Angelina Jolie has had her ovaries and fallopian tubes removed as a preventative measure following a cancer scare.
She's written about her decision to have the preventative surgery in a moving and inspirational op-ed in The New York Times because she wants other women at risk to be aware of their options.
This latest surgery comes two years after her mastectomy, which she also wrote about in The New York Times. Angelina carries a mutation in the BRCA1 gene, which gives her an estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer - the same disease that killed her mother.
She explains that her doctor advised her to undergo 'preventive surgery about a decade before the earliest onset of cancer in my female relatives.' Ange adds: 'My mother’s ovarian cancer was diagnosed when she was 49. I’m 39.'
Though Angelina knew she would have the surgery at some point, she thought she would have longer to prepare herself. 'I had been planning this for some time,' she writes. 'It is a less complex surgery than the mastectomy, but its effects are more severe. It puts a woman into forced menopause. So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine, and mapping my hormones for estrogen or progesterone replacement. But I felt I still had months to make the date.
'Then two weeks ago I got a call from my doctor with blood-test results. “Your CA-125 is normal,” he said. I breathed a sigh of relief. That test measures the amount of the protein CA-125 in the blood, and is used to monitor ovarian cancer. I have it every year because of my family history.
'But that wasn’t all. He went on. “There are a number of inflammatory markers that are elevated, and taken together they could be a sign of early cancer.” I took a pause. “CA-125 has a 50 to 75 percent chance of missing ovarian cancer at early stages,” he said. He wanted me to see the surgeon immediately to check my ovaries.'
In the end the PET/CT scan was clear, but because there was still a chance it was early stage cancer she decided to take the option of removing her ovaries and fallopian tubes.
The mother-of-five also revealed that she had decided to keep her uterus, saying: 'I have a little clear patch that contains bio-identical estrogen. A progesterone IUD was inserted in my uterus. It will help me maintain a hormonal balance, but more important it will help prevent uterine cancer. I chose to keep my uterus because cancer in that location is not part of my family history.'
'It is not possible to remove all risk, and the fact is I remain prone to cancer. I will look for natural ways to strengthen my immune system. I feel feminine, and grounded in the choices I am making for myself and my family. I know my children will never have to say, “Mom died of ovarian cancer.”
'Regardless of the hormone replacements I’m taking, I am now in menopause. I will not be able to have any more children, and I expect some physical changes. But I feel at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared.
'I feel deeply for women for whom this moment comes very early in life, before they have had their children. Their situation is far harder than mine. I inquired and found out that there are options for women to remove their fallopian tubes but keep their ovaries, and so retain the ability to bear children and not go into menopause. I hope they can be aware of that.
'It is not easy to make these decisions. But it is possible to take control and tackle head-on any health issue. You can seek advice, learn about the options and make choices that are right for you. Knowledge is power.'