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Ovarian Cancer: Should I Have My Ovaries Removed to Prevent Ovarian Cancer?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Ovarian Cancer: Should I Have My Ovaries Removed to Prevent Ovarian Cancer?
Get the facts
- Have surgery to remove your ovaries and fallopian tubes.
- Don't have surgery.
This decision aid is for women who are at high risk for ovarian cancer and are thinking of having their ovaries removed to prevent it. It is not for women at average risk for ovarian cancer. Deciding whether to have your ovaries removed when you have a hysterectomy and are at average risk for ovarian cancer is a different decision.
Key points to remember
- You can't make this decision until you know how high your risk is for ovarian cancer. Your doctor or a genetic counselor can help you. If your risk isn't high, removing your ovaries is not recommended.
- Women who have a strong family history of ovarian cancer have a higher chance of getting it themselves. (Family history means having relatives with the disease.)
- Women who have an increased risk for ovarian cancer, such as those with BRCA gene changes, may want to consider having their ovaries removed after age 35 if they are finished having children.
- Your decision will depend on how high your risk is. It also depends on your health, your age, and your personal feelings.
- Having the ovaries removed greatly lowers a woman's chances of getting ovarian cancer. The fallopian tubes are removed at the same time. This is another place where cancer can start.
- If you haven't yet started menopause, having your ovaries removed will cause you to start it. It will also take away your ability to get pregnant.
Your risk depends on your medical and family history of ovarian cancer. For example, having one relative with ovarian cancer means you are more likely than average to get it. But if you have more than one relative with this cancer, your chances of getting it are higher. You may want to talk to a genetic counselor.
Other family cancers may also affect your risk for ovarian cancer. Ovarian cancer and breast cancer can be related to BRCA gene changes. Women from families who inherit the gene changes for Lynch syndrome (also called hereditary nonpolyposis colorectal cancer syndrome, or HNPCC) are also at increased risk for getting ovarian and other cancers.
To understand how a family history of ovarian cancer can affect your chances of getting it, look at the numbers below. Remember that everyone’s case is different. These numbers may not show what will happen in your case.
- An average woman has a very low risk. Out of 100 average women, 1 will get ovarian cancer.
- A woman with one family member (mother, sister, daughter) who had this cancer has a slightly higher risk. Out of 100 women with one family member who has had this cancer, 5 will get ovarian cancer.
- A woman with at least two first-degree relatives (meaning mother, sister, or daughter) who had this cancer has a higher risk. Out of 100 women with two relatives who have had it, 7 women will get ovarian cancer.
- Women with the BRCA gene change have the highest risk. Out of 100 women who have the BRCA1 gene change, 20 to 60 will get ovarian cancer. Out of 100 women who have the BRCA2 gene change, 10 to 35 will get ovarian cancer.1
If you don't know whether you are at high risk, talk to your doctor. A genetic counselor can also help you. Having the BRCA gene test may be an option for some women, but it's not for everyone.
The most important benefit of surgery to remove your ovaries is that your chance of getting ovarian cancer goes way down. This may lower your risk so that it is the same or only slightly higher than the average woman's risk.
- Removing your ovaries makes you start menopause if you haven't started it already. Menopause often has symptoms like hot flashes, vaginal dryness, urinary frequency, and decreased sexual interest. And it raises your risk for other diseases, such as heart disease and osteoporosis.
- When your ovaries are removed, you can no longer get pregnant.
- Removing the ovaries does not always prevent cancer. Sometimes a woman already has cancer before the surgery but doesn't know it because she has no symptoms. And the cancer cells may already have begun to spread outside the ovaries. In that case, removing the ovaries will not remove all of the cancer cells. Cancer can also start in the belly after the ovaries are removed, but this is rare.
Being at higher risk for ovarian cancer does not mean you will definitely get it. This is why some women choose not to have surgery. If you decide not to have surgery, you have two other options:
- Birth control pills. Studies have found that taking birth control pills starts lowering a woman's risk of ovarian cancer in the first year. And the risk is reduced by about 50% if she keeps taking birth control pills for 5 years or longer. Most studies show that taking birth control pills helps women who have BRCA gene changes.2
- Extra checkups and testing. The goal is to find any cancer as early as possible, when the chances of treating it successfully are higher.
There is no proof that having extra screening tests helps women live longer by finding ovarian cancer early. Still, some experts recommend that women with an inherited risk of ovarian cancer have these tests at least once a year, starting at age 35:3
- Transvaginal ultrasound. Ultrasound uses sound waves to make pictures of body parts. A small handheld device is passed back and forth over the area in question. In a transvaginal ultrasound, the device fits into a woman's vagina. The test is used to look for tumors in and around the ovaries.
- CA-125 blood test. CA-125 is a protein in your blood. Having more of it than normal can mean you have cancer. The test is usually used to check how well treatment for ovarian cancer is working or to see if the cancer has returned.
Women who have inherited a BRCA1 gene change (not a BRCA2 gene change) may want to start having these regular tests as early as age 25.3
Your doctor might recommend this if:
- You have a very strong family history of ovarian cancer.
- A gene test shows that you have inherited a gene change, such as BRCA or the one for Lynch syndrome (HNPCC).
- You are done having children.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You will be asleep during the operation.
- If the operation is laparoscopic (done with very small cuts), you will likely go home the same day. Otherwise you will stay in the hospital for 2 to 3 days.
- Surgery greatly lowers your chances of getting ovarian cancer.
- You will not be able to get pregnant.
- You will start menopause. You could have symptoms such as hot flashes, vaginal dryness, frequent urination, and decreased sexual interest.
- You will have an increased risk for other diseases, such as heart disease and osteoporosis.
- You could still get cancer.
- You consider other options,
- Doing nothing.
- Having regular checkups and testing.
- Taking birth control pills.
- Women of childbearing age can still have children.
- You will go into menopause at your normal time.
- You will continue to have a high risk for ovarian cancer.
Personal stories about having the ovaries removed to prevent ovarian cancer
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I am from one of those families with lots of cancer—including ovarian cancer—in parents, aunts, and cousins. It was a hard decision to have my ovaries removed, but it was logical for me. I did a lot of research before I made the decision, and now I just feel safer.
Sandra, age 35
I had my ovaries removed last year because I have a very strong family history of breast and ovarian cancer. I wish I had thought more ahead of time about what can happen when your ovaries are gone. I went into menopause at age 40 and have had a pretty miserable time of it. I seem to have all the worst symptoms of menopause: hot flashes, mood changes, night sweats, and loss of sex drive.
Keiko, age 40
I have a couple of relatives with breast or ovarian cancer, but I'm not going to have my ovaries removed. Surgery seems like too drastic a step. I would rather take my chances and hope that cancer is not in the cards for me. I know some people couldn't live with the "threat" of cancer hanging over them, but I'm okay with it.
Dee, age 28
I have had genetic testing and am BRCA-positive, so my risk for ovarian cancer is very high. I had my ovaries removed because I want to do everything I can possibly do to keep from getting the cancer that runs in my family.
Amaia, age 31
My grandmother died of ovarian cancer, and I have a cousin who was just diagnosed with breast cancer. I thought that meant that I was definitely going to get one or both cancers. But I talked to my doctor and found out it's not a definite thing. I don't want to have my ovaries removed, but I am going to have regular checkups and testing. And I have started to take birth control pills too.
Salma, age 27
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have your ovaries removed
Reasons not to have your ovaries removed
I want to do everything I can to keep from getting ovarian cancer.
The thought of surgery scares me more than the thought of getting cancer.
The idea of early menopause doesn't bother me.
I don't want to go into menopause any earlier than I have to.
I am done having children.
I still want to have children.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having my ovaries removed
NOT having my ovaries removed
What else do you need to make your decision?
Check the facts
A decision about whether to have my ovaries removed depends a lot on how strong my family history of ovarian cancer is.
- TrueThat’s right. You can't begin to make this decision until you find out all you can about how strong your family history is. Your doctor will help you figure this out.
- FalseNo, that's not correct. In fact, finding out all you can about your family history is the first thing you need to do. This information will tell you how high your chances are of getting ovarian cancer.
- I'm not sureIt may help to go back read "Get the Facts." Finding out all you can about your family history is very important.
If I have a strong family history of ovarian cancer, having my ovaries removed will not lower my chances of getting the disease.
- TrueNo, that's not right. In fact, the opposite is true. Studies show that this surgery may lower your risk of ovarian cancer so that you have the same risk as the average woman, or only slightly higher.
- FalseYou are right. Studies show that this surgery may lower your risk of ovarian cancer so that you have the same risk as the average woman, or only slightly higher.
- I'm not sureIt may help to go back and read "Get the Facts." This surgery greatly lowers your chances of getting ovarian cancer.
If I haven't started menopause yet, having my ovaries removed will send me into menopause. This means I could start having menopause symptoms and I won't be able to get pregnant.
- TrueYou're right. Without ovaries, you can't get pregnant. And taking out your ovaries will send you into menopause if you haven't already started it.
- FalseSorry, that's wrong. After your ovaries are removed, you won't be able to get pregnant. And you will go into menopause if you haven't already started it.
- I'm not sureIt may help to go back and read "Get the Facts." Removing the ovaries will send you into menopause if you haven't already started it.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Adam Husney, MD - Family Medicine|
|Specialist Medical Reviewer||Ross Berkowitz, MD - Obstetrics and Gynecology|
- Cannistra SA, et al. (2008). Ovarian cancer, fallopian tube carcinoma, and peritoneal carcinoma. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 1568–1594. Philadelphia: Lippincott Williams and Wilkins.
- National Cancer Institute (2010). Ovarian Cancer Prevention PDQ–Health Professional Version. Available online: http://nci.nih.gov/cancertopics/pdq/prevention/ovarian/healthprofessional.
- National Cancer Institute (2011). Genetics of Breast and Ovarian Cancer (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional.