Bilateral Salpingo-Oophorectomy Overview

Bilateral salpingo-oophorectomy, also known as a BSO, is a surgical procedure in which both of the ovaries and the fallopian tubes are removed. This surgery can be performed on its own, but is usually performed during a hysterectomy, in which a woman's uterus is removed.

In contrast, when only one ovary and fallopian tube are removed, the procedure is called a unilateral salpingo-oophorectomy. It's sometimes designated as right or left with the acronym RSO (right salpingo-oophorectomy) or LSO (left salpingo-oophorectomy).

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What is a Bilateral Salpingo-Oophorectomy? 

A bilateral salpingo-oophorectomy is removal of both ovaries and fallopian tubes to treat ovarian cysts, eliminate fertility, or certain types of gynecologic cancer, especially ovarian cancer. In some cases, it may be done to prevent breast cancer and ovarian cancer in women with a strong genetic risk.

Surgical Approaches

There are several surgical approaches to performing a bilateral salpingo-oophorectomy. An abdominal approach is when an incision is made into the abdomen to expose the organs. This approach can take a longer time to recover from and is more painful than a minimally invasive approach because of the size of the incision.

Minimally invasive approaches use small incisions to insert a tiny camera into the abdomen so the surgeon can see inside the patient on a screen in the operating room. This is a type of laparoscopic surgery and is a commonly chosen approach for this surgery.

A more modern minimally invasive approach is called robotic-assisted surgery. This is when the surgeon operates a robot from a console in the operating room to perform the surgery. With this approach, the surgeon can maximize the benefits of a smaller incision, while having an increased range of motion and visualization throughout the surgery.

Results of This Surgery

When the ovaries are removed, women undergo immediate surgical menopause. This means that women who were pre-menopausal before surgery will be post-menopausal. Surgical menopause mimics what happens in natural menopause when a woman's estrogen levels decline with age, due to a decline in ovarian function. It also means that a woman will not be able to have children.

The drop in estrogen after removal of the ovaries may also increase a woman's risk of heart disease and osteoporosis, or bone loss — just as it does in natural menopause.

Symptoms After Surgery

The sudden drop of estrogen in the body with surgical removal of the ovaries can make the side effects of menopause more severe, as compared to the more gradual estrogen decline seen in natural menopause. This decline in estrogen commonly produces menopausal-related symptoms such as:

  • Depression
  • Hot flashes
  • Insomnia
  • Night sweats
  • Sexual dysfunction
  • Vaginal dryness

These symptoms may feel more dramatic for pre-menopausal women whose ovaries were not gradually declining in estrogen production.

Potential Risks

The immediate drop of estrogen from surgical removal of the ovaries can feel more pronounced and comes with increased health risks including for pre-menopausal women:

It's important to discuss the implications of surgically induced menopause with your doctor if you have not undergone menopause before surgery. There may be medications or treatment plans that can ease some of the symptoms following surgery.

Long-Term Care

A woman will need to follow up with her gynecologist and primary care healthcare provider after surgery to monitor health risks, like heart disease and osteoporosis, and to also determine if menopausal hormone therapy is warranted.

Menopausal hormone therapy consists of estrogen and/or progesterone, which are hormones that a woman's ovaries make. If a woman no longer has a uterus, she can take estrogen therapy alone. Estrogen plus progestogen therapy is recommended if a woman still has her uterus. Progesterone is added to estrogen therapy to prevent estrogen from thickening the uterine lining, which can cause uterine cancer.

The decision to take menopausal hormone therapy is complex and depends on many factors like your age, symptoms, family history, medical history, and personal needs. The dose, duration, risks, and benefits of menopausal hormone therapy must be discussed carefully with your healthcare provider — it's a decision that is unique for each woman.

Summary

Salpingo-oophorectomy is the surgical removal of both fallopian tubes and ovaries. The surgery can be performed with different surgical approaches for women who have gynecological cancer, to prevent cancer, or for sterilization purposes.

A Word From VeryWell

If you're having your fallopian tubes and ovaries surgically removed, discuss the implications with your doctor regarding post-surgical menopause. There are treatment options available to help manage the side effects.

Frequently Asked Questions

  • What is the difference between a salpingo-oophorectomy and a bilateral salpingo-oophorectomy?

    The terms generally mean the same thing. The difference is the description of bilateral, which means both the right and left fallopian tubes and ovaries will be removed.

  • What is a total hysterectomy with bilateral salpingo-oophorectomy?

    Total hysterectomy with bilateral salpingo-oophorectomy means surgical removal of the uterus, both fallopian tubes, and both ovaries.

  • How long does bilateral salpingo-oophorectomy surgery take?

    Typically, the surgery can last from one hour to several hours. The length of surgery varies depending on many factors such as the surgical approach, the complexity of each patient's anatomy, and if the surgery is being performed by itself or in combination with other procedures.

Originally written by Lisa Fayed
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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. The American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Hereditary breast and ovarian cancer syndrome.

  2. Mytton J, Evison F, Chilton P J, Lilford R J. Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkageBMJ 2017; 356 :j372 doi:10.1136/bmj.j372

  3. Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their managementEndocrinol Metab Clin North Am. 2015;44(3):497–515. doi:10.1016/j.ecl.2015.05.001

  4. Secoșan C, Balint O, Pirtea L, Grigoraș D, Bălulescu L, Ilina R. Surgically Induced Menopause-A Practical Review of LiteratureMedicina (Kaunas). 2019;55(8):482. doi:10.3390/medicina55080482

  5. Sarrel PM, Sullivan SD, Nelson LM. Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertil Steril. 2016;106(7):1580–1587. doi:10.1016/j.fertnstert.2016.09.018

Additional Reading
  • American Cancer Society. Surgery for Ovarian Cancer.

  • The North American Menopause Society. The Menopause Practice: A Clinician’s Guide, 5th ed. Mayfield Heights, OH: The North American Menopause Society.