Dr Sam Holford consulting with a patient

Risk-Reducing Gynaecological Surgery

If you have a higher inherited risk of ovarian, uterine, or fallopian tube cancer – due to a genetic condition like BRCA1, BRCA2, or Lynch syndrome – you may be considering risk-reducing surgery.

This typically involves laparoscopic (keyhole) removal of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy, or BSO) and may also include removal of the uterus (hysterectomy) depending on your risk and personal preference.

I offer individualised care to help you understand your options and make the best choice for your health and life stage.

Anatomy of the uterus, ovary, and tubes.
The ovaries have two main jobs: they produce and release eggs for reproduction, and they produce the key female hormones. The fallopian tubes then act as the channel to catch the released egg and transport it to the uterus, which is the organ where a fertilised egg can implant and a baby grows. The cervix is the narrow, lower part of the uterus that opens into the vagina, that allows menstrual flow to exit and dilates during childbirth.

Who might consider risk-reducing surgery?

You may be recommended this type of surgery if you carry a known pathogenic variant in:

  • BRCA1 or BRCA2 (Hereditary breast and ovarian cancer syndrome)
  • MLH1, MSH2, MSH6, PMS2, or EPCAM (Lynch syndrome)
  • Other rare syndromes such as STK11 (Peutz-Jeghers) or PTEN (Cowden)

Typical timing:

  • BRCA1: Surgery advised between ages 35–40
  • BRCA2: Often delayed until 40–45
  • Lynch syndrome: Often recommended after completing childbearing (late 30s–early 40s)

Procedures offered

Laparoscopic Bilateral Salpingo-Oophorectomy (BSO)

  • Removal of both ovaries and fallopian tubes
  • Can reduce risk of ovarian/fallopian tube cancer by over 95%
  • Leads to menopause if performed pre-menopause

Laparoscopic Total Hysterectomy

  • Removal of uterus and cervix
  • Offered to patients with Lynch syndrome, or BRCA carriers with abnormal uterine bleeding, family history of uterine cancer, or for convenience if already having BSO

Opportunistic Salpingectomy

  • For those not at high genetic risk but having surgery for another reason, fallopian tubes may be removed to reduce future ovarian cancer risk

What to expect

  • Day surgery or 1-night stay
  • Keyhole (laparoscopic) surgery, usually with 3–4 small incisions
  • General anaesthetic
  • You can typically return to driving and work after 1–2 weeks for office-based roles

Common side effects

  • Mild pain, bloating, and fatigue for a few days
  • Vaginal bleeding or discharge for up to 2 weeks
  • Hormonal symptoms (if ovaries removed before menopause)

Managing surgical menopause

If you’re premenopausal and have your ovaries removed, you will go into immediate menopause. Symptoms can include:

  • Hot flushes
  • Night sweats
  • Mood changes
  • Vaginal dryness
  • Changes in libido
  • Bone density loss

I’ll talk you through options to manage these, including Menopausal Hormone Therapy (MHT) – which is often appropriate even in BRCA carriers with no personal history of breast cancer. If you’ve had breast cancer, we can work with your oncologist or menopause specialist.

Fertility and family planning

If you haven’t yet completed childbearing, we’ll explore options such as:

  • Delaying surgery where safe
  • Egg or embryo freezing
  • Referral to a fertility clinic for advice and planning

Emotional and psychological support

Risk-reducing surgery is a big decision that affects your health, identity, and future. It’s completely normal to feel uncertain or emotional. I encourage:

  • Bringing a support person to appointments
  • Taking time to decide – there is rarely urgency
  • Connecting with a genetic counsellor or clinical psychologist
Dr Sam Holford

Is surgery for you?

If you carry a gene that increases your cancer risk, surgery may help protect your long-term health. These decisions are deeply personal, and I will support you with empathy, clarity, and expert care every step of the way.

Book an appointment

FAQs

We now understand that many high-grade serous "ovarian" cancers actually start in the fallopian tubes. Removing the tubes (a salpingectomy) along with the ovaries is a crucial part of the surgery as it maximises the risk reduction for this type of cancer.
Will I need to take hormone replacement therapy (MHT) after the surgery?
If your ovaries are removed before you have gone through menopause naturally, you will experience surgical menopause. MHT is strongly recommended to manage symptoms like hot flushes and to protect your long-term bone and heart health. For most people with BRCA mutations but no personal history of breast cancer, MHT is considered safe.
How long is the recovery from laparoscopic risk-reducing surgery?
Recovery from keyhole surgery is relatively quick. Most people go home the same day or the next morning. You can expect to return to a desk job and light activities within 1-2 weeks, with a full return to strenuous exercise at around 4-6 weeks. Read more in my Surgical Recovery Toolkit.
What if I haven’t finished having children?
This is a critical part of the decision-making process. If you still wish to have children, we would discuss the timing of your surgery and options for fertility preservation, such as egg or embryo freezing. This usually involves a coordinated plan with a fertility specialist.
Does this surgery guarantee I won’t get cancer?
Risk-reducing surgery dramatically lowers your chance of developing ovarian or fallopian tube cancer by over 95%, but it does not eliminate the risk entirely. A very small risk of a related cancer called primary peritoneal cancer remains. This surgery does not affect your breast cancer risk, so regular breast screening remains vital.

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Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.