Ovarian Cancer Risk Reduction: What to Know About Opportunistic Salpingectomy

Toni Hodges-Wills • September 1, 2026

Ovarian Cancer Risk Reduction: What to Know About Opportunistic Salpingectomy

Ovarian cancer causes more deaths than any other cancer of the female reproductive system, and it rarely announces itself early. At Evolve Gynecology in Las Vegas, one of the most useful conversations we have with patients isn't about a scan or a blood test; it's about a fairly simple surgical decision that a growing body of research says can meaningfully lower risk: opportunistic salpingectomy.

If you're not familiar with that term, you're not alone. It's a newer concept even among longtime gynecology patients, and the American College of Obstetricians and Gynecologists (ACOG) has spent the past several years refining its guidance on it. Here's what the evidence actually shows, who it applies to, and what questions to bring to your own gynecologist.

The Symptoms Most Women Miss

Ovarian cancer will be diagnosed in an estimated 21,010 women across the United States this year, and about 12,450 women will die from it, according to the American Cancer Society's most recent statistics. It's the fifth leading cause of cancer death among women and the deadliest cancer of the reproductive organs; a woman's lifetime risk of developing it is roughly 1 in 91.

Part of what makes it dangerous is how ordinary it feels at first. The symptoms most closely tied to ovarian cancer are bloating, pelvic or abdominal pain, feeling full quickly or having trouble eating, and urinary urgency or frequency. Every one of those can just as easily mean you ate too much at dinner or you're fighting a bladder infection. What separates a red flag from a bad week is the pattern: symptoms that are new for you, that stick around, and that show up more than twelve times a month deserve a call to your gynecologist.

If you're not sure whether what you're feeling counts, that's exactly the kind of question worth bringing to your next well-woman exam instead of sitting on it until next year's visit.

Why There's No Ovarian Cancer Equivalent of a Pap Smear

A lot of patients assume their annual Pap smear covers this. It doesn't: a Pap smear screens for cervical cancer and HPV, not ovarian cancer, and there is currently no reliable screening test that catches ovarian cancer early in women who have no symptoms and no known elevated risk. The CA-125 blood test and transvaginal ultrasound exist and are useful once ovarian cancer is already suspected, but neither has been shown to reduce deaths when used as routine screening in the general population. They tend to produce enough false positives to send healthy women into surgery they didn't need.

That gap is exactly why the stage at diagnosis changes everything. Ovarian cancer caught while still confined to the ovary has a five-year survival rate above 90%. Once it has spread beyond the pelvis, that number falls to roughly 30%. Symptom awareness and honest conversations with your gynecologist are doing a lot of the work a screening test can't.

Who's at Higher Risk, and What Actually Lowers It

Age is the biggest factor: ovarian cancer mainly affects women after menopause, and more than half of diagnoses happen at 63 or older. Family history raises risk substantially, especially with a BRCA1 or BRCA2 mutation or Lynch syndrome; both call for genetic counseling rather than a generic recommendation. Endometriosis, infertility, and never having carried a pregnancy are also associated with higher risk.

Some things measurably lower it, too. Oral contraceptive use is one of the most consistent protective factors in the research, with risk dropping the longer someone has used it; pregnancy and breastfeeding lower risk as well. And there's a third strategy that's gotten far more attention from ACOG over the past several years: removing the fallopian tubes during a surgery you're already having, for an entirely different reason.

Opportunistic Salpingectomy: The ACOG-Backed Strategy Worth Knowing About

For decades, ovarian cancer prevention research focused on the ovaries themselves. Then pathologists started finding the earliest cell changes for the most common and lethal type of ovarian cancer, high-grade serous carcinoma, not in the ovary, but in the fringed end of the fallopian tube. That single finding reshaped how gynecologic surgeons think about prevention.

Opportunistic salpingectomy means removing both fallopian tubes, and leaving the ovaries in place, during a pelvic surgery a woman is already having for another reason: most often a hysterectomy for benign conditions like fibroids, or as an alternative to traditional tubal ligation for permanent birth control. In 2019, ACOG formalized its support for this approach in Committee Opinion No. 774, recommending that obstetrician-gynecologists discuss the option with any woman who has completed childbearing and is already undergoing pelvic surgery.

The safety data is reassuring. Adding a salpingectomy to a planned hysterectomy or sterilization procedure doesn't increase the risk of complications like infection, blood transfusion, or hospital readmission, and it doesn't change which surgical approach your surgeon plans to use. Because the ovaries themselves stay in place, hormone production continues as it normally would: this isn't the same as removing the ovaries, and it doesn't cause surgical menopause. Follow-up studies measuring ovarian function years after the procedure haven't found a meaningful difference compared with women who didn't have it done.

The risk reduction itself is significant, if not absolute. ACOG cites a Swedish study showing a 65% drop in ovarian cancer risk among women who had both tubes removed. More recent research, including a large 2026 study published in JAMA Network Open, found the risk of serous ovarian cancer specifically, the most common and lethal form, dropped by 78% among women who'd had an opportunistic salpingectomy. It's not a guarantee: ACOG is clear that this strategy lowers risk substantially without eliminating it. But for a procedure that adds minimal time to a surgery already on the schedule, that's a real trade-off in your favor.

This is different from a bilateral salpingo-oophorectomy, which removes the ovaries as well as the tubes and offers even greater protection. Because it also ends ovarian hormone production, it induces surgical menopause and carries its own tradeoffs around bone health, cardiovascular risk, and menopausal symptoms. ACOG treats that as a separate, more individualized conversation, generally reserved for women whose personal or family history, such as BRCA1/2, Lynch syndrome, or a strong family pattern of ovarian or breast cancer, puts them at significantly higher risk. If that describes you, genetic counseling is the right next step before any surgical decision gets made.

Bringing This Up With Your Gynecologist

If you have a hysterectomy or a permanent sterilization procedure on the calendar and you're finished building your family, opportunistic salpingectomy is worth raising before surgery. It's a short conversation that can change what happens on the operating table, and ACOG's position is that every eligible woman deserves the chance to have it.

Dr. Toni Hodges-Wills and the team at Evolve work with a trusted network of gynecologic surgeons and specialists across Las Vegas. A large part of what happens at a concierge visit is exactly this: sitting down with your personal risk picture, family history, genetics, prior diagnoses, and making sure the right questions get asked before any procedure, whether it happens in our office or with a surgical colleague we coordinate with directly.

If ovarian cancer risk is something you've been meaning to ask about, schedule a visit and bring your questions. It's exactly the kind of unhurried conversation concierge care was built to make room for.

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Am I in Perimenopause? Early Signs, What to Expect, and When to Talk to Your Gynecologist

By Toni Hodges-Wills • October 6, 2026

Something feels off, but you can’t quite name it. Your period showed up a week early. Or a week late. You’re waking up at 3 a.m. drenched in sweat. Your mood shifts feel bigger than they used to. You’re 38, or 42, or 46, and you’re quietly Googling: am I in perimenopause? You probably are. And you’re not alone. Most women experience perimenopause symptoms for years before their periods actually stop, often starting in their late 30s or early 40s. The problem is that many women don’t recognize what’s happening, because perimenopause doesn’t always look the way you’d expect. At Evolve Gynecology in Las Vegas, NV, Dr. Toni Hodges-Wills, DO, FACOG, MSCP is a board-certified gynecologist and Menopause Society Certified Practitioner who helps women navigate this transition with clarity, evidence-based guidance, and the kind of time that a concierge practice actually allows. What Is Perimenopause, Exactly? Perimenopause is the transition period leading up to menopause. Menopause itself is defined as 12 consecutive months without a menstrual period; perimenopause is everything that happens before that line is crossed. During this phase, your ovaries gradually produce less estrogen and progesterone, and those hormonal fluctuations are what drive the symptoms you’re feeling. The transition can last anywhere from a few years to more than a decade. Most women reach menopause around age 52, but perimenopause commonly begins in the early to mid-40s . For some women, subtle changes start in their late 30s. This is one of the most misunderstood phases in women’s health. Because the symptoms overlap with stress, sleep disorders, thyroid problems, and other conditions, perimenopause often goes unrecognized or gets dismissed. A gynecologist with specific training in menopause care can make the difference between years of confusion and a clear path forward. Early Signs of Perimenopause Perimenopause doesn’t announce itself with a single, unmistakable symptom. It tends to arrive gradually, and many women spend months or years attributing what they’re experiencing to stress, aging, or simply “not sleeping well.” Here are the symptoms that bring women into our office most often: Changes to Your Menstrual Cycle This is usually the first sign. Your cycles may become shorter, longer, heavier, lighter, or simply less predictable than they used to be. You might skip a month entirely and then have two periods close together. Irregular bleeding is common, though any significant changes in menstrual bleeding should be discussed with your gynecologist to rule out other causes. Hot Flashes and Night Sweats Vasomotor symptoms, the clinical term for hot flashes and night sweats , affect roughly 60% of women around the menopause transition. They can start well before your periods stop. Night sweats in particular tend to disrupt sleep, which then cascades into daytime fatigue, difficulty concentrating, and mood changes. In Las Vegas, where summer temperatures regularly exceed 110°F, these symptoms can feel especially intense. Sleep Disruption Waking up in the middle of the night and struggling to fall back asleep is one of the most common complaints we hear. Sometimes it’s triggered by night sweats; sometimes it happens on its own. Hormonal shifts affect the brain’s sleep regulation, and the resulting fatigue compounds nearly every other symptom. Mood Changes and Brain Fog Irritability, anxiety, low mood, difficulty focusing, forgetting words mid-sentence: these are real, physiological effects of fluctuating estrogen levels. They are not a character flaw, and they are not “just stress.” Many women tell us they feel relieved simply hearing that their experience has a biological explanation. Other Common Symptoms Perimenopause can also involve: Vaginal dryness or discomfort during intercourse Decreased libido Joint stiffness or increased aches Changes in skin and hair texture Weight changes, particularly around the midsection Urinary urgency or increased frequency Headaches or migraines that worsen around your cycle Not every woman will experience all of these, and severity varies widely. That’s one reason a personalized evaluation matters more than a checklist. When Should You Talk to Your Gynecologist About Perimenopause? The short answer: whenever you have questions. There is no minimum symptom threshold you need to meet before the conversation is worth having. Your annual well-woman exam is also a natural time to bring this up. That said, certain situations warrant a visit sooner rather than later: Your periods have become significantly heavier, more painful, or much more irregular Hot flashes or night sweats are disrupting your sleep or daily life You’re experiencing mood changes that feel out of proportion or hard to manage You’re under 40 and noticing symptoms that suggest hormonal changes You want to understand your options for managing symptoms, including menopause hormone therapy You’re unsure whether what you’re experiencing is perimenopause or something else A gynecologist trained in menopause care can evaluate your symptoms in context, order labs if clinically indicated, and help you build a plan. Perimenopause is not a diagnosis that requires a specific test; it’s a clinical assessment based on your symptoms, age, and medical history. Why Your Choice of Provider Matters Here’s something that surprises most women: menopause education is not a significant part of standard OB/GYN residency training. A 2023 survey found that the average medical resident receives fewer than five hours of menopause-specific instruction across their entire training. That means the provider you choose matters more than you might think. Dr. Hodges holds the Menopause Society Certified Practitioner (MSCP) credential, which requires demonstrated competency in menopause medicine, including evidence-based menopause hormone therapy, non-hormonal management options, and long-term health considerations for women in midlife. This credential matters because it means your care is guided by current research, not outdated assumptions about what women should “just live with.” At Evolve Gynecology, perimenopause conversations aren’t squeezed into a 10-minute insurance visit. As a concierge gynecology practice , appointments are 30 to 60 minutes long, giving you the time to discuss your symptoms thoroughly, ask questions, and make decisions together with your provider. That’s the kind of care this phase of life deserves. What Can Be Done About Perimenopause Symptoms? A lot, actually. The idea that women need to simply endure perimenopause is outdated and, frankly, wrong. Treatment options depend on your specific symptoms, health history, and preferences. At Evolve Gynecology, Dr. Hodges works with each patient to develop a plan that may include: Menopause hormone therapy (formerly called hormone replacement therapy, or HRT): FDA-approved options to address hot flashes, night sweats, vaginal dryness, and other estrogen-related symptoms. For most women in perimenopause and early menopause, the benefits outweigh the risks. Non-hormonal medications: For women who cannot or prefer not to use hormones, there are effective prescription alternatives for managing vasomotor symptoms, mood changes, and sleep disruption. Lifestyle modifications: Targeted guidance on nutrition, exercise, sleep hygiene, and stress management that can meaningfully reduce symptom severity. Ongoing monitoring: Regular follow-up to assess how your body is responding, adjust treatment as needed, and address new symptoms as they arise. The goal is not to eliminate every symptom; it’s to help you feel like yourself again and make informed decisions about your health during a time when your body is changing. Perimenopause Care at Evolve Gynecology in Las Vegas Evolve Gynecology is located at 851 S. Rampart Blvd., Suite 260, Las Vegas, NV 89145 , serving women throughout the Las Vegas Valley, including Summerlin, Sun City, Spring Valley, Paradise, Henderson, and surrounding communities. The practice offers concierge gynecology memberships with longer visits, priority scheduling, and direct access to Dr. Hodges. If you’re wondering whether what you’re experiencing is perimenopause, you don’t have to figure it out alone. A single conversation with a provider who understands this transition can change how you feel about what’s happening in your body. To learn more about membership options or to schedule a visit , go to https://www.evolvegynecology.com/concierge , or call 702-813-7200 . Evolve Gynecology | 851 S. Rampart Blvd. #260, Las Vegas, NV 89145 | 702-813-7200 | www.evolvegynecology.com

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Ovarian Cancer Risk Reduction: What to Know About Opportunistic Salpingectomy