Whilst there are several reasons that the surgical removal of all or part of the ovaries may be indicated to benefit a woman, potential risks must be considered.
Oophorectomy is not the preferred method of prophylaxis from breast or ovarian cancer for every woman, as the potential risks are significant and must be weighed up against the benefits.
Serious complications as a direct result of the surgery involved in an oophorectomy are rare. On occasion, injury to the ureter at the suspensory ligament of the ovary may occur.
The most common surgery performed intra abdominally is not associated with a high incidence of subsequent issues. On the other hand, Laparotomic adnexal surgeries may cause adhesive small bowel obstructions in up to 24% of all surgeries.
Over the long-term, women who have had an oophorectomy are associated with a significantly higher risk of mortality from all causes of death. The only exception to this is women who carry high-risk BRCA gene mutations.
Women who have their ovaries removed before the age of 45 are particularly prone to this risk, and the effect is more prominent (170% risk in comparison to women that retain ovaries). However, it is not limited to women who undertake an oophorectomy at an earlier age. In fact, it is expected that the overall survival rate is impacted for surgeries done up until the age of 65. This risk is primarily associated with deaths resulting from hormonal changes, cardiovascular disease, and hip fractures.
Even when a hysterectomy is performed simultaneously, there is an improved long-term survival rate seen for women who do not have their ovaries removed.
As women who have undertaken a bilateral oophorectomy lose their ability to produce the female hormones estrogen and progesterone in the ovaries, they enter a phase known as surgical menopause.
Women often experience a sudden, pronounced onset of menopause. This is because the hormones are stopped instantaneously, rather than for women who progress to menopause naturally over a period of years.
The symptoms such as hot flashes, mood swings, and vaginal dryness can be particularly severe. Many women choose to take hormone replacement therapy to help them cope with hormones' adjustment in their bodies.
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While the exact mechanism is not known, removing a woman’s ovaries is associated with a risk of cardiovascular disease seven times greater than without ovary removal. It is thought that this cardiovascular effect is related to the changes in hormonal levels of the woman.
However, even with pharmacological hormone replacement therapy, the ovaries' natural hormone production cannot be imitated. According to her individual needs, the ovaries are required to produce the hormones throughout a woman’s life at varying levels. Without them functioning, the effects on the woman’s body are evident.
Another outcome of the sudden change to the female hormones usually produced by the ovaries is the increased risk of osteoporosis. Estrogen is vital for maintaining bone density, and when the hormone levels change after undertaking an oophorectomy, women are more prone to osteoporosis.
Additionally, reduced levels of testosterone may contribute to a certain loss of height. This is usually attributed to the lower bone density also observed in women affected by osteoporosis.
Some non-hormonal medications, such as bisphosphonates, may increase the bones' strength and help prevent osteoporosis and risk of fractures.
It is widely accepted that oophorectomy can lead to significant impairment of sexuality. This may include symptoms such as:
- Loss of libido.
- Difficulty becoming sexually aroused.
- Vaginal dryness.
As a result of these effects, women may have more difficulty maintaining romantic relationships to the same extent as before surgery.
The risks associated with an oophorectomy can be quite severe, and it is for this reason, many women are advised against undertaking the surgery. The individual circumstances of each woman should be considered to make the best clinical decision.
Dr. Lu on the Challenges of Risk-Reducing Salpingo-Oophorectomy