6 11 16 20 21 22.

Patients should fully discuss the risks, benefits, and alternatives with their healthcare provider, ensuring decisions are individualized and evidence-based.