Minimally invasive surgery - Laparoscopic oophorectomy
During the course of any laparoscopy, the ovaries can be removed (oophorectomy)or the ovaries and fallopian tubes (salpingo-oophorectomy). Actually, this procedure is generally not difficult and any trained gynecologic laparoscopist should be capable of performing this procedure with minimal risk. Exceptions due occur, however, if the ovary is very enlarged, or encased in adhesions (scars). The ovary is in close proximity to vital structures, which can be damaged in such cases.
Indications for laparoscopic oophorectomy:
- Pelvic pain unresponsive to medical treatment
- Ovarian tumors or cysts
- Endometriosis
- Supportive therapy for women with breast cancer
- Prophylactic removal of the ovaries for patients who are at risk for breast or ovarian cancer
Prophylactic oophorectomy is usually recommended if you're at greatly increased risk of breast cancer and ovarian cancer due to an inherited mutation in the BRCA1 or BRCA2 gene — two genes linked to breast cancer, ovarian cancer and other cancers. High-risk women age 35 and older who have completed their families are the best candidates for this surgery.
Because BRCA1 carriers are at risk of developing ovarian cancer at an earlier age than are BRCA2 carriers, they usually have the procedure at an earlier age — between ages 35 and 40. Carriers of a BRCA2 alteration can usually delay the procedure until age 45. In either case, be certain that your childbearing is complete before you arrange for surgery. Your doctor can help you understand and manage your risk in the meantime.
Prophylactic oophorectomy may also be recommended if you have a strong family history of breast cancer and ovarian cancer but no known genetic alteration. It might also be recommended if you have a strong likelihood of carrying the gene mutation based on your family history but choose not to proceed with genetic testing.
How much of an impact can this have on your risk of breast and ovarian cancers? A significant one. If you have a BRCA mutation, prophylactic oophorectomy reduces your risk of breast cancer by about 50 percent if you're premenopausal, and it reduces your risk of ovarian cancer by 80 percent or more — regardless of your menopausal status. But if you don't have a BRCA mutation or a genetic predisposition based on a strong family history of breast or ovarian cancer, the drawbacks of this surgery probably outweigh the benefits.
You might think that preventive mastectomy would be the most likely way to lower your risk of breast cancer — and it does reduce breast cancer risk to a much greater extent than does prophylactic oophorectomy. However, you might choose prophylactic oophorectomy over mastectomy because oophorectomy protects against both breast and ovarian cancer, rather than just breast cancer. Having a BRCA1 or BRCA2 gene mutation puts you at risk of both diseases.
Laparoscopic oophorectomies are generally completed in less than one hour. We at Women’s Health Associates have over 20 years’ experience performing this procedure.
Possible problems
- Osteoporosis
If you're premenopausal, removal of your ovaries takes away the protective effect of estrogen on your bones, so you will be at increased risk of the bone-thinning disease osteoporosis. You may need to take a bone-building medication to prevent or treat osteoporosis.
- Discomforts of menopause
Hot flashes, vaginal dryness, sexual problems, sleep disturbance and sometimes cognitive changes are problems for some women during menopause. Removing your ovaries doesn't mean you'll immediately have these problems, but it does mean that any menopausal symptoms you develop will occur earlier and are more likely to reduce your quality of life.
- Cancer
Prophylactic oophorectomy doesn't completely eliminate your risk of breast or ovarian cancer. A type of cancer that looks and acts identical to ovarian cancer can develop after the ovaries and fallopian tubes are removed. The risk for this type of cancer, called primary peritoneal cancer, is low — much lower than the lifetime risk of ovarian cancer if the ovaries remain intact.