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What age to have risk-reducing ovary removal | CION Cancer Clinics
For a BRCA1 carrier, guidelines suggest removing both tubes and ovaries between about 35 and 40, once childbearing is complete. For BRCA2 the window is later, about 40 to 45. These are ranges to discuss, not deadlines. A young diagnosis in the family can bring the year forward; a planned pregnancy can push it back. This page explains what moves it, and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- At what age should the ovaries be removed to lower the risk?
- BRCA1 and BRCA2, compared for timing
- What moves the age earlier, and what moves it later
- How the timing conversation usually goes
- Words you will meet, in plain language
- Three things families say, and what is actually true
- What to ask before you settle on a year
- Common questions about when to have risk-reducing surgery
The short answer
At what age should the ovaries be removed to lower the risk?
For a woman with a faulty BRCA1 gene, guidelines suggest removing both tubes and ovaries between about 35 and 40, once she has finished having children. For BRCA2 the suggested window is later, between about 40 and 45. These are ranges to discuss, not dates to obey.
Why the two genes get different ages
Ovarian cancer in BRCA1 carriers tends to start earlier in life than in BRCA2 carriers, and the lifetime chance is higher. So the window for BRCA1 opens sooner. For both genes the risk is low in the twenties and early thirties, which is why the operation is rarely suggested then. Taking the ovaries out at 28 would buy little protection at a high cost in years of lost hormones.
Why the ranges are wide
A range of five years is there on purpose. It leaves room for a last pregnancy, for egg freezing, for a job or a wedding, and for the simple fact that no woman is ready on a guideline's schedule. Within the range, earlier means more protection sooner; later means more years of your own hormones. Neither end is wrong.
This page cannot tell you your year. That comes from which gene you carry, the ages at which relatives were diagnosed, whether you have had breast cancer, and what you still want from your fertility.Side by side
BRCA1 and BRCA2, compared for timing
BRCA1
BRCA2
Suggested window: about 35 to 40
Suggested window: about 40 to 45
Higher lifetime chance of ovarian cancer
Lower lifetime chance, though still well above average
Cancers tend to appear from the late thirties on
Cancers tend to appear later, more often after the mid-forties
Less room to delay past forty
More room to delay, if the family history allows
Not sure whether this applies to you?
Ask an oncologistWhat shifts the year
What moves the age earlier, and what moves it later
The guideline range is the starting point. These are the things your team weighs to place you inside it, or outside it.
Earlier: a young diagnosis in the family
If your mother or sister was diagnosed with ovarian cancer at 42, many teams suggest the operation before that age rather than at the top of the range. The family pattern guides as much as the gene.
Earlier: childbearing is finished
Once you are sure you will not want another pregnancy, the main reason to wait has gone. Many women then go ahead rather than spend the remaining years watching the calendar.
Later: you still want children
A planned pregnancy, or eggs being frozen, is a legitimate reason to sit at the top of the range. Ask what monitoring is offered while you wait, and be told honestly that monitoring is a bridge rather than a substitute.
Later or earlier: a breast cancer already
If you have had a hormone-fed breast cancer, removing the ovaries may be suggested earlier, because it also removes the oestrogen that fed the tumour. Hormone replacement would then not be offered, which changes the plan for bones and symptoms.
Settling on a year
How the timing conversation usually goes
Your own risk is spelled out
The counsellor takes your gene result and your family tree and gives you a picture of how your risk rises with age. Ask for it in plain numbers, and ask which relatives' diagnoses shaped it.
Fertility is settled first
If children are still wanted, that comes before any date. A fertility visit, egg or embryo freezing, or a planned pregnancy all take time, and the surgery is placed after them.
Menopause is planned for
Whether you can take hormone replacement afterwards changes how much an earlier date costs. A carrier who can take it loses less by going early than one who cannot. Ask this before choosing a year.
A year is chosen, and can be revisited
You leave with a year in mind, not a booking. Life changes, and so can the plan. What matters is that the wait is a decision you have made with your team, and that monitoring runs while you wait.
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On your letter
Words you will meet, in plain language
- Pathogenic variant
- The gene fault itself. A variant of uncertain significance is a change whose meaning is not yet known, and does not on its own lead to surgery.
- RRSO
- Risk-reducing salpingo-oophorectomy. Removal of both tubes and both ovaries before any cancer has been found.
- Surveillance
- Regular scans and blood tests offered while you wait. It does not lower the risk and often does not catch ovarian cancer early.
- CA-125
- A blood protein that can rise with ovarian cancer, and also with many harmless conditions. It is used as part of monitoring, not as a test that rules cancer in or out.
Commonly believed
Three things families say, and what is actually true
"If the guideline says 35, she must have it done
by 35 or it is too late."
The guideline gives a range for discussion, and the chance of cancer does not jump on a birthday. A woman who has the operation at 41 rather than 39 has not missed a deadline. What matters is that the delay is chosen, with monitoring in place.
"Better to do it in her twenties and be safe."
The chance of ovarian cancer in the twenties is low even for carriers, while the cost of losing hormones that early is high for the bones, heart and brain. Guidelines do not suggest it that young, and most surgeons will not offer it without a specific reason.
"She has no symptoms and her scans are clear, so
there is no hurry."
Ovarian cancer usually has no symptoms until it has spread, and a clear scan does not mean a clear ovary. That is exactly why the operation is offered at an age rather than in response to a finding. A clear scan is good news, not a reason to stop the clock.
Being straight with you
What to ask before you settle on a year
The right year is the one you and your team arrive at together, with the risks on the table and your own life taken seriously. Nobody should choose it for you, and nobody should let you drift past it without a conversation.
Questions for the counsellor
What is my own chance of ovarian cancer by 40, by 50 and over my lifetime? Which relatives' diagnoses pushed that figure up? Does my result carry any other cancer risks I should plan for? Which of my relatives should be tested, and when?
Questions for the surgeon
Given my gene and my family, where in the range would you place me, and why? What monitoring is offered while I wait, and how good is it, honestly? Can I take hormone replacement afterwards, and until what age? If I wanted eggs frozen first, who arranges it and how long would that add?
Who this page does not apply to
If you have a strong family history but no gene test, the timing question does not yet apply; testing does. If a cancer has already been found, the operation is a treatment and its timing is set by the cancer.
Bring your gene report and a written family tree. Ages at diagnosis matter more than the number of relatives.Questions we are asked
Common questions about when to have risk-reducing surgery
Is 35 too early for a BRCA1 carrier?
Not according to the guidelines, which place the BRCA1 window at about 35 to 40 once childbearing is complete. Some women go at the lower end because a relative was diagnosed young or because they want the worry over. Others wait towards 40. Both are within the advice.
I am a BRCA2 carrier aged 38. Should I wait?
The suggested BRCA2 window starts at about 40, so many women in your position do wait, with monitoring in the meantime. A young ovarian cancer in the family, or a hormone-fed breast cancer of your own, can bring it earlier. Ask your counsellor where your family history places you.
Can I have the tubes removed now and the ovaries later?
This two-stage approach is being studied, because many of these cancers start in the tube and removing it first might delay menopause without losing much protection. It is not yet standard care, and not a reason to skip the ovaries later. Ask your team whether it is offered.
What if I am already past the menopause?
Then the main cost of the operation, early menopause, no longer applies, and the operation is usually suggested without much delay once the gene result is known. The tubes and ovaries still carry the risk after the menopause, so age does not remove the reason for surgery.
Does waiting a year or two make a big difference?
Within the guideline range, a year or two is usually a modest change in risk, and a fair trade for a planned pregnancy or a settled life event. Beyond the range, each year adds a little more. Ask your counsellor to show you how your own risk rises with age.
Will monitoring keep me safe while I wait?
Monitoring with scans and a CA-125 blood test is offered while you wait, but it does not lower the risk and often does not catch ovarian cancer early. It is a bridge, and teams are honest that it is a weak one. That is why a year is agreed rather than left open.
Should my daughter be tested now so she can plan?
Testing is usually offered from adulthood, because nothing is acted on before then and an adult can decide for herself. A daughter in her twenties who tests positive would not be offered surgery for many years, but she can plan her fertility and screening around the result.
Who decides the final date?
You do, with your team. The counsellor gives you the risk, the surgeon explains the operation and its costs, and you bring what you want from the next few years. A good team will not push you, and will not let the question quietly drop.
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Sources
- National Cancer Institute — BRCA Gene Changes: Cancer Risk and Genetic Testing
- Cancer.Net — Hereditary Breast and Ovarian Cancer
- NHS — Predictive genetic tests for cancer risk genes
- Cancer Research UK — Ovarian cancer risks and causes
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Risk-Reducing Salpingo-Oophorectomy for BRCA CarriersWhat the operation does and does not doEgg Freezing Before Ovary RemovalIf children are the reason you are waitingOophorectomy in Young Women: What to WeighWhat early menopause costs, and what helpsFollow-Up After Risk-Reducing SurgeryWhat the years after look like
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Have a BRCA result and not sure when to act?
Send us the report and your family history, or call the helpline. A surgical oncologist will talk through where the guidelines place you and what the next step is. One helpline serves every CION centre.