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Should You Be Removing Your Ovaries & Fallopian Tubes?

Should You Be Removing Your Ovaries & Fallopian Tubes?
You might remember a couple of years ago when Angelina Jolie shocked the public at her drastic decision to have a double mastectomy, due to her increased risk of breast cancer.

After she had her blood tested, she found that she carried the mutation of the BRCA1 gene, which gave her an estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer. Jolie has stated in interviews that she lost her mother, grandmother and aunt to cancer.

Recently, she revealed that she would be also removing her ovaries and fallopian tubes because of the increased risk of cancer, and how she wants to inform all women who might one day or who are in her shoes, questioning what to do next.

However, having an oophorectomy (if you're under a certain age) can throw you into early menopause. This means you won't be able to have children, and you might have to take hormones to keep your body in balance.

What are the risks of this surgery, and should you consider having it?

Philip M. Sarrel, MD, discusses Angelina Jolie's latest surgery and if you should consider doing the same.
Featured Speaker:
Philip M. Sarrel, MD
Philip SarrelPhilip M. Sarrel, MD, completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital; all in addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine.

Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King's College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York.. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.

RadioMD Presents: HER Radio | Original Air Date: April 16, 2015
Host: Michelle King Robson and Pam Peeke, MD

It's all about her. Her body. Her mind. Her wellness. Her sex. Her relationships. Her aging. Her beauty. It's HER Radio starring acclaimed entrepreneur and women's advocate, Michelle King Robson and leading women's health expert, the doc who walks the talk, Dr. Pam Peeke.

PAM: Well, she did it again, Michelle.

MICHELLE: She sure did.

PAM: Angelina Jolie. Yes. She, two years ago, she revealed that she'd undergone a preventative double mastectomy because she carries the breast cancer gene and it's all over her family and then, boom! Another bombshell two years after that. You know, very recently, she had her ovaries and fallopian tubes removed and this just started the firestorm that's been all over your wonderful website, EmpowHER, all over radio and television. What is going on? Women asking a million and a half questions. So, we have our "go to" expert on all things women's health, Dr. Phil Sarrel.

Dr. Sarrel—Phil—We're so happy you're back on HER Radio because we have some really important questions here. You know, and we want to make certain that women out there understand what happened with Angelina Jolie. So, let's just start right in there with that. What was this all about?

DR SARREL: What this is all about is related to your previous speaker. This is related to Angelina Jolie doing one of the bravest and most courageous things a person can do. That is, to go ahead with surgery to remove cells from her body that could become cancer because of her family history and replace the missing hormone so that she wouldn't suffer the results of a surgical menopause. So, let's back up a second. Remember the history in the family—her family—is three close relatives, including her mother, dying of either breast cancer or ovarian cancer.


DR SARREL: Two years ago, she had her breasts removed. She was followed, subsequently, and it was determined that because of the 3 members of her family having died of those diseases and her having the genetic predisposition, she could also develop cancer in her ovaries. But, listen to what she did. She gathered information. She became an authority on her own. She made a rational decision. The decision was: take out the ovaries and tubes, a place where a cancer could occur, but replace the missing hormone.


DR SARREL: Now, it may be a little bit controversial that she held onto her uterus. I, personally, agree with her having done that. I think that by keeping her uterus and putting the progesterone IUD to protect the lining of the uterus, then she can get all the benefits of her estrogen patch and not have to worry about complications in the uterus. The uterus being there will help to support her bladder.

MICHELLE: Exactly.

DR SARREL: To support her vagina, and it may also be, for her, important in her sex response. So, I think all things considered, this woman came to an extremely mature decision. She had to go through lots of different data. Things that usually are confusing and the facts are often obscured. But, I think she overcame that. Obviously, she had good advice, but she's got a good head on her shoulders. You know, when you talk about, as you did with the last speaker, loving yourself. The first self is your body self and her taking care of her body and being there for her husband and for her children in the decades to come, I think is the most important thing. Just that little thing of replacing the estrogen patch, if she hadn't done that, at age 39, without ovaries and without ovarian estrogen, her risk of a heart attack, her risk of a hip fracture, her risk of being hospitalized for a suicide attempt would be tripled. By just replacing that missing estrogen, she totally eliminates that risk of a heart attack, risk of a fracture, risk of psychiatric complications.

MICHELLE: I was so happy to see that. I was happy to see that in the article, Phil, when she talks about the patch and, you know, you and I have had many conversations, as had Pam. We've all had conversations about the estrogen patch and I do believe that...I thought that her leaving her uterus in place was such a fascinating that I really hadn't thought about much before, but I thought it was really smart that she did that. She got really great help and advice and she ultimately made the decision and then shared it with everybody, which I think is hugely powerful and is exactly what we're all trying to do when we, you know, like I started EmpowHER because of this.

So, let's talk a little bit about...So, we kind of...We talked about the procedure, but depending on a woman's age, should she wait on having this type of procedure? For example, if you're young and still want to have children. So, what do you do?

DR SARREL: Well, you know, Angelina Jolie makes it very clear in her article in the New York Times that hers was an individual decision. She understands. She has her family. She's had three children by her own, through her own uterus and her own reproductive system and, I believe, three more through adoption. For a woman in her late 30's who faced her situation, who had no children, who might want to have the potential for children, you might have waited a little longer, but there was a guidance for her. Her mother died, one of the close relatives, died at age 49 and she was now age 39, so she was within that 10 year window when, in fact, the cancer in the ovaries could have developed at almost any time and her advisor said, "Well, you know, we think that that's important information. So, when you put all of this together, Angelina, this is the best decision for you." It would be different for someone else and hers is a wonderful case, emphasizing how important it is in making a medical decision that the care be individualized.

PAM: I think that that's terribly important. You know, as a fellow physician, I've seen so many variances on peoples' stories and their needs. You really have to sit down and spend down with each woman, and maybe their family, whatever she wishes, to be able to understand what's going to work best for them because this is so complex. It's also emotional. Have you already had children? Have you not? What's the fear factor going on in your life because that's stressful in and of itself. I've had plenty of young women who've been diagnose at the age of 32 and 35 and this is a very tough disease to deal with. I think what you've done, Phil, is you've really helped us understand some of the framework that physicians and women are using to help navigate these very stormy waters. I think you brought up something huge that Michelle and I talk about a lot and that is, Angelina really sat down; did her homework; was her best advocate.

MICHELLE: Knowledge is power, right?

PAM: Oh, yeah. Talk about EmpowHer. I mean, she really did her homework and she understood the pros and cons.

DR SARREL: Just imagine. Just imagine under stress like that, facing the life situation such as hers. You know, all of the kinds of things. It would have been more common for her to have an irrational decision. Most people under stress like that are irrational.

PAM: Right.

DR SARREL: She came to a very rational decision.

PAM: That was excellent.

MICHELLE: Good for her.

PAM: That's something that Michelle and I and you, Phil, really congratulate her for. Kudos to her and I really think she set an example for other women. They need to take this individually. There's no doubt about it.

I want to thank Dr. Phil Sarrel, our "go to" expert on all things women's health to help us parse apart what's going on with this Angelina phenomenon.

Thank you, Dr. Sarrel, for being on HER Radio. I'm Dr. Pam Peeke with Michelle King Robson.

MICHELLE: Ladies, knowledge is power, so make sure you have information and resources to help you. You're listening to HER Radio on RadioMD. Follow us on Twitter. Like us on Facebook. Stay well.