ACOG Strengthens Ovarian Cancer Prevention Guidance: Why Removing the Fallopian Tubes During Gynecologic Surgery May Reduce Risk

Ovarian cancer remains one of the most serious cancers affecting women, in large part because it is often diagnosed after it has already spread within the abdomen. Unlike cervical cancer, there is currently no effective population screening test that reliably finds ovarian cancer early. In 2026, an estimated 20,890 ovarian cancer cases and 12,730 deaths were expected in the United States.

That reality makes prevention especially important.

New guidance from the American College of Obstetricians and Gynecologists, or ACOG, has strengthened recommendations regarding bilateral salpingectomy, the surgical removal of both fallopian tubes, as a strategy to reduce ovarian cancer risk in women at average risk who are already undergoing certain gynecologic or abdominal procedures.

At Complete Healthcare in Richland, Washington, this is an important development because it directly affects conversations we have with patients considering hysterectomy, permanent contraception, and other gynecologic surgery.

Richard Lorenzo, D.O., is a dual board-certified obstetrician-gynecologist with extensive experience in gynecologic surgery, including hysterectomy and minimally invasive procedures. Kortney Jones, ARNP, works closely with patients in women’s health, hormone management, preventive care, and preoperative counseling. Together, our goal is to help patients understand not only what surgery treats today, but how the right surgical plan may also reduce future health risks.

What Changed in the ACOG Guidance?

The major change is the strength of the recommendation. ACOG’s previous guidance from 2019 advised physicians to discuss whether patients should consider removal of the fallopian tubes during hysterectomy.

The updated guidance is stronger. For average-risk patients undergoing hysterectomy who have completed childbearing, ACOG now advises clinicians to routinely perform bilateral salpingectomy when appropriate.

This change reflects growing evidence that removal of the fallopian tubes may substantially reduce the later development of ovarian cancer.

Importantly, this recommendation applies to women at average ovarian cancer risk. Patients with BRCA mutations, strong family histories of ovarian cancer, or other hereditary cancer syndromes require a different risk-reduction strategy and individualized genetic counseling.

Why Would Removing the Fallopian Tubes Reduce Ovarian Cancer Risk?

For decades, ovarian cancer was thought to arise primarily from the ovary itself. Research has changed that understanding.

Many of the most dangerous ovarian cancers, particularly high-grade serous cancers, appear to originate in the distal fallopian tube before spreading to the ovary and abdominal cavity. This discovery created an opportunity for prevention: remove the tubes while preserving the ovaries.

That distinction matters. Removing the ovaries before natural menopause causes an immediate loss of ovarian hormone production and can lead to premature surgical menopause. Removing the fallopian tubes alone does not intentionally remove ovarian hormone function.

This is why opportunistic salpingectomy has become such an important prevention strategy. The term simply means removing the fallopian tubes during another surgery that is already medically indicated.

How Much Can Salpingectomy Reduce Ovarian Cancer Risk?

The evidence is increasingly compelling. A 2016 meta-analysis involving 3,509 patients who underwent salpingectomy and more than 5.6 million controls found an approximately 49% reduction in ovarian cancer risk, with an odds ratio of 0.51. A similar analysis in 2025 supported those findings, while other observational studies cited in the updated discussion have reported risk reductions as high as 78%.

These numbers should be interpreted correctly. Salpingectomy reduces ovarian cancer risk. It does not completely eliminate it because not every ovarian cancer originates in the fallopian tubes.

Even so, a potential reduction approaching 50% or more represents a meaningful preventive opportunity in a disease for which effective screening remains unavailable.

What Does This Mean for Women Having a Hysterectomy?

This is probably the most immediate implication of the new guidance. If a patient is already undergoing hysterectomy and does not desire future fertility, removal of both fallopian tubes can often be performed during the same operation. The ovaries can usually remain in place.

For many premenopausal patients, this allows the surgeon to reduce ovarian cancer risk while preserving natural ovarian hormone production.

At Complete Healthcare, this type of planning is especially relevant when hysterectomy is being performed for conditions such as:

• Fibroids

• Adenomyosis

• Heavy or abnormal uterine bleeding

• Chronic pelvic pain

• Other benign gynecologic conditions

The discussion should occur before surgery so the patient understands the purpose, benefits, limitations, and alternatives.

Salpingectomy vs Tubal Ligation for Permanent Birth Control

The updated guidance also has implications for permanent contraception. For patients who are certain they have completed childbearing and desire surgical sterilization, ACOG now identifies complete bilateral salpingectomy as the preferred tubal procedure rather than traditional tubal ligation or partial salpingectomy.

Traditional tubal ligation blocks or divides the tubes but leaves much of the fallopian tube tissue in place. Complete salpingectomy removes the tubes themselves.

This provides permanent contraception while also offering greater potential ovarian cancer risk reduction because the fimbrial portion of the tube, where many high-grade serous cancers are believed to originate, is removed. For the right patient, that creates a dual benefit: permanent birth control and cancer-risk reduction.

What About Other Gynecologic Surgeries?

The updated guidance goes further than hysterectomy. ACOG now recommends that complete salpingectomy be discussed with patients undergoing other gynecologic surgery that enters the abdominal or pelvic cavity when future fertility is not desired.

Depending on the clinical situation, this may include surgery for ovarian cysts, endometriosis, or other pelvic conditions. This does not mean every woman undergoing surgery automatically needs her fallopian tubes removed. Shared decision-making remains essential.

The key question is whether the patient is already undergoing a procedure where the tubes can be safely removed without meaningfully increasing surgical risk.

Does Removing the Tubes Increase Surgical Risk?

According to the updated discussion, adding salpingectomy to an otherwise planned pelvic operation is estimated to add approximately 12 to 16 minutes to the procedure and has not been shown to significantly alter the established operative or preoperative risks of the underlying surgery.

There is, however, an important technical consideration. The fallopian tubes and ovaries share portions of their blood supply. Surgeons must carefully remove the tubes while preserving ovarian circulation.

Existing studies suggest ovarian hormone levels return to normal following opportunistic salpingectomy and that the procedure does not appear to cause immediate premature menopause. However, longer-term data are still being collected to determine whether there could be a small effect on the timing of natural menopause later in life. That is an important example of where current evidence is reassuring but not absolutely complete.

Should Women Have Salpingectomy as a Standalone Preventive Surgery?

For most average-risk women, this is not currently the recommendation. The strongest evidence supports removing the tubes when another abdominal or gynecologic surgery is already planned.

The updated review specifically notes that more research is needed to define the benefits and risks of performing salpingectomy purely as a standalone ovarian cancer prevention procedure in average-risk patients. The risk-benefit equation changes when a patient would otherwise not need surgery at all.

What About Women at High Genetic Risk?

This updated recommendation should not be confused with the management of women carrying BRCA1, BRCA2, or other hereditary ovarian cancer mutations.

Those patients may require different preventive strategies, often involving removal of both fallopian tubes and ovaries at an age determined by the specific mutation and family history. Women with a significant family history of ovarian, breast, pancreatic, or related cancers should discuss whether genetic counseling or testing is appropriate.

Why This Matters for Complete Healthcare Patients

This guidance is especially relevant to a gynecologic practice because ovarian cancer prevention opportunities often arise during surgeries being performed for completely different reasons.

A patient may be planning a hysterectomy because of fibroids or heavy bleeding. Another may want permanent contraception. Another may need pelvic surgery for an ovarian cyst. Historically, the fallopian tubes might have simply been left in place unless there was a specific reason to remove them.

The evolving evidence suggests we should now ask a different question: If a woman has completed childbearing and is already undergoing pelvic surgery, is there a good reason not to remove the fallopian tubes? That is the conversation ACOG is encouraging gynecologists to have more routinely.

Why Patients Choose Complete Healthcare

Complete Healthcare provides both diagnostic gynecology and advanced surgical care, allowing patients to move from evaluation through treatment within one coordinated practice.

Richard Lorenzo, D.O., is a dual board-certified obstetrician-gynecologist with extensive operative experience in hysterectomy, ovarian surgery, and other complex gynecologic procedures. His surgical background allows cancer-prevention strategies such as opportunistic salpingectomy to be considered in the broader context of the patient’s anatomy, diagnosis, fertility goals, and hormone health.

Kortney Jones, ARNP, provides women’s health and hormone-focused care and works closely with patients before and after treatment to ensure they understand their options and long-term health implications.

For patients in Richland, Kennewick, Pasco, and throughout the Tri-Cities, our goal is not simply to perform a procedure. It is to use every appropriate opportunity to improve long-term women’s health.

Final Thoughts

The updated ACOG guidance represents an important change in ovarian cancer prevention.

For average-risk women who have completed childbearing and are already undergoing hysterectomy or another appropriate pelvic procedure, complete bilateral salpingectomy may substantially reduce future ovarian cancer risk while preserving the ovaries and avoiding immediate surgical menopause.

The available evidence suggests ovarian cancer risk may be reduced by approximately 50%, with some studies suggesting an even greater reduction. The procedure adds relatively little operative time when performed during an already planned surgery, and current evidence is reassuring regarding short-term ovarian hormone function.

The important message is not that every woman needs surgery. It is that women who are already having appropriate gynecologic surgery should understand that removal of the fallopian tubes may offer an additional opportunity to reduce one of the most difficult gynecologic cancers to detect early.

That conversation should occur before surgery, with the decision based on each patient’s fertility plans, medical history, values, and long-term health goals.

Complete Healthcare – Obstetrics and Gynecology

509-392-6700

Richard Lorenzo, D.O.

Kortney Jones ARNP