For most women having a hysterectomy for a non-cancer problem, who haven’t reached menopause and carry no inherited cancer gene, keeping healthy ovaries is the safer choice for long-term health. The ovaries keep making hormones that protect the heart, bones and brain long after the uterus is gone, even for years after menopause. The best way to cut ovarian cancer risk is also changing, since much of that protection can now come from removing the fallopian tubes instead of the ovaries. The answer shifts for women with BRCA or Lynch gene changes, and it can shift for some women with severe endometriosis.
What Large Studies Found When Women Kept Their Ovaries
At hysterectomy you can keep your ovaries or have them taken out along with the uterus. The removal is called oophorectomy, and your consent form may list it by that name.1MyHealth Alberta. Hysterectomy: Should I Also Have My Ovaries Removed? In a national record study of more than 110,000 women who had benign hysterectomies before menopause, about 0.6% of those who kept their ovaries died during follow-up, compared with about 1.0% of those who had both removed.2PubMed Central. Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkage The women who kept their ovaries were also about 15% less likely to be hospitalized for heart disease, and they had fewer heart-related and cancer-related deaths.3PubMed Central. Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkage
Both numbers are small because most of these women were fairly young and the follow-up was limited. Over longer stretches the absolute difference grows. A large group of US nurses was followed for 28 years, and 13.3% of women who kept their ovaries died, compared with 16.8% of women who had them removed.4PubMed Central. Long-term Mortality Associated with Oophorectomy versus Ovarian Conservation in the Nurses’ Health Study
Removing the ovaries did sharply lower deaths from ovarian cancer, and when done before about age 47 it also lowered deaths from breast cancer.5PubMed Central. Long-term Mortality Associated with Oophorectomy versus Ovarian Conservation in the Nurses’ Health Study But at no age was removal linked to longer survival overall, because more women died of other causes such as heart disease.6PubMed Central. Long-term Mortality Associated with Oophorectomy versus Ovarian Conservation in the Nurses’ Health Study Ovarian cancer affects only around 1 in 70 to 80 women over a lifetime, while heart disease is the leading cause of death in women. A small rise in heart risk can therefore outweigh preventing a rare cancer.
“Benign” on your surgical plan means the operation is for a problem that isn’t cancer, such as fibroids, heavy bleeding or prolapse. All of these findings come from women in that situation, and women having surgery for a known or suspected cancer face a different decision.
These studies show association, not proof. Most come from records and long-term follow-up of women who chose, or were advised, to have one operation or the other, not from random assignment. Surgeons may have removed ovaries more often in women who were already sicker, which could make removal look worse than it is. Researchers adjusted for differences such as age and other health conditions, and the same pattern appeared across several separate groups of women. That consistency is why experts treat it as meaningful even though it isn’t a perfect experiment.
What Happens to Your Body When Ovaries Come Out Before Menopause
Removing both ovaries before natural menopause causes surgical menopause: hormone levels fall within days instead of over years. Estrogen helps keep blood vessels flexible and influences cholesterol, so its sudden loss can shift both in an unfavorable direction. Heart disease risk normally rises after natural menopause, and surgery can bring that rise forward by years. Women whose menopause came before age 45 had about twice the rate of heart disease and stroke in later years, even after other risk factors were accounted for.7PubMed Central. Early Menopause Predicts Future Coronary Heart Disease and Stroke: The Multi-Ethnic Study of Atherosclerosis (MESA) The rise seemed strongest when early menopause came from ovary removal.8PubMed. The association between early menopause and risk of ischaemic heart disease: influence of Hormone Therapy Women who had both ovaries removed before age 45 also had more deaths from heart and blood vessel disease.9PubMed Central. Increased cardiovascular mortality following early bilateral oophorectomy
Memory is affected too. Removing the ovaries before menopause roughly doubles the long-term risk of memory problems or dementia.10PubMed Central. Oophorectomy, estrogen, and dementia: A 2014 update The risk was higher the younger a woman was at surgery.11PubMed Central. Oophorectomy, estrogen, and dementia: A 2014 update Changes in verbal and working memory can show up within 6 months of surgery in middle-aged women.12PubMed. Cognitive markers of dementia risk in middle-aged women with bilateral salpingo-oophorectomy prior to menopause Risk rose step by step with the extent of surgery: lowest after hysterectomy alone, higher when one ovary was also removed, and highest when both were removed.13PubMed Central. Hysterectomy, Oophorectomy, Estrogen, and the Risk of Dementia
Bones may take a smaller hit. Across ten studies, removing both ovaries was linked to about a 17% higher risk of fracture.14PubMed. Hysterectomy, oophorectomy, and bone health: a systematic review and meta-analysis One study found no clear increase in fragility fractures, so the bone effect looks modest. Mood evidence is mixed. In a US national survey, women who had a hysterectomy with both ovaries removed had more severe depression symptoms than women who had neither surgery.15PubMed Central. Bilateral oophorectomy amplifies depression risk following hysterectomy NHANES 2006–2017 But in a study that followed women through midlife, depression and anxiety did not differ by whether the ovaries were kept.16PubMed Central. Mood Symptoms After Natural Menopause and Hysterectomy With and Without Bilateral Oophorectomy Among Women in Midlife
Surgical menopause feels different from the natural kind. Hot flashes and night sweats can start within days of surgery, while natural menopause usually unfolds over several years. Vaginal dryness and poor sleep can also come on suddenly, and symptoms are often stronger the younger you are at surgery.
Age matters because of how many hormone years are lost. Removal at 40 means about a decade without hormones that natural menopause would not have taken away. Removal at 50 means only a year or two. For women past natural menopause, the trade-off is closer to even.
Removing the Fallopian Tubes Instead to Lower Cancer Risk
The most common deadly type of ovarian cancer often starts in the fallopian tubes.17PubMed. Opportunistic Salpingectomy and Other Methods of Risk Reduction for Ovarian/Fallopian Tube/Peritoneal Cancer in the General Population So removing the tubes while keeping the ovaries has become common practice; your consent form may call this salpingectomy.18PubMed. Role of Fallopian Tubes in the Development of Ovarian Cancer It is linked to about an 80% lower ovarian cancer risk.19PubMed Central. Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review It is safe and has not been linked to an earlier menopause.20PubMed Central. Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review For comparison, removing both ovaries and tubes cuts the risk by about 95%.21Ovarian Cancer Action. Ovarian cancer prevention | Ovarian cancer information Both percentages apply to what is already a small lifetime risk, so the remaining gap between 80% and 95% is small for a woman at average risk.
Removing the tubes is a minor addition. They carry an egg from the ovary toward the uterus, and after a hysterectomy they no longer serve a purpose for pregnancy. The ovaries stay in place with their main blood supply, which is why their hormone production generally continues.
To raise this with your surgeon, ask whether the tubes can come out during the same operation. It usually adds little time. Check the consent form for the word salpingectomy, and make sure it doesn’t say oophorectomy if you plan to keep your ovaries.
When Removing Your Ovaries Makes Sense
Women with BRCA gene changes or Lynch syndrome are advised to consider having their ovaries and tubes removed, which sharply cuts their ovarian cancer risk.22Ovarian Cancer Action. Ovarian cancer prevention | Ovarian cancer information For these women, the cancer benefit outweighs the hormone losses. Timing is usually individualized, since the right age depends on the specific gene and the woman’s family history. Because removal can bring early menopause, genetic specialists often discuss hormone therapy, particularly for younger carriers.
A family history of ovarian or breast cancer may point to a BRCA gene change, and a family history of colon or uterine cancer may point to Lynch syndrome. A test result can change what is recommended for you. If your family history raises these questions, ask for genetic counseling before your surgery date, so the decision can be made with a counselor and your surgeon together.
Endometriosis is the other common exception. In one study of hysterectomy for endometriosis, pain returned in 62% of women who kept ovarian tissue, compared with 10% of those who had their ovaries removed.23PubMed. Incidence of symptom recurrence after hysterectomy for endometriosis And 31% of those who kept ovarian tissue needed another operation, compared with 3.7% of those who had their ovaries removed.24PubMed. Incidence of symptom recurrence after hysterectomy for endometriosis A much larger recent study found 13% of women who kept their ovaries needed another operation, compared with 5% of those who had them removed, and pain-related doctor visits and opioid use were similar.25PubMed. Reoperation and pain-related outcomes after hysterectomy for endometriosis by oophorectomy status
Before surgery, ask how severe your disease is and where it is located. Ask whether all visible endometriosis will be removed during the operation, and whether keeping one ovary is an option.
Age shapes the guidance as well. Current practice leans toward keeping normal-looking ovaries through age 65.26PubMed. Ovarian Conservation at the Time of Hysterectomy One proposed decision guide strongly favors keeping the ovaries for women under 45 who have no inherited cancer gene.27PubMed Central. The Optimal Age for Oophorectomy in Women with Benign Conditions: A Narrative Review
Hormone Therapy If Your Ovaries Are Removed
Starting estrogen at the time of ovary removal and continuing until at least age 51 to 52 lowers most, but not all, of the added risks.28PubMed Central. Hormone replacement therapy in young women with surgical primary ovarian insufficiency Women who had their ovaries removed before 49 and took estrogen until at least 50 had no increased risk of dementia.29PubMed Central. Oophorectomy, menopause, estrogen treatment, and cognitive aging: clinical evidence for a window of opportunity Before age 50, the added risk of death after removal was seen mainly in women who never used estrogen.30PubMed Central. Long-term Mortality Associated with Oophorectomy versus Ovarian Conservation in the Nurses’ Health Study In a trial of women aged 50 to 59 who had their ovaries removed, those given estrogen had 32% lower death rates over 18 years.31PubMed Central. Menopausal Estrogen-Alone Therapy and Health Outcomes in Women with and without Bilateral Oophorectomy: A Randomized Trial The usual goal is to continue until around the typical age of natural menopause, then reassess with your doctor whether to keep going.
Plan with your doctor before surgery when estrogen will start, since delaying may lose some of the benefit. Estrogen alone is usually used, because without a uterus progestin isn’t needed. Ask your doctor about any reasons, such as some cancers, that you shouldn’t take estrogen.
Estrogen doesn’t fully replace the ovaries. They make several hormones, including testosterone, not just estrogen. Some women stop therapy early, and remembering daily pills or patches for years can be hard.
What to Expect If You Keep Your Ovaries
Four years after hysterectomy, 14.8% of women who kept their ovaries had lost ovarian function, compared with 8.0% of women who had no surgery.32PubMed Central. Effect of Hysterectomy With Ovarian Preservation on Ovarian Function In another study, women reached menopause about 3.7 years earlier after hysterectomy.33BJOG: An International Journal of Obstetrics & Gynaecology. The association of hysterectomy and menopause: a prospective cohort study It is unclear whether the surgery itself causes this or the condition that led to it.34PubMed Central. What We Know about the Long-Term Risks of Hysterectomy for Benign Indication—A Systematic Review The uterus and ovaries share part of their blood supply, so surgery may reduce flow to the ovaries. Either way, expect that menopause may arrive a few years sooner than your mother’s or older sisters’ did. Even after menopause, the ovaries keep making testosterone for 10 years or more.35PubMed. Ovarian androgen production in postmenopausal women
Without a uterus you have no periods to signal menopause. Hot flashes, night sweats or sleep changes may be the first sign, and a blood test can help confirm it when symptoms are unclear. Tell your doctor about new symptoms rather than waiting them out.
Between about 3% and 11% of women who keep their ovaries later need them removed.36International Journal of Reproduction, Contraception, Obstetrics and Gynecology. Analysis of adnexal masses requiring reoperation following hysterectomy One long-running series found that about 3% developed problems with a kept ovary, most often pelvic pain.37PubMed. The residual ovary syndrome: a 20-year experience Lumps found on a kept ovary after hysterectomy were all benign in one hospital series, and about half went away on their own, though a single series can’t rule out cancer for any one lump.38PubMed Central. Adnexal lesions after hysterectomy: A retrospective observational study
Signs that a kept ovary needs checking include pelvic pain on one side that keeps coming back, pain during sex that is new since your surgery, or a lump found during a routine exam or scan. Most such lumps are not cancer, but they still need follow-up.
Sex After Ovary Removal
Older women who had their ovaries removed reported desire and sexual problems at rates similar to women who kept their ovaries.39PubMed Central. Sexual function in older women after oophorectomy Some studies show better lubrication and orgasm after hysterectomy when the ovaries are kept, but studies that compared the two choices directly did not confirm this.40The Journal of Sexual Medicine. Hysterectomy and sexual function: a systematic review and meta-analysis Among women who had their ovaries removed to lower cancer risk, those with hot flashes or depression were about twice as likely to report sexual problems.41PubMed Central. RISK FACTORS FOR SEXUAL DYSFUNCTION IN BRCA MUTATION CARRIERS FOLLOWING RISK-REDUCING SALPINGO-OOPHORECTOMY Treating hot flashes and low mood after surgery may help protect your sex life.
Lower estrogen often causes vaginal dryness and discomfort. Lubricants and moisturizers can ease it, and low-dose vaginal estrogen is another option to ask about. Raise any changes with your doctor rather than assuming they’re permanent.