Oophorectomy

Encyclopedia of Medicine, Apr 06, 2001 by Tish Davidson

Oophorectomy is the surgical removal of one or both ovaries. If one ovary is removed, a woman may continue to menstruate and have children. If both ovaries are removed, menstruation stops and a woman loses the ability to bear children.

Oophorectomy is performed to:

• Remove cancerous ovaries
• Remove a large ovarian cyst
• Excise an abscess
• Treat endometriosis
• Remove the source of estrogen that stimulates some cancers.

In an oophorectomy one, both, or a portion of one ovary may be removed. When oophorectomy is done to treat ovarian cancer or other spreading reproductive system cancers, both ovaries are removed. This is called a bilateral oophorectomy. Sometimes a bilateral oophorectomy is performed in women with breast cancer to remove the main source of estrogens, since estrogens seem to stimulate the growth of some breast cancer.

Occasionally both healthy ovaries are removed in women over age 45 when they have a hysterectomy to eliminate the risk of ovarian cancer. The value of this practice has been questioned in recent years. The removal of both ovaries may also be done to treat pelvic inflammatory disease (PID) or endometriosis. Removing both ovaries to treat premenstrual syndrome (PMS) is controversial, since other, less drastic, treatments for this disorder are available.

Until the 1980s, women over age 40 having hysterectomies routinely had healthy ovaries and fallopian tubes removed at the time of the hysterectomy. This operation is called a bilateral salpingo-oophorectomy. Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs. Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years.

In the 1990s, the thinking about routine oophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than one percent. Meanwhile, removing the ovaries increases the risk of cardiovascular disease and accelerates osteoporosis unless a woman takes prescribed hormone replacements.

Although there are many situations where oophorectomy is a medically wise choice, women with healthy ovaries who are undergoing hysterectomy for reasons other than cancer should discuss with their doctors the benefits and disadvantages of having their ovaries removed at the time of the hysterectomy.

Oophorectomy is also called ovariectomy. The procedure can be done under general anesthesia. Oophorectomy is performed through the same type of incision as an abdominal hysterectomy. The surgeon makes a 4-6 in (10-15 cm) incision either horizontally across the pubic hair line from hip bone to hip bone or vertically from naval to pubic bone. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity.

After the incision is made, the abdominal muscles are pulled apart (not cut) so that the surgeon can see the ovaries. The blood vessels are tied off to prevent excess bleeding. Then the ovaries, and often the fallopian tubes, are removed.

The advantages of abdominal incision are that the ovaries can be removed even if a woman has many adhesions from previous surgery. The surgeon gets a good view of the abdominal cavity and can check the surrounding tissue for disease. A vertical abdominal incision is mandatory if cancer is suspected. The disadvantages are that bleeding is more likely to be a complication of this type of operation. The operation is more painful than a laparoscopic operation and the recovery period is longer. A woman can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities.

Oophorectomy can sometimes be done with a laparoscopic procedure. With this surgery, a tube containing a tiny lens and light source is inserted through an incision in the navel. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor. The surgeon then inserts slender instruments through small incisions in the abdomen and uses them to cut and tie off the blood vessels and fallopian tubes. When the ovaries are detached, they are removed though a small incision at the top of the vagina. The ovaries can also be cut into smaller sections and removed through the tiny abdominal incisions.

The advantages of a laparoscopic procedure are that the incisions are only about .5 in (1.3 cm) long, the operation is causes less discomfort than an abdominal procedure, and bleeding rarely occurs. The hospital stay is usually only one day and recovery time is reduced to about two weeks. The disadvantage is that this operation is relatively new and requires great skill by the surgeon.

Before surgery, the doctor will order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman's condition. The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia.