Anna Darelius: To remove or not to remove the fallopian tubes during a hysterectomy - that is the question?
Could removing the fallopian tubes during a hysterectomy lower the risk of developing ovarian cancer later in life? And if so, are there any downsides to removing them? This is what Anna Darelius is exploring in her research. She is also investigating how women who have undergone a hysterectomy weigh the pros and cons of this additional procedure - and what influences their decisions.
ANNA DARELIUS
Dissertation defense: 9 May 2025 (click for details)
Doctoral thesis: The Fallopian tube - to be or not be removed. Opportunistic salpingectomy at benign hysterectomi
Research area: Obstetrics and Gynecology
Sahlgrenska Academy, The Institute of Clinical Sciences
Ovarian cancer is a relatively rare but deadly disease, often diagnosed at a late stage, which contributes to its poor prognosis. It’s not just one disease, but rather a group of subtypes with different characteristics. Since there’s currently no effective screening method, improving both diagnosis and treatment—as well as finding ways to reduce the risk of developing the disease—is critical.
“Traditionally, healthy fallopian tubes were left in place when the uterus was removed due to a benign indication. But research now shows that the most aggressive type of ovarian cancer often starts in the Fallopian tubes. This insight has raised hope that we might prevent ovarian cancer by also removing the Fallopian tubes during a hysterectomy.” Anna Darelius explains, gynecologist and obstetrician at the Sahlgrenska University Hospital, and a doctoral student at the Institute of Clinical Sciences.
However, it’s still unclear whether removing the fallopian tubes increases the risk of surgical complications or affects ovarian function. If ovarian function declines, it could potentially trigger earlier menopause, which could result in increased risk of cardiovascular disease and osteoporosis.
“My research focuses on opportunistic salpingectomy. I’ve examined existing evidence about the potential risks and benefits of removing the fallopian tubes, looked at how different types of gynecological surgeries relate to Type I and Type II ovarian cancer, and studied whether ovarian function is affected when healthy Fallopian tubes are removed during a hysterectomy.”
Through interviews, Anna Darelius has also explored what influences women’s decisions to accept or decline the additional preventive procedure—and how they perceive its possible pros and cons.
Illustration from thesis: The qualitative study on perceptions and experiences of hysterectomized women regarding the decision to remove the fallopian tubes or not during hysterectomy resulted in three categories. By Christine Falk Klein.
Lower risk of a certain type of ovarian cancer
The findings suggest that women who previously had their fallopian tubes removed—typically due to ectopic pregnancy or infection—may have a reduced risk of developing Type II ovarian cancer, which originates in the fallopian tubes.
“And ovarian function doesn’t seem to be significantly affected one year after removing healthy fallopian tubes during a hysterectomy. But we still need longer follow-up studies to assess the long-term effects,” Anna Darelius says.
Personalized information key to informed decisions
The decision to remove or keep the fallopian tubes during a hysterectomy was influenced by several factors, including the woman’s age, personal or family experience with ovarian cancer, and individual health priorities.
“For example, the possibility of lowering ovarian cancer risk was an important motivator for some, but many also feared entering menopause earlier than expected,” she explains.
The study showed that many women felt they did not receive enough information about the pros and cons of the procedure, which made decision-making more difficult.
“Women want to be involved in the decision and are asking for a personalized discussion about the potential risks and benefits of removing healthy fallopian tubes,” says Anna Darelius.
“More research is needed, but these findings could help shape future recommendations on whether or not to remove healthy fallopian tubes during a hysterectomy.”
What has been the most rewarding and challenging part of this PhD project?
“It’s incredibly meaningful and inspiring to conduct research that could directly influence the standard practices concerning hysterectomies. Should we start recommending that women have their fallopian tubes removed during the surgery, or is it better to leave them in place?”
Text: Susanne Lj Westergren