Bilateral salpingo-oophorectomy in New Zealand: What you need to know

Why undergo bilateral salpingo-oophorectomy?

A bilateral salpingo-oophorectomy is recommended for women at high risk of developing cancer or for those facing specific medical conditions affecting the reproductive system.

Cancer prevention and treatment

BSO plays a crucial role in reducing the risk of several types of cancer, particularly ovarian cancer.  This is of special interest to women with BRCA mutations, who are at much higher risk of developing ovarian cancer than women in general.  

For those diagnosed with ovarian, fallopian tube, uterine, or cervical cancer, removing the ovaries and fallopian tubes may prevent metastasis to other organs. Under certain conditions, some health insurers may cover BSO as a prophylactic measure for high-risk women. If you have health insurance and are considering this procedure, check whether your insurer can cover all or part of the costs.

Other medical conditions affecting the reproductive organs

Bilateral salpingo-oophorectomy serves as a treatment option for various gynaecological diseases. Here are some key medical issues relevant to a BSO:

Endometriosis

BSO can alleviate the symptoms of endometriosis, where tissue similar to the lining of the uterus (the endometrial tissue) grows outside the uterus, causing chronic pain, heavy periods, and infertility.

Ovarian cysts

BSO may be recommended to remove fluid-filled sacs in the ovaries, particularly if the cysts are large and cause pain and discomfort.  

Severe pelvic inflammatory disease (PID)   

Bilateral salpingo-oophorectomy can remove damaged tissue and reduce the risk of complications caused by PID - an infection of the reproductive organs that can lead to chronic pain, infertility, and ectopic pregnancy.  

Uterine fibroids

Uterine fibroids are non-cancerous growths in the uterus that can cause pain, heavy bleeding, and reproductive problems. BSO may be performed alongside a hysterectomy to manage severe symptoms. 

Can bilateral salpingo-oophorectomy eliminate cancer risk?

BSO has been shown to significantly reduce cases of ovarian and fallopian cancer in women with BRCA mutations. However, it does not completely eliminate the risk of getting cancer.

Women with BRCA mutations remain at risk for other types of cancer, such as breast cancer and peritoneal cancer - a rare condition that develops in the lining of the abdomen. 

Considerations before undergoing surgery

Deciding to undergo a bilateral salpingo-oophorectomy is a significant step that requires careful thought and specialist advice. Here are some factors to consider:

Medical necessity

Assess the specific medical reasons for considering BSO, including your current health status, existing issues, alternatives to BSO, and whether BSO surgery is the most appropriate treatment option.  

Infertility

If you wish to have children in the future, it’s important to understand the implications of BSO on fertility. The procedure will prevent natural conception, so discussing alternatives, such as egg preservation or surrogacy, may be necessary if you are still of childbearing age.

Risks and complications

Like any surgical procedure, BSO carries potential risks, including infection, bleeding, and complications related to anaesthesia.

Additionally, removing the ovaries results in the immediate onset of menopause if you are premenopausal, which may lead to menopausal symptoms, such as hot flushes, night sweats, an increased risk of mood and sleep disturbances, and sexual dysfunction.

Observational studies also suggest a link between pre-menopausal BSO and higher risks of coronary heart disease, osteoporosis, cognitive decline, and other health issues.  

Understanding how BSO may impact your long-term health and quality of life and discussing hormone replacement therapy (HRT) options with your healthcare provider may help manage these changes and risks.

Bilateral salpingo-oophorectomy procedure

Here’s an overview of what to expect, from pre-surgery preparation to post-surgery recovery.

Pre-surgery preparation

Before the surgery, your healthcare provider will conduct a thorough assessment to ensure you are physically fit for the procedure. This may include:

• Medical evaluation: Your medical history is collected and a physical examination, blood tests, and imaging studies will be performed.
• Preoperative instructions: Your doctor will provide guidelines regarding your usual medications, such as blood thinners, and may instruct you to refrain from eating or drinking for several hours before the surgery. 
• Discussion of anaesthesia: You may meet with your anaesthetist to discuss the type of anaesthesia to be used, usually general, which means you will be unconscious throughout the procedure.
• Planning for recovery: Discuss your postoperative care and recovery plan with your healthcare team, including any necessary support at home following surgery.

The surgery

On the day of your BSO, you will be admitted to hospital and prepped for surgery. A bilateral salpingo-oophorectomy typically takes from one to a few hours, however, this can vary depending on the complexity of your case and whether additional procedures are performed simultaneously.

Surgical approach

The surgeon may perform your bilateral salpingo-oophorectomy using one of the following techniques:

• Open abdominal surgery (laparotomy): In this method, a large incision is made in the abdomen to access the ovaries and fallopian tubes.
• Laparoscopic surgery: Less invasive, a laparoscopy involves small incisions through which a camera and specialised instruments are inserted. This typically results in quicker recovery, less pain, and minimal scarring compared to open surgery.
• Robotic surgery: Similar to laparoscopy, robotic-assisted surgery uses small incisions but allows for more precision with the aid of robotic arms controlled by a surgeon.

Post-surgery recovery

After surgery, you will be moved to a recovery area and monitored by medical staff as you wake up from anaesthesia.

• Immediate monitoring: Your vital signs will be noted, and you may be given pain relief medication as needed.
• Hospital stay: Following laparoscopic or robotic BSO, many patients can go home either on the day of the surgery or after one night in hospital. Open surgery may necessitate a longer hospital stay.
• Follow-up appointments: You will likely have follow-up appointments to monitor your recovery, discuss any symptoms, and evaluate your overall health.

Potential complications and side effects

While most patients experience a smooth recovery, it's important to be aware of potential complications and side effects. Here is a list of possible issues that could occur after your bilateral salpingo-oophorectomy surgery:

• Infection: Surgical sites can become infected, leading to fever, increased pain, redness, swelling, or discharge.
• Bleeding: Some bleeding is normal, but excessive bleeding, either during or after surgery, requires prompt medical attention.
• Blood clots: Patients are at risk of developing blood clots in the legs or lungs, which can be serious. Symptoms include swelling, redness, pain in the leg, and/or sudden shortness of breath or chest pain.
• Damage to surrounding organs: In rare cases, BSO surgery may inadvertently damage nearby organs, such as the bladder, bowel, or ureters.
• Severe pain: Call a doctor if you experience pain not relieved by prescribed medications or that significantly worsens over time.
• Hormonal changes: Removing the ovaries will lead to a sudden decrease in hormone production, potentially causing hot flushes, mood swings, or vaginal dryness, similar to those experienced during menopause.
• Changes in bowel or bladder function: If you have difficulty urinating or experience changes in bowel habits (bowel obstruction), see your doctor.

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