Women at increased risk of ovarian cancer are currently advised to have their fallopian tubes and ovaries removed as a preventive measure. New research shows that an alternative approach, in which the fallopian tubes are removed first and the ovaries several years later, results in fewer menopause-related symptoms five years after the initial surgery. These findings are reported in the PhD thesis of Tamar Gootzen at Radboud university medical center. A large follow-up study involving 3,000 women is now investigating whether this new approach is as safe and effective as the current standard treatment.
Approximately one in 200 women has a hereditary increased risk of ovarian cancer, the deadliest form of gynecological cancer. Most carry a mutation in one of the BRCA genes, which is also associated with a higher risk of breast cancer. Their lifetime risk of ovarian cancer ranges from 10% to 45%, compared with just over 1% in the general population.
Women with this hereditary predisposition are advised to undergo preventive removal of their fallopian tubes and ovaries once they have completed their families. The procedure is performed before the natural onset of menopause. Because the ovaries are still producing hormones at that stage, surgery induces premature menopause. This can lead to symptoms such as hot flashes and sleep disturbances. In the long term, it may also increase the risk of osteoporosis, cardiovascular disease, and cognitive problems.
Removing the fallopian tubes first
Although ovarian cancer is named after the ovaries, previous research has shown that the disease often originates in the fallopian tubes. Based on these findings, PhD candidate Tamar Gootzen investigated a new preventive strategy for women with a hereditary increased risk of ovarian cancer. Under this approach, only the fallopian tubes are removed initially. The ovaries are removed five to twenty years later, depending on a woman’s age and individual cancer risk at the time of the first procedure.
A total of 570 women participated in the study. They were able to choose between the standard treatment, in which the fallopian tubes and ovaries are removed at the same time, and the new approach, in which only the fallopian tubes are removed initially. The vast majority opted for the latter.
Fewer menopause-related symptoms
Women who underwent fallopian tube removal first and delayed ovary removal experienced fewer menopause-related symptoms five years after surgery than women who had both organs removed simultaneously. The study also showed that removal of the ovaries is the key event driving the decline in quality of life associated with menopausal symptoms. Gootzen is encouraged by the findings: ‘This new approach may allow women to postpone menopause and its associated symptoms for several years while still benefiting from risk-reducing treatment.’
Large international follow-up study
The next step is to determine whether the new approach offers the same level of protection against ovarian cancer as the current standard treatment. To answer this question, a large international study is currently underway, with more than 3,000 women already enrolled. The study is led by Radboudumc in collaboration with more than seventy centers across sixteen countries. The first results are expected in approximately ten years. In the meantime, the study remains open to another 5,000 participants. The larger study population will allow the researchers to address additional questions, including the optimal age at which fallopian tube removal should be performed.
Principal investigator and gynecologic oncologist Joanne de Hullu explains: ‘Because several Dutch hospitals are participating in the study, all women in the Netherlands with a hereditary increased risk of ovarian cancer can take part if they wish.’ Participants are free to choose either the new approach or the standard treatment. ‘That is important,’ Gootzen adds. ‘Every woman weighs the benefits and drawbacks of these options differently. Together with her physician, she can choose the approach that best suits her personal circumstances.’
About the PhD defense
Defense on 27 October 2026, at 16:30h by Tamar Gootzen. Dissertation title: Taking the tube: Improving personalised tubo-ovarian cancer prevention in women with an increased inherited risk (online available after 27 October). Supervisors: Prof. dr. J.A. de Hullu and prof. dr. R.P.M.G. Hermens. Co-supervisors: dr. M.P. Steenbeek and dr. M.M.H.J. van Gelder. The defense can be followed via this livestream.
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