A salpingo-oophorectomy is a surgical procedure that removes one or both fallopian tubes and ovaries. When performed on one side, it’s called a unilateral salpingo-oophorectomy. When both sides are removed, it’s a bilateral salpingo-oophorectomy, sometimes abbreviated as BSO. The surgery is performed for a range of reasons, from treating ovarian cysts and endometriosis to reducing cancer risk in people with certain genetic mutations.
Unilateral vs. Bilateral: What Gets Removed
In a unilateral procedure, the surgeon removes one ovary and its connected fallopian tube, leaving the other side intact. This preserves some hormone production and, in many cases, fertility. The remaining ovary continues producing estrogen, progesterone, and testosterone, so you won’t experience menopause afterward.
A bilateral salpingo-oophorectomy removes both ovaries and both fallopian tubes. This is a more significant hormonal event. In premenopausal women, it causes an immediate and complete stop in ovarian hormone production, triggering what’s known as surgical menopause. The procedure is sometimes done alongside a hysterectomy (removal of the uterus), but the two are separate surgeries that can be performed independently.
Why the Surgery Is Performed
The most common reasons include ovarian cysts, ovarian or fallopian tube cancer, endometriosis, ovarian torsion (when the ovary twists on its blood supply), and tubo-ovarian abscesses. In some cases, the ovaries are removed during a hysterectomy to reduce the future risk of ovarian cancer.
For people who carry BRCA1 or BRCA2 gene mutations, which substantially increase the lifetime risk of ovarian and breast cancer, the surgery is performed preventatively. UCSF guidelines recommend risk-reducing salpingo-oophorectomy between ages 35 and 40 for BRCA1 carriers, and between 40 and 45 for BRCA2 carriers, once childbearing is complete or no longer desired.
How the Surgery Is Done
Three surgical approaches are used: laparoscopic, robotic-assisted, and open (laparotomy). Laparoscopic surgery is the most common for benign conditions. The surgeon makes a few small incisions in the abdomen and uses a camera and thin instruments to remove the tissue. Compared to open surgery, laparoscopic approaches result in less pain, shorter hospital stays, and lower costs by over $1,000 on average.
Robotic-assisted surgery works similarly to laparoscopic surgery but uses a robotic system that the surgeon controls from a console. Studies comparing the two approaches show similar blood loss, complication rates, and hospital stays, though robotic procedures tend to take about 12 minutes longer. Open surgery, which requires a larger abdominal incision, is typically reserved for large masses, cancer cases, or situations where the surgeon needs better visibility.
Complication Risks
Like any surgery, salpingo-oophorectomy carries risks. In a retrospective analysis of gynecologic surgeries, intraoperative bleeding requiring intervention occurred in about 3.6% of cases, bladder injury in 0.8%, and urethral injury in 0.25%. The most common postoperative complication was surgical site infection, affecting roughly 10% of patients. Overall, about 19% of patients experienced some form of postoperative complication, though many of these were minor and resolved with standard treatment.
Recovery Timeline
Recovery depends heavily on whether the surgery was done laparoscopically or through an open incision. For laparoscopic or robotic procedures, you can generally expect at least two to three weeks of restricted activities. Open surgery requires a longer recovery, sometimes up to six weeks before you can return to your normal routine.
During recovery, typical restrictions include no heavy lifting, no strenuous exercise (though walking is encouraged), no sexual intercourse, and no tampon use. If you’re taking prescription pain medication, you shouldn’t drive. Your surgeon will schedule a follow-up to assess healing and let you know when specific restrictions can be lifted. Most people return to desk work within two to four weeks after a laparoscopic procedure, though physically demanding jobs take longer.
Surgical Menopause After Bilateral Removal
If both ovaries are removed before you’ve gone through natural menopause, the hormonal shift is immediate and dramatic. Natural menopause is a gradual process, with a transitional period that can last up to 10 years, and noticeable symptoms typically building over about four years before the final menstrual period. The average age of natural menopause is 51.
Surgical menopause, by contrast, happens overnight. Estrogen, progesterone, and testosterone levels all drop abruptly rather than tapering. This causes more severe symptoms than natural menopause: intense hot flashes (experienced by nearly 80% of menopausal women), night sweats, mood disturbances, sleep disruption, vaginal dryness, and changes in sexual desire. The sudden loss of testosterone production is a key difference from natural menopause, and it particularly affects libido and energy levels in younger women.
When the surgery is performed before age 40, it’s classified as premature ovarian insufficiency, which carries additional long-term health considerations.
Long-Term Health Effects
Removing both ovaries before natural menopause has consequences beyond menopausal symptoms. The Nurses’ Health Study found a 17% higher risk of cardiovascular disease in women who had bilateral removal, and a 44% higher risk among women whose ovaries were removed before age 45. Bone density also declines more rapidly without ovarian estrogen, increasing the risk of osteoporosis over time.
These risks are one reason surgeons increasingly try to preserve ovaries when possible, especially in younger patients undergoing hysterectomy for non-cancerous conditions. When ovary removal is necessary, the long-term effects can be partially offset with hormone therapy.
Hormone Therapy After Surgery
For premenopausal women who have both ovaries removed, hormone replacement therapy is strongly recommended at least until the age when natural menopause would have occurred (around 51). Without it, the rapid decline in estrogen, progesterone, and testosterone leads to more severe vasomotor symptoms, higher rates of mood disorders, sexual dysfunction, joint pain, and reduced quality of life compared to women who go through menopause naturally.
Hormone therapy typically includes estrogen, and for some women, testosterone supplementation is considered to address changes in sexual function and desire. The specific approach depends on whether a hysterectomy was performed at the same time, your age at the time of surgery, and your individual risk factors. Women who had their ovaries removed for cancer-related reasons may have different options, since some cancers are hormone-sensitive.