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Removing the Ovaries and Tubes — The Part That Is a Decision
Most of a hysterectomy for endometrial cancer is not negotiable: the uterus contains the cancer and it comes out. Removing the ovaries is different. It is a genuine decision, with reasons on both sides, and it is the part most often settled by default rather than by conversation. For a woman already past the menopause, removal adds little and the reasoning is straightforward. For a woman who has not reached it, removing the ovaries causes menopause within days and carries consequences for bone and heart health over decades. That trade-off deserves a discussion before the operation, not an explanation afterwards.
- The tubes come out routinely — no benefit after childbearing, and a recognised origin of some cancers
- The ovaries are a separate question — and the answer depends heavily on your age
- After the menopause, removal is usual — the cost is low and the reasoning is clear
- Before it, there is a real trade-off — and preservation is an option in selected cases
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Why the Ovaries Are Usually Removed
Three reasons, and they carry different weight depending on your situation.
- They are a possible site of spread. Endometrial cancer can reach the ovaries, and involvement is sometimes found only when they are examined after removal — it may not have been visible on imaging or at operation. Finding it changes the stage and therefore the treatment.
- A second, separate cancer is sometimes present. Simultaneous cancers of the uterus and ovary occur, particularly in younger women. Often these turn out to be two independent early cancers rather than one that has spread — a distinction that matters greatly for the outlook and one that can only be made on pathology.
- They continue producing oestrogen. Which is the hormone that drove the tumour in the first place, in the commoner oestrogen-dependent form of this disease. Removing that source is a reasonable step where the cancer is hormone-driven.
- And an inherited risk may apply. Where Lynch syndrome is present or suspected, ovarian cancer risk is also raised, which strengthens the case considerably. See Lynch syndrome.
For a woman already past the menopause, these reasons apply and the cost is low — her ovaries have largely stopped working. That is why removal is nearly always advised in that group and rarely debated.
Did You Know? The fallopian tubes are removed routinely now for a reason that emerged only in the last two decades, and it has nothing to do with the uterus. A substantial proportion of what were long classified as high-grade serous ovarian cancers are now understood to originate in the fimbrial end of the fallopian tube, with the ovary a secondary site. That finding changed practice across gynaecological surgery: where the abdomen is being opened anyway and childbearing is complete, removing the tubes costs nothing and removes a genuine future risk. It is one of the clearer examples of a pathology insight translating directly into an operating-theatre decision. Sources: NCCN Clinical Practice Guidelines in Oncology — Uterine Neoplasms and Ovarian Cancer; ESGO–ESTRO–ESP guidelines for the management of patients with endometrial carcinoma; RCOG guidance on opportunistic salpingectomy.
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The Trade-Off Before the Menopause
For a woman who has not yet reached the menopause, both columns are real and the balance is genuinely individual.
| Reasons to remove | Reasons to consider keeping | |
|---|---|---|
| Cancer risk | Removes a possible site of spread and a possible second cancer; removes the oestrogen driving the tumour. | In early low-grade endometrioid disease confined to the uterus, the chance of ovarian involvement is low. |
| Immediate effect | None beyond the operation itself in a postmenopausal woman. | Avoids abrupt menopause — hot flushes, sleep disruption, mood change and vaginal dryness within days. |
| Bone health | Not a consideration after the natural menopause. | Oestrogen protects bone. Losing it years early accelerates bone loss over decades. See bone health. |
| Cardiovascular health | Not a consideration after the natural menopause. | Early oophorectomy is associated with increased long-term cardiovascular risk, more pronounced the younger the woman. |
| Sexual function | Not materially changed in a postmenopausal woman. | Abrupt loss of ovarian hormones affects desire and vaginal comfort. Treatable, but real. See intimacy after treatment. |
| Later options | Definitive — the decision cannot be revisited. | Retained ovaries can be removed later if circumstances change; the reverse is not possible. |
Ovarian preservation is a recognised option, not an unusual request. International guidance supports considering it in selected premenopausal women with early-stage, low-grade endometrioid cancer confined to the uterus. It is not appropriate where the disease is higher grade, non-endometrioid, more advanced, or where Lynch syndrome is present. If you are premenopausal and it has not been raised, raise it — before the operation.
Premenopausal and Nobody Has Discussed the Ovaries?
It is a real decision with reasons on both sides, and it is far easier to have this conversation before surgery than after.
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This Part of the Operation Should Be a Decision
Not something you discover afterwards. Ask before you consent — it is a short conversation.
If the Ovaries Are Removed Before the Menopause
Then menopause begins within days, and it is generally more abrupt than a natural transition because there is no gradual decline — the hormone supply simply stops. This is treatable and it is not something to endure quietly.
- Symptoms start quickly and are often intense. Hot flushes, night sweats, disturbed sleep, mood change and vaginal dryness, arriving on top of surgical recovery. See surgical menopause explained.
- Non-hormonal treatments genuinely help. Several options exist for hot flushes and sleep that do not involve hormones at all, and local vaginal treatment is very effective for dryness and considerably under-used.
- Hormone replacement is not automatically forbidden. This is important, because blanket refusals are common and frequently not justified. Whether HRT is appropriate depends on the stage, grade and histology of your cancer, and it deserves a proper discussion. See HRT after endometrial cancer.
- Bone health needs attention from the start. Not in ten years. Bone density assessment, adequate calcium and vitamin D, weight-bearing exercise and, where indicated, specific treatment all work best when started early.
- Cardiovascular risk deserves the same attention. Blood pressure, lipids and activity matter more after early oophorectomy than they would otherwise, and they are worth reviewing rather than assuming.
The general principle: surgical menopause after cancer treatment is a clinical problem with clinical answers, not an inevitable consequence to be tolerated. If nobody has offered you management for it, ask.
Want This Discussed Properly Before Surgery?
Whether the ovaries need to come out in your case, and what happens about menopause if they do. The opinion is free.
Questions to Ask Before You Consent
All four are short, specific, and much easier asked beforehand.
“Are you planning to remove my ovaries?”
A surprising number of women are unsure what was removed until they read the operation note afterwards. It is worth establishing plainly, particularly if you are premenopausal, because the answer determines whether menopause will begin within days of your operation and whether you should be prepared for that.
“Given my age and my pathology, is keeping them an option?”
For a premenopausal woman with early-stage, low-grade endometrioid disease confined to the uterus, ovarian preservation is a recognised option in international guidance. It is not appropriate for higher-grade or non-endometrioid disease, for more advanced stage, or where Lynch syndrome is present. Asking directly gets you the reasoning rather than the default.
“What will you do about the menopause afterwards?”
The best time to ask is before the operation, because the answer should be a plan rather than a shrug. Symptoms begin within days, and a woman who leaves hospital with no discussion of how they will be managed frequently endures months unnecessarily. This includes asking whether hormone replacement might be considered in your case.
“Does my family history change this?”
A family pattern of bowel, womb or ovarian cancer, particularly at younger ages, may indicate Lynch syndrome — which raises ovarian cancer risk as well as endometrial and strengthens the case for removing the ovaries considerably. If that history exists and nobody has asked about it, it is worth volunteering. See family history.
Why This Deserves a Conversation, Not a Default
It is the one part of the operation with a genuine choice in it — and the consequences last decades.
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Ask What Is Being Removed, Before the Day
For the ovaries especially. It is a decision, and decisions are easier made in advance.
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Common questions
Removing the Ovaries & Tubes — Frequently Asked Questions
Why are the ovaries removed if the cancer is in the womb?
For three reasons. The ovaries are a possible site of spread, and involvement is sometimes found only when they are examined after removal, having been invisible on imaging and at operation — which changes the stage and therefore the treatment. Simultaneous separate cancers of the uterus and ovary also occur, particularly in younger women, and distinguishing two independent early cancers from one that has spread is only possible on pathology. And the ovaries continue producing oestrogen, which is the hormone that drove the tumour in the commoner form of this disease. For a woman past the menopause these reasons apply while the cost is low, which is why removal is nearly always advised in that group.
Can I keep my ovaries if I have not reached the menopause?
It is a recognised option in selected cases rather than an unusual request. International guidance supports considering ovarian preservation in premenopausal women with early-stage, low-grade endometrioid cancer confined to the uterus, where the chance of ovarian involvement is low. It is not appropriate where the disease is higher grade, non-endometrioid in type, more advanced in stage, or where Lynch syndrome is present or suspected, since that raises ovarian cancer risk independently. If you are premenopausal and this has not been raised with you, it is worth raising yourself — and it is far easier to discuss before the operation than afterwards.
Why are the fallopian tubes always removed?
Because they carry no benefit once childbearing is complete, and because of a finding that emerged over the last two decades: a substantial proportion of what were long classified as high-grade serous ovarian cancers are now understood to originate in the fimbrial end of the fallopian tube, with the ovary a secondary site. Where the abdomen is being opened anyway, removing the tubes therefore costs nothing and removes a genuine future risk. This is now standard practice across gynaecological surgery, not only in cancer operations, and it is a separate decision from whether the ovaries are removed.
What happens if my ovaries are removed before menopause?
Menopause begins within days, and it is typically more abrupt and more intense than a natural transition because there is no gradual decline — the hormone supply simply stops. Hot flushes, night sweats, disturbed sleep, mood changes and vaginal dryness arrive on top of surgical recovery. These are treatable rather than something to endure: non-hormonal options genuinely help several of them, and local vaginal treatment is very effective for dryness and considerably under-used. There are also longer-term consequences for bone density and cardiovascular health, both more pronounced the younger you are, and both warranting active attention from the start rather than in a decade.
Can I take HRT if my ovaries were removed for endometrial cancer?
It is not automatically forbidden, and this is worth knowing because blanket refusals are common and frequently not justified. Whether hormone replacement is appropriate depends on the stage, grade and histological type of your cancer, and on how much you are suffering — a woman put into abrupt surgical menopause in her forties has a great deal at stake, both in symptoms now and in bone and cardiovascular health over decades. For some women with early low-grade disease it is a reasonable option after discussion; for others it is not. What is not reasonable is being refused without the question being properly considered.
Medical disclaimer: This page explains why the ovaries and fallopian tubes are removed during surgery for endometrial cancer and is reviewed by a CION oncologist, following current NCCN and ESGO–ESTRO–ESP guidance. Whether ovarian preservation is appropriate depends on stage, grade, histological type and genetic risk specific to you. It is general health information rather than advice about your own operation, and the decision should be discussed with your surgeon before you consent.