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I have a consultation for a bilateral salpingectomy scheduled with my doctor next week. I am interested in this procedure primarily for birth control and love the added bonus of the decrease in ovarian cancer risk. I understand that I will still have periods with a salpingectomy since my ovaries are still there, and I’m considering continuing to use the hormone-based IUD that I currently have in order to decrease period symptoms like bleeding.
But now I’m wondering, should I also request that my ovaries be removed? Would the effects of going into menopause at 39 be worth what I see as the benefit of no more periods and more control of knowing when I’m in menopause? Or is the risk of decreased bone health not something that I should risk, since I don’t have any other cancer risk factors?
—Anonymous
Bilateral salpingectomy, a surgical procedure to remove the fallopian tubes, is an effective form of contraception and has been found to reduce the risk of developing ovarian cancer by about 80%. This is because many ovarian cancers actually come from the cells of the fallopian tubes, not the ovaries.
Many women who have bilateral salpingectomy have it done during a scheduled C-section. Adding the salpingectomy adds very little time and virtually no additional risk. A bilateral salpingectomy on its own, however, involves some risks. A reasonable person could make arguments both for and against having a standalone bilateral salpingectomy in a woman at normal risk of developing ovarian cancer.
Removing the ovaries, a procedure called a bilateral oophorectomy, involves a very different risk-benefit calculation, particularly in a premenopausal woman. The incidence of ovarian cancer is about 1.1% among women in the U.S. If you have a bilateral salpingectomy, you effectively reduce your risk for ovarian cancer to about 0.2%. There are, as you point out, significant risks associated with experiencing menopause — whether naturally or surgically — before the age of 45. And experiencing menopause later than the average age of 52 is associated with some benefits.
The risk for osteoporosis is important. Hip fractures are a source of significant morbidity and mortality in elderly women. However, the bigger concern is heart disease. Heart disease is the number one cause of death for women in the U.S., and 44% of women have some form of heart disease. Early menopause from any cause increases that risk.
As a result, most physicians would conclude that the benefit of decreasing your risk of ovarian cancer to virtually zero would not outweigh the increase in risk for heart disease and osteoporosis, both of which are far more common than ovarian cancer. There are some exceptions — some women with gene mutations, such as the BRCA gene, choose to have their ovaries removed because their risk of ovarian cancer is much higher than that of the general population. But for women at average risk for ovarian cancer, it is unlikely that the benefits would outweigh the risks.
The takeaway: Bilateral salpingectomy reduces the risk of developing ovarian cancer by about 80%. For women at average risk for ovarian cancer, the marginal benefit of also removing the ovaries would be far outweighed by the increased risk of developing heart disease and osteoporosis.
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Thank you for posting on this topic! While I don’t have the BRCA gene, I do have a mutation in another gene that does increase my risk of breast and ovarian cancer (not as significantly as BRCA). The guidance is bilateral ovary removal between age 45-50 currently, given there’s no good preventive screening/early detection like there is for breast cancer. I knew about the bone density issue, did not know about the heart disease link. In addition, I’ve read papers citing a link between increased risk of dimensionally when ovaries are removed before menopause. Wondering if you had any analysis on that risk?
Dementia * not dimensionally 😂