When are ovaries removed for Polycystic Ovary Syndrome (PCOS)?

From the Research

Ovary removal (oophorectomy) is rarely recommended for PCOS and is typically considered only as a last resort in severe cases that haven't responded to other treatments, as it can lead to significant morbidity and mortality, and impact quality of life. According to the most recent study 1, ovarian drilling is currently being adopted as a second-line treatment for PCOS, and laparoscopic ovarian drilling (LOD) is considered effective for gonadotropins in terms of live birth rates, but without the risks of iatrogenic complications in gonadotropin therapy. Oophorectomy may be considered in the following situations:

• Severe, treatment-resistant symptoms causing significant quality of life issues
• Women who are post-menopausal or near menopause
• Cases where there's a high risk of ovarian cancer Before considering ovary removal, patients should try standard PCOS treatments, including:

• Lifestyle changes (diet and exercise)
• Hormonal birth control pills
• Metformin (500-2000 mg daily)
• Anti-androgen medications like spironolactone (50-200 mg daily) Removing the ovaries is a major decision as it leads to immediate menopause and can have long-term health implications, including increased risk of osteoporosis and cardiovascular disease, as noted in a study on long-term complications of PCOS 2. The rationale behind ovary removal in PCOS is to stop androgen production, which drives many PCOS symptoms, but this is an extreme measure and modern medical management can usually control symptoms effectively without surgery, as supported by a study on ovarian surgery for symptom relief in women with PCOS 3. Additionally, a case study on unilateral oophorectomy in a patient with resistant PCOS 4 and a study on surgical treatment of PCOS associated with infertility 5 provide further insight into the potential benefits and risks of ovarian surgery in PCOS patients. However, the most recent and highest quality study 1 suggests that ovarian drilling, rather than oophorectomy, may be a more effective and safer treatment option for PCOS patients.