Oophorectomy: Pros and Cons of Post-Menopausal Ovary Removal

The end of a woman’s menstrual cycle is marked by the natural biological process known as menopause. It’s officially diagnosed after a woman has gone 12 months without a menstrual period, typically occurring in their late 40s or early 50s. This phase signifies the end of a woman’s reproductive years, but it also brings about a host of physical and emotional changes.

Women often endure a variety of symptoms during menopause, including mood swings, hot flashes, nocturnal sweats, and difficulty sleeping. These are brought on by the ovaries’ declining production of the female reproductive hormones progesterone and estrogen. Some women may also experience symptoms like vaginal dryness and discomfort during sex, while others may suffer from longer-term effects such as bone loss or osteoporosis due to the low estrogen levels.

According to the Women’s Health Study, nearly 80% of women experience some symptoms during menopause, but only about 20 to 25% of menopausal women seek medical treatment. This emphasizes how menopause can negatively affect a woman’s quality of life.

However, an aspect of menopause that is less commonly discussed is the potential need for ovary removal, or oophorectomy. In certain situations, it may be beneficial or necessary to remove the ovaries before menopause, despite the associated risks.

Ovary Removal Before Menopause: A Delicate Decision

Oophorectomy, or ovary removal surgery, is a procedure that can lead to immediate menopause if performed before natural menopause. This sudden change deprives the body of essential hormones such as estrogen and progesterone, leading to an abrupt onset of menopausal symptoms. This condition, often referred to as surgical menopause, can be more severe than natural menopause due to the abrupt hormone changes.

However, the necessity for an oophorectomy before menopause is not always based on immediate health threats. It can be a preventive measure for those at high risk of developing ovarian or breast cancer. For instance, for women at high genetic risk of ovarian or breast cancer, an oophorectomy can significantly reduce these risks. The operation can also provide relief from chronic conditions such as endometriosis, Pelvic Inflammatory Disease (PID), or recurrent ovarian cysts.

In fact, according to the National Cancer Institute, prophylactic oophorectomy can reduce the risk of ovarian cancer by 80% and the risk of breast cancer by 50% in high-risk women.

The decision to undergo this surgery should always involve careful consultation with healthcare providers, taking into account the individual’s overall health, genetic risks, and personal circumstances.

The Cons of Ovary Removal After Menopause

The decision to undergo an oophorectomy, or the surgical removal of one or both ovaries, can be a complex one. This becomes even more intricate when considering this procedure after menopause. Here are some potential cons of ovary removal after menopause:

Sexual Function

The decrease in both serum estrogen and androgen levels following surgical menopause can affect female sexual function. Estrogen helps maintain genital tissue and reduces discomfort during intercourse.

Immediate Menopause

Relative to your age, menopause will start the moment your ovaries are removed, whether you had a total or radical hysterectomy.

Side Effects

An elective oophorectomy is sometimes recommended for postmenopausal women who are also undergoing a hysterectomy for benign conditions. However, the procedure can come with side effects.

Surgery Risks

Like all surgeries, prophylactic ovary removal comes with some risks. It throws premenopausal women’s bodies straight into menopause.

Potential Weight Gain

Some women might experience changes in their metabolism due to a further decrease in hormone levels, which can lead to weight gain. It’s important to note that this isn’t a guaranteed side effect and may vary greatly among individuals.

Long-Term Health Impact

Bilateral oophorectomy before the onset of menopause increases the risk of Parkinsonism, cognitive impairment, dementia, and anxiety or depression.

Cognitive Impairment

A bilateral oophorectomy performed before the onset of menopause is associated with an increased risk of cognitive impairment or dementia.

Increased Mortality Risk

Studies have indicated that women who have their ovaries removed before they reach natural menopause may have a higher risk of premature death, primarily from heart disease and stroke. This could be due to the abrupt drop in estrogen levels post-surgery, which can affect cardiovascular health.

But if you are already in menopause, hormone-related side effects should not affect you too much because your ovaries have already stopped functioning. Furthermore, there is no evidence linking oophorectomy performed after menopause to a higher risk of hip or vertebral fractures.

The Pros of Ovary Removal After Menopause

Opting for an oophorectomy, or the surgical removal of one or both ovaries, after menopause can come with certain benefits. Here are some potential pros of ovary removal after menopause:

Ovarian Cancer Risk Reduction

One of the most significant benefits of prophylactic ovary removal is the reduction in risk of ovarian cancer. This is particularly important for women who have a high risk due to genetic mutations such as BRCA1 or BRCA2. The risk reduction can be as much as 90%, providing substantial peace of mind.

Potential Relief from Benign Conditions

Some women experience benign but painful conditions, such as ovarian cysts or endometriosis. In these cases, removing the ovaries can bring substantial relief from chronic pain.

Reduction in Bone Loss Rate

Postmenopausal women who keep their ovaries experience a slower rate of bone loss. This is because even after menopause, the ovaries continue to produce small amounts of estrogen, which plays a crucial role in maintaining bone density.

Androgen Production

Androgens, the ‘male’ hormones, are still produced by the ovaries even after menopause. These hormones play a role in maintaining a woman’s sex drive and overall sense of well-being.

Elimination of Ovarian Maintenance Medications

For women who were taking medications to manage ovarian cysts or other ovarian issues, ovary removal can eliminate the need for these drugs.

May Lower the Risk of Breast Cancer

In premenopausal women with a high risk of breast and ovarian cancer, removing the ovaries can reduce the risk of developing breast cancer.

When to Consider Oophorectomy: A Checklist

After understanding the potential disadvantages of an oophorectomy, it’s essential to recognize when it might be time to consider this procedure. Here’s a checklist to guide you:

• High Risk of Ovarian or Breast Cancer: If you have a strong family history or carry genetic mutations (like BRCA1 or BRCA2), an oophorectomy might be considered to reduce your risk.
• Existing Ovarian, Fallopian tube, or Peritoneal Cancer: An oophorectomy is often performed to remove existing cancer and prevent its spread.
• Endometriosis or Severe Pelvic Inflammatory Disease: For some women with severe endometriosis or pelvic inflammatory disease, an oophorectomy may provide relief from chronic pain.
• Non-cancerous Ovarian Tumors or Cysts: In some cases, non-cancerous tumors or cysts may require an oophorectomy if they cause symptoms or are large.

Remember, this checklist is not exhaustive, and each woman’s situation is unique. It’s crucial to have thorough discussions with your healthcare provider about the risks, benefits, and alternatives before making a decision. With the right support, information, and healthcare guidance, you can navigate this journey confidently.