Most bilateral oophorectomies (63%) are performed prophylactically without any medical indication at the same time as hysterectomy (87%).
Conversely, unilateral oophorectomy is commonly performed for a medical indication (73%; cyst, endometriosis, benign tumor, inflammation, etc.) and less commonly in conjunction with hysterectomy (61%).
In addition, women with a familial history of ovarian cancer and/or with genetic polymorphisms such as BRCA1/BRCA2 must also weigh those factors into their decision to undergo prophylactic bilateral oophorectomy.
For carriers of high risk BRCA1 mutations, prophylactic oophorectomy around age 40 reduces the risk of ovarian and breast cancer and provides significant and substantial long-term survival advantage.
Earlier intervention does not, on average, provide any additional benefit but increases risks and adverse effects.
For carriers of high risk BRCA2 mutations, oophorectomy around age 40 has only marginal effect on survival; the positive effect of reduced breast and ovarian cancer risk is nearly balanced by adverse effects.
The survival advantage is more substantial when oophorectomy is performed together with prophylactic mastectomy.
Reduced problems of endometriosis
In rare cases, oophorectomy can be used to treat endometriosis. This is done to remove a source of hormones that fuel uterine lining growth, thus reducing the overgrowth responsible for endometriosis.
Oophorectomy for endometriosis is usually a last-resort surgery due to the risks associated with a sudden cessation of hormone production, most notably early-onset osteoporosis.
For this reason, hormonal agonists such as Lupron are usually prescribed first to alter the hormonal cycle prior to proceeding directly to a non-reversable surgical intervention.
Oophorectomy for endometriosis is often done in conjunction with a hysterectomy as a final shot at removing all traces of endometriosis in cases where non-surgical treatments such as hormonal agonists have failed to stop the uterine overgrowth.
Ovarian cyst removal without oophorectomy or through partial oophorectomy is often used to treat milder cases of endometriosis when non-surgical hormonal treatments fail to stop cyst formation, or to treat extreme pelvic pain from chronic hormonal-related pelvic problems.
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