Oophorectomy is the surgical procedure which leads to removal of an ovary or ovaries. The surgery is also called ovariectomy, but this term has been traditionally used in basic science research to describe the surgical removal of ovaries in laboratory animals. Removal of the ovaries in women is the biological equivalent of castration in males; however, the term castration is only occasionally used in the medical literature to refer to oophorectomy in humans. 

Oophorectomy can be divided into several categories depending on the amount of removed tissue. If the whole ovary is taken away, than it is a complete oophorectomy. If there is remaining part of ovary, we are talking about partial oophorectomy. Partial oophorectomy or ovariotomy is a term sometimes used to describe a variety of surgeries such as ovarian cyst removal or resection of parts of the ovaries. This kind of surgery is fertility-preserving, although ovarian failure (a loss of normal function of your ovaries before age 40) may be relatively frequent. Also it is distinguished between bilateral (on both sides) and unilateral (just one side) oophorectomy.

In humans, oophorectomy is most often performed because of diseases such as ovarian cysts or cancer; as prophylaxis to reduce the chances of developing ovarian cancer or breast cancer; or in conjunction with hysterectomy (removal of the uterus). Some cases require removal of other organs in small pelvis, such as Fallopian tubes or uterus. 

The removal of an ovary together with the Fallopian tube is called salpingo-oophorectomy or unilateral salpingo-oophorectomy (Pic. 1; USO). When both ovaries and both Fallopian tubes are removed, the term bilateral salpingo-oophorectomy (BSO) is used.

In many cases, surgical removal of the ovaries is performed concurrently with a hysterectomy. The formal medical name for removal of a woman's entire reproductive system (ovaries, Fallopian tubes, uterus) is "Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO); the more casual term for such a surgery is "ovariohysterectomy". 

Associated diseases

  • ovarian cysts 
  • ovarian cancer
  • breast cancer
  • endometriosis (the layer of tissue that normally covers the inside of the uterus grows outside it)
  • colon cancer
  • pancreatic cancer
  • adnexal torsion (rotation of the ovary and portion of the fallopian tube)

Complications

The risks associated with this surgery include infection as well as internal organ damage. The most harmful side effect of this surgery, however, is the loss of hormones produced by the ovaries. 

Women who have had bilateral oophorectomy surgeries lose most of their ability to produce the hormones estrogen and progesterone, and lose about half of their ability to produce testosterone, and subsequently enter what is known as "surgical menopause" (as opposed to normal menopause, which occurs naturally in women as part of the aging process). 

In natural menopause the ovaries generally continue to produce low levels of hormones, especially androgens, long after menopause, which may explain why surgical menopause is generally accompanied by a more sudden and severe onset of symptoms than natural menopause, symptoms that may continue until the natural age of menopause. These symptoms are commonly addressed through hormone therapy, utilizing various forms of estrogen, testosterone, progesterone or a combination.

When the ovaries are removed, a woman is at a seven times greater risk of cardiovascular disease, but the mechanisms are not precisely known. 

Oophorectomy is also associated with an increased risk of osteoporosis and bone fractures. A potential risk for oophorectomy performed after menopause is not fully elucidated. Lower levels of testosterone in women are predictive of height loss, which may occur as a result of reduced bone density. 

Risk factors

Women with deleterious mutations in either the BRCA1 or BRCA2 genes have a high risk of developing breast and/or ovarian cancer potentially leading to oophorectomy. 

Prevention

If there is familiar history of ovarian cancer in family, women you should be tested for BRCA 1 or BRCA 2 mutation.
It is very important to visit gynecologist once a year, to be regulary checked. Early diagnosis leads to more conservative approach and has better results in prognosis and decreases complications.

The absence of both ovaries clearly leads to infertility due to absence of eggs and women should consider techniques of assisted reproduction such as ovum donation and in vitro fertilization.

If there is one ovary left, there is still posibility, that woman will conceive naturally. Women have ovary reserve and fertility is not generally reduced. But in these women, which have already diminished ovarian reserve, could loss of one ovary be crucial.

Oophorectomy also impairs sexuality. Substantially more women who had both an oophorectomy and a hysterectomy reported libido loss, difficulty with sexual arousal, and vaginal dryness than those who had a less invasive procedure (either hysterectomy alone or an alternative procedure), and hormone replacement therapy was not found to improve these symptoms. In addition, testosterone levels in women are associated with a greater sense of sexual desire, and oophorectomy greatly reduces testosterone levels.

Prognosis after oophorectomy depends on the reason, why the surgery has to be performed. If it is because of removal of cyst or endometriosis there is bigger chance, that there still is some healthy ovary tissue left. 

In case of tumor, ectopic pregnancy or ovarian cancer, the ovary has to be removed entire. After complete oophorectomy, there are side effects related to decreased level of hormones such as osteoporosis, coronary heart deseases and cognitive impairment. For these women, there is hormone replacement therapy, which relieves these consequences, but without ovaries, woman remains infertile.

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Sources

Oophorectomy ―sourced from Wikipedia licensed under CC BY-SA 3.0
BRCA mutation ―sourced from Wikipedia licensed under CC BY-SA 3.0
Oophorectomy ―sourced from Wikispaces licensed under CC BY- SA 3.0
Salpingo-Oophorectomy ―by squiddles licensed under CC BY- NC 2.0
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