Recently our team had the opportunity to attend the AAGL conference in Vancouver, an annual gathering focused on advancing minimally invasive GYN surgery. One session that stood out was a thoughtful debate on whether to preserve or remove ovaries in patients under 45 who are undergoing surgery for deep endometriosis. After hearing the discussion, the argument for keeping the ovaries—in most cases—was the clear and compelling winner. As presenter Dr. Sarah Maheux-Lacroix from Quebec, Canada powerfully said, we should be “waging war on endometriosis, not on the ovaries.”

A key point emphasized during the session was that hormone replacement therapy (HRT) does not fully compensate for the body’s natural hormone production. Even when HRT is prescribed after oophorectomy, the risks associated with early loss of ovarian hormones—particularly related to heart health—remain elevated. This is especially important for patients in their 20s and 30s, whose bodies still rely heavily on the protective effects of estrogen. The take-home message was clear: removing the ovaries should never be used as a substitute for thoroughly removing endometriosis.

Of course, the speaker acknowledged that while ovary  reservation is generally preferred, there are situations where removal may still be appropriate. For example, a strong family history of ovarian cancer or repeated surgeries on the same ovary may shift the balance toward recommending oophorectomy on one side. These scenarios require thoughtful, personalized discussion.

At Pacific Endometriosis and Pelvic Surgery in Gig Harbor, WA, our general approach is to preserve the ovaries whenever safely possible for premenopausal patients. We believe that expert excision of endometriosis—not hormone deprivation—is the cornerstone of treating the disease and the best chances at long-term pain relief. That said, every patient’s situation is unique, and we take time to review options and individualize recommendations with each person we care for.