You may have an increased risk of developing ovarian cancer if you have:

• A strong family history of ovarian (and sometimes breast or bowel) cancer

and/or

• An inherited gene change (gene mutation) associated with an increased risk of developing ovarian cancer

A family cancer clinic can assess your risk and offer information and support about possible ways to manage it.

Some women at high risk of developing ovarian cancer are offered surgery to remove their ovaries. Doctors call this risk reducing surgery or prophylactic oophorectomy.

The operation involves removing the ovaries and the fallopian tubes. Some women, who also have a high risk of womb cancer, have their womb taken away as well.

If you have a prophylactic oophorectomy you cannot develop cancer of the ovary in the future. But, studies show that a small proportion of women, have early stage cancer of the ovary at the time of the operation. There is also, a small risk of developing a closely related cancer called primary peritoneal cancer. So risk-reducing (prophylactic) oophorectomy greatly reduces the risk of ovarian cancer but does not completely take it away.

As well as having an increased risk of ovarian cancer, women who have a BRCA1 or BRCA2 gene mutation have a high risk of developing breast cancer. Removing the ovaries can also reduce the risk of breast cancer. This is because the risk of breast cancer is linked to oestrogen levels in the body and after your ovaries are removed your oestrogen levels are much lower.

Most of the side effects of prophylactic oophorectomy are due to lower levels of oestrogen in the body. After the operation women immediately go into the menopause. This causes menopausal side effects such as hot flushes and mood swings. It can also cause vaginal dryness and may affect a woman’s sex drive.

Oestrogen is important in protecting bones and keeping them strong. So, having lower levels can increase your risk of bone thinning. In time this may lead to a condition called osteoporosis. There are medications that can help to strengthen the bones and prevent osteoporosis called bisphosphonates.

Sometimes doctors can prescribe HRT in low doses to lessen these side effects. Your specialist can talk over with you, the individual risks and benefits to you of taking HRT.

As well as physical effects you may experience emotional effects from the surgery. On the positive side, some women feel less anxious about their future because they have a lower risk of cancer. But, you may also feel sad at the loss of your fertility and going through an early menopause.

The decision whether or not to have this type of surgery is a highly personal one. It may depend on a number of factors including your individual cancer risk, your age, and whether you have completed your family, as well as your personal preferences. It is important to talk through the risks and benefits with your specialist and a genetics counsellor. You will also be told about alternative ways of managing your risk before making up your mind. You may find it helpful to be put in touch with other women who have had this type of surgery. Your specialist may be able to arrange this for you.

There is no right or wrong answer, only what feels right for you. So, take as much time as you need to make your decision.

For some women an alternative to surgery is ovarian screening. Doctors hope that this may help to detect cancer of the ovary, if it occurs, at an earlier stage, when it is more curable. But, at the moment, there is no evidence that ovarian screening helps to improve survival in women at higher risk of ovarian cancer.