Ovarian ablation

Ovarian ablation is surgery to remove the ovaries. It is recommended for some women with breast cancer that grows in response to the hormone estrogen. This kind of breast cancer is called hormone receptor-positive.

The ovaries make most of the estrogen in women’s bodies, so removing them lowers the amount of estrogen in the body and helps slow or stop hormone receptor-positive breast cancer from growing.

What is ovarian ablation?

In surgical ovarian ablation your surgeon takes out the ovaries and sometimes the fallopian tubes, the thin tubes eggs use to move from the ovaries to the uterus. This surgery is usually performed by an obstetrician/gynecologist (OB/GYN) or a gynecologic oncologist.

You might hear your doctor refer to the surgery in two other ways:

• as an oophorectomy, if you only have the ovaries removed
• as a salpingo-oophorectomy, if you have the ovaries and the fallopian tubes removed

Oophorectomy permanently lowers the amount of estrogen in your body because the ovaries are no longer there to create it. This helps keep hormone receptor-positive breast cancer from growing or spreading.

When the ovaries are no longer there to make estrogen or release eggs, you will

• no longer get your monthly period
• no longer be able to get pregnant
• start menopause, no matter what age you are

If you want or might want children in the future, talk to your doctor before having this surgery.

Who gets ovarian ablation?

Oophorectomy is recommended for some women who have any stage of hormone receptor-positive breast cancer and are premenopausal, meaning they still get their monthly period.

If you have already gone through menopause, oophorectomy will not lower your risk of future breast cancer. If you aren’t sure whether you started menopause your doctors will be able to test you to find out.

Because removing the ovaries means you won’t be able to have children in the future, you should talk to your doctors about ovarian suppression if future pregnancy is a concern. Ovarian suppression uses medicines to temporarily stop the ovaries from making estrogen rather than removing them. Many people who use ovarian suppression medicines are able to stop taking them to safely become pregnant.

Salpingo-oophorectomy may also be recommended to you if you do not have breast cancer but are considered at high risk of developing ovarian cancer. This might be true if you have tested positive for a BRCA gene mutation or have a very strong family history of breast or ovarian cancer. If you have the surgery to lower your risk of ovarian cancer, your doctors may call it a risk-reducing salpingo-oophorectomy.

What happens during surgery?

Most often, your surgeon will be able to remove the ovaries and fallopian tubes in laparoscopic surgery, a type of surgery that uses only a few small cuts. Your surgeon will then use special tools to take the ovaries and tubes out through these small cuts.

The surgeon can see what they’re doing through a laparoscope, a thin tube with a light and a camera on the end that allows them to watch on a screen.

Before the surgery you will be given general anesthesia, common medicines to put you into a deep sleep that lasts through the whole surgery. You won’t be aware of what’s going on around you or feel any pain during the surgery. The surgery itself usually lasts an hour or less.

Depending on your medical history your surgeon will determine whether you may be able to have laparoscopic surgery. If you can’t for any reason, you will need to have traditional surgery, or open surgery, in which the surgeon makes a longer cut. For oophorectomy, this cut is made across the lower part of your abdomen, or belly, so that the surgeon can see and remove your ovaries and fallopian tubes. If you have open surgery you will still be put into a deep sleep with general anesthesia and the surgery may last a few hours instead of one. You may also need more stitches or need to stay in the hospital longer to heal.

Recovering after surgery

Immediately after surgery, you will be taken to the recovery room. In the recovery room nurses will keep track of your heart rate, blood pressure, breathing, and body temperature while the general anesthesia wears off and you wake up.

Watching these things — called your vital signs — allows the nurses to keep track of how well you are doing and whether you need medicines for pain. How long you stay in the recovery room is different for every person.

It’s normal after any type of surgery to have some pain, especially where the surgeon cut your skin. Your body may also feel stiff or generally sore. Always tell your care team how much pain you feel so they can help you ease it.

In addition to pain, many people experience side effects after having general anesthesia. Common side effects are nausea and vomiting, a feeling of motion sickness or dizziness, and shivering. Tell the nurses if you have any of these effects: They will be able to give you medicine or make you more comfortable.

Going home

If you had laparoscopic surgery, you are likely to go home the same day. You should be able to go back to work or daily activities the following week. But remember that everyone is different. Be mindful of your body and what it’s telling you.

If you had open surgery, you may need to stay in the hospital for 2 to 4 days. Recovery at home takes about 6 weeks because more healing is needed.

Side effects after surgery

Removing the ovaries immediately starts what’s called surgical menopause. Because the ovaries are no longer there to make estrogen, your body will react to the lower levels of the hormone in the same way it would if you started natural menopause later in life.

The side effects you might feel include hot flashes, night sweats, changes in sexual desire or mood swings, among others. Learn more about menopausal side effects here.