Salpingo-Oophorectomy: Types, Hormones, and Health Risks

Salpingo-oophorectomy is the surgical removal of one or both ovaries along with the adjacent fallopian tube. When both sides are removed, it is called bilateral salpingo-oophorectomy (BSO); when only one side is removed, it is unilateral. The procedure is performed for a range of reasons, from treating ovarian cysts and endometriosis to reducing cancer risk in women who carry BRCA gene mutations. Because the ovaries are a major source of reproductive hormones, the surgery triggers a cascade of changes throughout the body, and the trade-offs look very different depending on why the surgery is done and how old you are when it happens.

Why the Surgery Is Performed

The most common reasons for salpingo-oophorectomy fall into two broad categories: treating existing disease and preventing future disease. On the treatment side, the procedure may be recommended for ovarian or fallopian tube tumors, severe endometriosis, large or complex ovarian cysts, ovarian torsion, tubo-ovarian abscess, or as part of a hysterectomy for conditions like uterine cancer. On the prevention side, the surgery is most often discussed in the context of BRCA1 and BRCA2 gene mutations. Women who carry these mutations face a substantially higher lifetime risk of ovarian and breast cancer, and risk-reducing bilateral salpingo-oophorectomy (RRBSO) is the most effective strategy available to lower that risk. Current guidelines recommend RRBSO between roughly age 35 and 40 for BRCA1 carriers and between 40 and 45 for BRCA2 carriers.¹

How Much Does It Reduce Cancer Risk?

The numbers are striking. A meta-analysis pooling data from multiple studies of BRCA mutation carriers found that RRBSO was associated with roughly an 80% reduction in ovarian and fallopian tube cancer risk and about a 50% reduction in breast cancer risk. A linked prospective study found even larger reductions in cancer-specific mortality: around 90% lower breast cancer death, 95% lower gynecologic cancer death, and 76% lower overall mortality.² An earlier trial comparing women who chose RRBSO with those who chose ongoing surveillance found that the surgery group had about a 75% lower hazard of developing a subsequent BRCA-related cancer during follow-up.³

For women without known genetic mutations, ovary removal at the time of hysterectomy has historically been performed to prevent the small baseline risk of ovarian cancer. But as research has clarified the long-term costs of losing ovarian hormones early, the calculus has shifted. In the general population, routine removal of healthy ovaries is now less commonly recommended.

Laparoscopic Versus Open Surgery

Salpingo-oophorectomy can be done through a traditional open incision (laparotomy) or through small keyhole incisions (laparoscopy). Robotic-assisted laparoscopy is also increasingly common. When researchers have compared the two approaches directly, the pattern is consistent: laparoscopy takes somewhat longer in the operating room but results in shorter hospital stays, faster recovery, and fewer complications. One randomized trial found that women who had laparoscopic surgery stayed in the hospital about half as long and returned to normal activities in roughly three weeks compared with six weeks after open surgery.⁴ Another study reported a 25% complication rate with open surgery versus 0% with laparoscopy, along with a faster return to work.⁵ A cost-benefit analysis confirmed the shorter hospitalization and convalescence with laparoscopy, though the equipment costs were higher; the overall surgical cost still favored laparoscopy because of the much shorter hospital stay.⁶

Today the vast majority of salpingo-oophorectomies are performed laparoscopically or robotically unless the complexity of the case, such as severe adhesions from prior surgeries or large masses, requires an open approach.

What Happens to Your Hormones

If you still have regular periods at the time of surgery, bilateral salpingo-oophorectomy triggers immediate surgical menopause. The ovaries are the body’s primary factory for estrogen, progesterone, and a meaningful share of testosterone. Losing them abruptly is different from natural menopause, which unfolds over years and allows the body to adapt gradually. The hormone drop is sudden and often more intense in its symptoms: hot flashes, night sweats, vaginal dryness, mood changes, and sleep disruption can begin within days.

Even after natural menopause, the ovaries continue to produce small amounts of hormones. A meta-analysis looking specifically at postmenopausal women who had their ovaries removed found that estradiol, testosterone, and DHEA levels all dropped significantly compared with women who kept their ovaries, while other androgens like DHEAS and androstenedione did not change significantly.⁷ A separate study focused on postmenopausal BRCA carriers found that estradiol dropped by about 62% after RRBSO, though other hormones were not significantly affected.⁸ The take-home point is that even postmenopausal ovaries are not hormonally inert, and removing them has measurable endocrine consequences.

Bone Loss After Surgery

One of the more predictable consequences of losing ovarian hormones is accelerated bone loss. Estrogen helps maintain bone density, and without it, the skeleton starts shedding mineral at a pace that exceeds normal aging. In premenopausal women who had RRBSO, one study measured annual bone density losses of about 3.5% at the lumbar spine, 2.9% at the femoral neck, and 2.2% at the total hip.⁹ Another prospective study found that at two years post-surgery, women who were not taking hormone therapy had lost about 6% of bone density at the lumbar spine, total hip, and femoral neck, along with a roughly 15% decrease in a measure of tibial bending stiffness.¹⁰ At 18 months in a separate cohort of high-risk women who did not take hormones, lumbar spine density dropped by about 8.5%.¹¹

This rate of loss is steep enough that fracture prevention becomes a genuine clinical concern, especially for women who have the surgery in their thirties or early forties and face decades of compromised bone health. Hormone replacement therapy, weight-bearing exercise, calcium, and vitamin D are the standard countermeasures, and bone density monitoring after surgery is routine.

Heart Health and Metabolic Changes

The relationship between oophorectomy and cardiovascular disease is one of the more contentious areas. Some studies have found a clear signal of harm. Data from the Mayo Clinic showed that women who had both ovaries removed before age 45 had about a 44% higher risk of cardiovascular death compared with women who kept their ovaries, and this risk jumped to 84% higher in those who did not take estrogen therapy through at least age 45.¹² However, the Women’s Health Initiative observational study, a much larger dataset, found no statistically significant increase in heart disease, stroke, or total cardiovascular disease among women who had BSO compared with those who had a hysterectomy alone, regardless of age at surgery.¹³

Among BRCA carriers specifically, a population-based study found no significantly increased cardiovascular risk when comparing BRCA mutation carriers who had RRBSO with other women who had bilateral oophorectomy. But when those same BRCA carriers were compared with women who kept their ovaries, they did show a higher cardiovascular risk.¹⁴ The overall picture suggests that the cardiovascular concern is most relevant for women who lose their ovaries well before natural menopause and do not take hormone replacement therapy.

Beyond the heart itself, premenopausal oophorectomy appears to nudge metabolic markers in unfavorable directions. A study tracking metabolic parameters over ten years found that women who had bilateral oophorectomy before menopause experienced unfavorable shifts in weight, body mass index, and HDL cholesterol, with most of the changes occurring in the first four to five years.¹⁵ Another prospective study found that women who had RRBSO gained more visceral abdominal fat than a comparison group.¹⁶

Cognitive Risks and Dementia

This is the area that tends to catch people off guard. A large Mayo Clinic cohort study found that women who had either unilateral or bilateral oophorectomy before natural menopause had roughly a 46% higher risk of cognitive impairment or dementia, and the risk increased the younger they were at the time of surgery.¹⁷ A later systematic review and meta-analysis reinforced this: while surgical menopause at any age was not conclusively linked to dementia overall, early surgical menopause before age 45 was associated with a 70% higher risk. Even outside of a dementia diagnosis, surgical menopause at any age was linked to faster decline in verbal memory, processing speed, and other cognitive measures.¹⁸

The evidence here is not ironclad — observational studies cannot fully disentangle cause from correlation — but the consistency of the signal across multiple study designs has made it an important part of the decision-making conversation, especially for younger women considering the surgery.

Does Age at Surgery Change the Mortality Picture?

Age turns out to be the single biggest variable in whether bilateral salpingo-oophorectomy helps or harms overall survival. A large population-based cohort study broke this down clearly. In women under 45, BSO was associated with a 31% increase in all-cause death over 20 years compared with ovarian conservation, driven primarily by an increase in non-cancer deaths. In women aged 45 to 49, there was a smaller but still significant 16% increase. But from age 50 onward, BSO was not associated with increased mortality and may have been associated with decreased mortality.¹⁹ Results from the Nurses’ Health Study told a similar story over 28 years of follow-up: oophorectomy was associated with lower ovarian cancer death and, in women under roughly 47.5, lower breast cancer death, but at no age was it associated with lower all-cause mortality.²⁰ Another study confirmed that the mortality hazard from BSO was greatest in women who had the surgery by age 35 and progressively shrank at later ages, disappearing entirely by age 50.²¹

This is where the tension lies for BRCA carriers: the cancer risk reduction is massive, but the surgery itself carries long-term health costs that are most pronounced when it is done at the younger ages the guidelines recommend. That trade-off is what makes hormone replacement therapy and newer staged strategies so important.

Hormone Replacement Therapy After Surgery

For premenopausal women who undergo RRBSO, hormone therapy is widely regarded as essential to mitigate the abrupt hormone loss. Estrogen therapy effectively controls menopausal symptoms, helps protect bones and the cardiovascular system, and reduces mortality. Despite this, many women go untreated, often because of overblown fears about estrogen use.²²

A common and understandable worry is whether taking hormones after RRBSO might cancel out the cancer protection the surgery was supposed to provide. For BRCA1 carriers, the evidence is reassuring: a large study found that estrogen-only hormone therapy after oophorectomy did not increase breast cancer risk.²³ A systematic review of the broader literature on BRCA1 and BRCA2 carriers found no evidence that short-term hormone use after RRBSO increases breast cancer risk or negates the protective effect of the surgery.²⁴ The effect of combined estrogen-plus-progesterone therapy is less firmly settled, but the overall consensus is that short-term use is safe in this population.

Beyond estrogen, testosterone supplementation may improve sexual desire and overall sexual functioning in surgically menopausal women, though long-term safety data are limited.²⁵ For women who cannot or prefer not to take hormones, certain antidepressants and gabapentin can help manage hot flashes, though they do not address the bone, heart, or metabolic concerns.²⁶

Opportunistic Salpingectomy and the Fallopian Tube Theory

Research over the past two decades has increasingly pointed to the fallopian tube, not the ovary itself, as the starting point for many of the most lethal ovarian cancers, especially the high-grade serous subtype. This insight has led to a separate but related practice: opportunistic salpingectomy, which means removing the fallopian tubes during an unrelated pelvic surgery, such as a hysterectomy or even a cesarean section, while leaving the ovaries in place. The appeal is obvious — you get a significant portion of the cancer-prevention benefit without triggering surgical menopause.

A systematic review estimated that salpingectomy alone is associated with about an 80% reduction in ovarian cancer risk, is cost-effective, and does not push the onset of menopause earlier. If adopted widely, it could reduce ovarian cancer deaths in the United States by an estimated 15%.²⁷ In one large cohort, no serous cancers at all developed in the group that had undergone opportunistic salpingectomy, despite the statistical expectation of more than five cases based on the follow-up time.²⁸ A cost-effectiveness analysis found the procedure associated with a 49% to 77% reduction in ovarian cancer when performed during gynecologic surgeries.²⁹

A Two-Step Approach for High-Risk Women

Building on the fallopian tube origin theory, researchers have been studying a staged strategy for BRCA carriers: removing the fallopian tubes first (risk-reducing salpingectomy) and delaying removal of the ovaries to a later age. The reasoning is that by taking out the tubes in a woman’s twenties or thirties, you eliminate the tissue where most of these cancers start, while preserving the ovaries and their hormone production for additional years. The oophorectomy then happens later — typically by 40 to 45 for BRCA1 carriers and by 45 to 50 for BRCA2 carriers.³⁰

A prospective preference trial comparing this two-step approach with the standard one-step RRBSO found that menopause-related quality of life was better in the staged group, even when the RRBSO group used hormone therapy afterward.³¹ Several ongoing trials are still evaluating whether the cancer protection of this approach is truly equivalent to the standard RRBSO, and patients are increasingly asking their clinicians about it.³² The strategy remains investigational for the highest-risk groups, but it reflects a broader move toward preserving ovarian function as long as safely possible.

Unilateral Salpingo-Oophorectomy

When only one ovary and tube are removed, the hormonal consequences are far less dramatic. The remaining ovary can usually produce enough estrogen and progesterone to maintain menstrual cycles and avoid surgical menopause. Fertility is affected but not eliminated: the remaining ovary takes on the work of both, though ovarian reserve is reduced. A meta-analysis comparing women who had one ovary removed with those who had two intact ovaries found that unilateral oophorectomy reduced the quantity of available eggs but did not affect their quality.³³ This means that women who need fertility treatment after losing one ovary may need higher medication doses or produce fewer eggs per cycle, but the eggs they do produce have the same chance of resulting in a healthy pregnancy.³⁴

Sexual Health After Surgery

Concerns about sexual function after oophorectomy are common and valid. The picture depends largely on menopausal status at the time of surgery. Among older women who were already past natural menopause, a large study found that reports of sexual problems were statistically indistinguishable between women with prior bilateral oophorectomy and those who still had their ovaries, across domains including desire, lubrication, orgasm, and pain.³⁵ For premenopausal women, the situation is different: removing the ovaries before natural menopause can cause more pain during intercourse, decreased desire, and more difficulty reaching orgasm compared with ovary-sparing surgery.³⁶ Hormone replacement therapy typically mitigates these effects, particularly estrogen for vaginal symptoms and testosterone for libido.

Sleep Disruption

Sleep problems are among the most persistent complaints after surgical menopause. A study from the Study of Women’s Health Across the Nation tracked midlife women before and after surgical menopause and found that sleep maintenance difficulty, the most common problem, affected about 28% of women at baseline, rose to about 33% in the period before surgery, and jumped to over 43% after surgery. Once the new rate was established, it remained stable rather than improving over time.³⁷ Night sweats are a major contributor, but the disruption appears to go beyond simple hot flashes, likely involving changes to how estrogen and other hormones modulate brain circuits involved in sleep architecture.

Ovarian Remnant Syndrome

A rare but frustrating complication specific to salpingo-oophorectomy is ovarian remnant syndrome. This occurs when a small piece of ovarian tissue is inadvertently left behind during surgery. That remnant can remain hormonally active, causing pelvic pain, a pelvic mass, and even continued hormone production that shows up on blood tests. The risk is highest when the original surgery was complicated by adhesions from prior operations, endometriosis, or pelvic inflammatory disease.³⁸ Removing the remnant tissue requires another surgery, which is often technically demanding. In one case series, the reoperation averaged about two hours and frequently required careful dissection around the ureter and bowel, with complications including bowel and bladder injuries.³⁹ The syndrome is uncommon, but awareness of it matters because it can masquerade as other conditions for years before diagnosis.

Psychological Impact and Decision Satisfaction

Given the magnitude of the surgery’s consequences, you might expect high rates of regret. In practice, most women who undergo RRBSO report satisfaction with the decision. A cross-sectional study found that about 90% of women expressed complete satisfaction, and only about 6% reported persistent stress.⁴⁰ An earlier qualitative study echoed this: nearly all participants said the procedure decreased their anxiety about developing ovarian cancer. Postmenopausal women reported no negative impact on libido, and premenopausal women who started hormone therapy generally found that it mitigated the sexual side effects. Where women did express frustration, it was most often about unmet information needs before and after surgery — particularly about what surgical menopause would actually feel like and what the implications of long-term hormone therapy would be.⁴¹

That information gap is worth emphasizing. The decision to have a risk-reducing salpingo-oophorectomy involves trading a serious cancer threat for a set of chronic health management challenges — hormonal, skeletal, cardiovascular, metabolic, cognitive, and sexual. The women who fare best tend to be those who understood the full scope of what was coming and had a plan in place for hormone replacement, bone monitoring, cardiovascular screening, and ongoing support. The surgery itself is straightforward; managing its aftermath is what requires long-term attention.

1
PubMed Central. Risk-Reducing Bilateral Salpingo-Oophorectomy for BRCA Mutation Carriers and Hormonal Replacement Therapy: If It Should Rain, Better a Drizzle than a Storm ↩︎
2
JNCI: Journal of the National Cancer Institute. Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers ↩︎
3
PubMed. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation ↩︎
4
PubMed. A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo-oophorectomy ↩︎
5
The Journal of the American Association of Gynecologic Laparoscopists. Salpingo-oophorectomy: Clinical and financial analyses of laparoscopic and open techniques ↩︎
6
PubMed. Cost-benefit analysis of laparoscopic versus laparotomy salpingo-oophorectomy for benign tubo-ovarian disease ↩︎
7
PubMed Central. Changes of hormone levels for postmenopausal women after bilateral oophorectomy: A meta-analysis ↩︎
8
PubMed Central. Effect of risk-reducing salpingo-oophorectomy on sex steroid hormone serum levels among postmenopausal women ↩︎
9
JAMA Network Open. Changes in Bone Mineral Density After Prophylactic Bilateral Salpingo-Oophorectomy in Carriers of a BRCA Mutation ↩︎
10
PubMed. Loss of bone density and bone strength following premenopausal risk-reducing bilateral salpingo-oophorectomy: a prospective controlled study (WHAM Study) ↩︎
11
PubMed Central. Bone Loss Following Oophorectomy Among High-Risk Women ↩︎
12
PubMed Central. Increased cardiovascular mortality following early bilateral oophorectomy ↩︎
13
Archives of Internal Medicine. Oophorectomy vs Ovarian Conservation With Hysterectomy ↩︎
14
PubMed. Risk of cardiovascular disease among women carrying BRCA mutations after risk-reducing bilateral salpingo-oophorectomy ↩︎
15
PubMed Central. Trajectories of metabolic parameters after bilateral oophorectomy in premenopausal women ↩︎
16
The Journal of Clinical Endocrinology & Metabolism. WHAM—A Prospective Study of Weight and Body Composition After Risk-Reducing Bilateral Salpingo-oophorectomy ↩︎
17
PubMed. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause ↩︎
18
PubMed. Surgical menopause in association with cognitive function and risk of dementia: A systematic review and meta-analysis ↩︎
19
BMJ. Association of bilateral salpingo-oophorectomy with all cause and cause specific mortality: population based cohort study ↩︎
20
PubMed Central. Long-term Mortality Associated with Oophorectomy versus Ovarian Conservation in the Nurses’ Health Study ↩︎
21
PubMed Central. Long-term Overall and Disease-specific Mortality Associated with Benign Gynecologic Surgery Performed at Different Ages ↩︎
22
PubMed Central. Hormone replacement therapy in young women with surgical primary ovarian insufficiency ↩︎
23
PubMed Central. Hormone Replacement Therapy After Oophorectomy and Breast Cancer Risk Among BRCA1 Mutation Carriers ↩︎
24
PubMed. Safety of hormone replacement therapy following risk-reducing salpingo-oophorectomy: systematic review of literature and guidelines ↩︎
25
The Journal of Sexual Medicine. Surgical Menopause and Bilateral Oophorectomy: Effect of Estrogen-Progesterone and Testosterone Replacement Therapy on Psychological Well-Being and Sexual Functioning ↩︎
26
PubMed. Non-hormonal treatment strategies for vasomotor symptoms: a critical review ↩︎
27
PubMed Central. Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review ↩︎
28
JAMA Network Open. Outcomes From Opportunistic Salpingectomy for Ovarian Cancer Prevention ↩︎
29
PubMed Central. Opportunistic salpingectomy during gynecologic and non-gynecologic abdominopelvic procedures for ovarian cancer primary prevention ↩︎
30
PubMed Central. Risk-reducing salpingectomy with delayed oophorectomy to prevent ovarian cancer in women with an increased inherited risk ↩︎
31
PubMed Central. Salpingectomy With Delayed Oophorectomy Versus Salpingo-Oophorectomy in BRCA1/2 Carriers: Three-Year Outcomes of a Prospective Preference Trial ↩︎
32
PubMed Central. Patient perspectives on risk-reducing salpingectomy with delayed oophorectomy for ovarian cancer risk-reduction ↩︎
33
PubMed. The impact of unilateral oophorectomy on ovarian reserve in assisted reproduction: a systematic review and meta-analysis ↩︎
34
PubMed Central. Biological Impact of Unilateral Oophorectomy: Does the Number of Ovaries Really Matter? ↩︎
35
PubMed Central. Sexual function in older women after oophorectomy ↩︎
36
PubMed. Comparison of female sexual function in women who underwent abdominal or vaginal hysterectomy with or without bilateral salpingo-oophorectomy ↩︎
37
PubMed Central. Trajectory Analysis of Sleep Maintenance Problems in Midlife Women Before and After Surgical Menopause ↩︎
38
PubMed. The ovarian remnant syndrome and ureteral obstruction: medical management ↩︎
39
PubMed. Laparoscopic excision of ovarian remnants: retrospective cohort study with long-term follow-up ↩︎
40
PubMed. Psychophysical and social impact of risk-reducing salpingo-oophorectomy in China: a cross-sectional study ↩︎
41
Psycho-Oncology. Psychological impact of prophylactic oophorectomy in women at increased risk for ovarian cancer ↩︎