Medical Oncologist
BRCA & Hereditary Risk
Removing Your Ovaries and Tubes: — Timing, Consequences, and What Comes Next
If you carry a BRCA1 or BRCA2 gene variant, your lifetime ovarian cancer risk is substantially higher than average. Removing both ovaries and fallopian tubes — called RRSO — is the most effective risk-reduction step available, but the decision involves timing, consequences, and trade-offs that are worth understanding before you reach that age.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- Risk depends on which variant you carry — NCCN estimates a lifetime ovarian cancer risk of around 44 in 100 for BRCA1 carriers and around 17 in 100 for BRCA2 — both substantially higher than the general population risk of about 1 in 100.
- Surveillance alone is not enough — Regular ultrasound and blood tests have not been shown to reliably catch ovarian cancer early in BRCA carriers. Surgery is the recommended step, not monitoring indefinitely.
- Timing differs by variant and family plans — BRCA1 carriers are typically advised to consider surgery between age 35 and 40. For BRCA2, the recommendation is between 40 and 45 — both after completing your family.
- Surgical menopause is real but manageable — RRSO causes immediate menopause if done before your natural menopause. Hormone therapy is an option for most BRCA carriers and can significantly reduce the effects.
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If you carry a BRCA1 or BRCA2 gene variant, your lifetime ovarian cancer risk is substantially higher than average. NCCN recommends considering surgery to remove both ovaries and tubes — called RRSO — by a specific age depending on your variant. Done at the right time, RRSO is the most effective risk-reduction step available.
What do these terms mean?
- BRCA1 and BRCA2
- Genes that, when carrying a harmful variant, substantially raise the lifetime risk of ovarian and breast cancer. BRCA1 variants carry a higher ovarian cancer risk than BRCA2, and risk peaks at a younger age.
- RRSO (risk-reducing salpingo-oophorectomy)
- Surgery to remove both ovaries and both fallopian tubes before cancer develops. The tubes are included because ovarian cancers often begin there, not in the ovary itself.
- Surgical menopause
- Menopause that occurs immediately when the ovaries are removed, regardless of your age. Unlike natural menopause, it is abrupt, which can make symptoms more pronounced.
- Interim surveillance
- Regular monitoring — transvaginal ultrasound and the blood marker CA-125 — while you are deciding about or waiting for surgery. It is standard care in the gap, but it has not been shown to replace surgery for people who are candidates.
What is the process from genetic confirmation to long-term follow-up?
Genetic counselling
A geneticist or genetic counsellor confirms your variant, gives you a personal risk estimate, and helps you think through the implications for family planning and surgical timing.
Start interim surveillance
NCCN recommends beginning transvaginal ultrasound and CA-125 testing every six months from around age 30 to 35, while you are deciding or awaiting surgery.
Discuss surgical timing with a gynae-oncologist
Your oncologist will review your specific variant, your family history, and your plans for children. The recommended age range differs between BRCA1 and BRCA2.
Have the surgery
RRSO is usually done laparoscopically under general anaesthesia. Most people stay in hospital for one night and return to normal activity within two to three weeks.
Review hormone therapy with your team
Hormone replacement therapy to around the age of natural menopause is an option for most BRCA carriers after RRSO. It can significantly reduce the effects of surgical menopause.
Continue breast and long-term monitoring
RRSO does not remove your breast cancer risk. Annual MRI and mammography continue, alongside bone density scans and cardiovascular monitoring.
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Dr. Mohammed Imran
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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When is RRSO recommended — and does the timing differ by variant?
Yes, and the difference is meaningful. NCCN recommends that BRCA1 carriers consider RRSO between age 35 and 40, after completing their family. For BRCA2 carriers, the recommendation is between age 40 and 45, because the ovarian cancer risk rises later.
The reason for the earlier window with BRCA1 is the higher absolute risk. NCCN estimates the lifetime ovarian cancer risk at around 44 in 100 for BRCA1 carriers and around 17 in 100 for BRCA2, compared with about 1 in 100 for the general population.
In the years before surgery, NCCN recommends starting surveillance between age 30 and 35: transvaginal ultrasound and CA-125 every six months. This is the gap to manage — surveillance is standard interim care, but it has not been shown to reliably detect early-stage ovarian cancer, which is one of the core reasons surgery is recommended over monitoring alone.
What does RRSO do to your body?
If your ovaries are removed before your natural menopause, you enter surgical menopause immediately after the operation. Your oestrogen level drops sharply rather than gradually, and this abruptness can make symptoms more noticeable than natural menopause.
Common effects include hot flushes, sleep disruption, mood changes, vaginal dryness, and reduced sex drive. Over time, low oestrogen also reduces bone density and increases cardiovascular risk. These are real consequences, and planning for them before surgery is part of making a fully informed decision.
Some people notice changes in memory and concentration after RRSO. The evidence here is still developing. Tell your team if this happens — it is worth documenting, and there are approaches that can help.
How do you manage the effects of surgical menopause?
Hormone replacement therapy taken to around the age of natural menopause is the most effective way to reduce the consequences. For most BRCA carriers who have had RRSO, the evidence suggests this does not substantially increase breast cancer risk beyond what the variant already carries — though this is a nuanced area, and your oncologist and gynaecologist will advise based on your full picture.
Bone protection needs to start from the day of surgery. Your team will likely recommend weight-bearing exercise, adequate calcium and vitamin D, and a baseline bone density scan. Some people will need medication.
Vaginal dryness and sexual health changes respond well to local oestrogen, which can be used even if you are not on systemic HRT. These effects are not trivial. Asking for help with them is appropriate, and they are a routine part of care after RRSO.
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Common questions
Frequently asked questions
Does RRSO completely eliminate ovarian cancer risk?
No. RRSO removes the main source of ovarian cancer, but a small residual risk remains from the peritoneum — the lining of the abdomen, which is the same tissue type. NCCN and ESMO describe this residual risk as small but real. The surgery substantially lowers your risk, but 'eliminates' is not accurate. Any new abdominal or pelvic symptoms after RRSO should still be reported to your team promptly.
Can I take HRT after RRSO if I carry a BRCA variant?
For most people, yes. Current evidence and NCCN guidance suggest that taking HRT to around the age of natural menopause after RRSO does not substantially add to the breast cancer risk the variant already carries. This is a nuanced and evolving area — your oncologist and gynaecologist will advise on the type and duration that suits your specific situation. If you have already had breast cancer, the answer may differ.
What if I have not finished having children?
RRSO ends natural conception, so family planning is central to the timing conversation. If you are not ready, interim surveillance is the appropriate alternative while you complete your family. Fertility preservation — egg or embryo freezing — is worth discussing with a fertility specialist before RRSO if it matters to you. Your genetic counsellor can help you weigh the surveillance gap against your personal timeline.
Is surveillance alone as effective as surgery?
No. Transvaginal ultrasound and CA-125 testing have not been shown to reliably detect early ovarian cancer in BRCA carriers — which is why surgery is recommended over monitoring alone. Surveillance is appropriate while you are waiting or deciding, and it is the standard interim step. It is not an equivalent alternative to RRSO for people who are candidates and have completed their family.
Does RRSO also reduce my breast cancer risk?
For premenopausal women, in part, yes. RRSO performed before natural menopause reduces oestrogen levels, and ASCO and NCCN associate this with a reduction in breast cancer risk in premenopausal BRCA carriers. The benefit appears greater when surgery is done at a younger age. RRSO does not replace breast surveillance — annual MRI and mammography continue after surgery regardless.
What does the surgery involve, and how long is recovery?
RRSO is usually done laparoscopically — through small incisions — under general anaesthesia. Most people stay in hospital for one night or go home the same day, and return to most normal activities within two to three weeks. Because it involves the reproductive organs, it is performed by a gynaecological oncology team. At CION, your team coordinates the surgical referral and manages your follow-up care across the 35-plus centres in our network.