In an op-ed in the New York Times, Angelina Jolie Pitt announced that she recently had surgery to remove her ovaries and fallopian tubes. The procedure put her into menopause at age 39, and she will take replacement hormones for another decade or so.
“It is not easy to make these decisions,” she writes. She describes how she felt she “still [had] months to make the date” for her operation as she prepared herself both physically and emotionally to end her reproductive years.
Angelina Jolie: Humanitarian
![FILES-EUROPE-MIGRANTS-UN-US-PEOPLE UNHCR's Goodwill Ambassador Angelina Jolie Pitt greets refugees and migrants during her visit to the port of Piraeus, Greece, March 16, 2016. She urged the international community to respond to Europe's worst refugee crisis since World War II with generosity and not the "politics of fear."](https://api.time.com/wp-content/uploads/2014/06/angelina-jolie-refugee-crisis.jpg?quality=75&w=2400)
![UNHCR special envoy Jolie Pitt shakes hand with Kachin ethnic refugee kid as she visits Eight Miles Palana IDP camp in Myitkyina capital city of Kachin state Angelina Jolie UNHCR Refugees Myanmar](https://api.time.com/wp-content/uploads/2014/06/angelina-jolie-myanmar-01.jpg?quality=75&w=2400)
![UNHCR Special Envoy Angelina Jolie meets displaced Iraqis who are members of the minority Christian community, living in an abandoned school in Al Qosh United Nations High Commissioner for Refugees (UNHCR) Special Envoy Angelina Jolie meets displaced Iraqis who are members of the minority Christian community, living in an abandoned school in Al Qosh, northern Iraq on Jan. 26, 2015.](https://api.time.com/wp-content/uploads/2014/06/angelina-jolie-un-iraq-refugees.jpg?quality=75&w=2400)
![Angelina Jolie, Queen Elizabeth II Actress Angelina Jolie, right, is presented with the Insignia of an Honorary Dame Grand Cross of the Most Distinguished Order of St Michael and St George by Britain's Queen Elizabeth II at Buckingham Palace, London, Oct. 10, 2014.](https://api.time.com/wp-content/uploads/2014/06/angelina-jolie.jpg?quality=75&w=2400)
![UNHCR Special Envoy Angelina Jolie visits Syrian refugees in Malta Angelina Jolie. in her role as the United Nations High Commissioner for Refugees Special Envoy, listening to Maltese military officers discussing rescue at sea operations for refugees at a military base in Valetta, Malta, Sept. 14, 2014.](https://api.time.com/wp-content/uploads/2014/10/angelina-jolie.jpg?quality=75&w=2400)
![Handout photo shows Angelina Jolie, UNHCR special envoy, visiting ethnic Karenni refugee Baw Meh from Myanmar on World Refugee Day, at Ban Mai Nai Soi refugee camp in the province of Mae Hong Son Handout photo shows Angelina Jolie, UNHCR special envoy, visiting ethnic Karenni refugee Baw Meh from Myanmar on World Refugee Day, at Ban Mai Nai Soi refugee camp in the province of Mae Hong Son](https://api.time.com/wp-content/uploads/2014/06/angelina-jolie-humanitarian-un.jpg?quality=75&w=2400)
![Actress and Special Envoy of the United Nations High Commissioner for Refugees, Angelina Jolie, hugs Neema Namadamu of the Democratic Republic of Congo a the 'End Sexual Violence in Conflict' summit in London Actress and Special Envoy of the United Nations High Commissioner for Refugees, Angelina Jolie, hugs Neema Namadamu of the Democratic Republic of Congo a the 'End Sexual Violence in Conflict' summit in London](https://api.time.com/wp-content/uploads/2014/06/rtr3t7xl.jpg?quality=75&w=2400)
![FILE: Actress Angelina Jolie Reveals She Underwent a Preventative Double Mastectomy FILE: Actress Angelina Jolie Reveals She Underwent a Preventative Double Mastectomy](https://api.time.com/wp-content/uploads/2014/06/166301276.jpg?quality=75&w=2400)
![UNHCR Special Envoy Angelina Jolie Visits The Zaatari Refugee Camp In Jordan Angelina Jolie meets with refugees at the Zaatari refugee camp on Dec. 6, 2012 outside of Mafraq, Jordan.](https://api.time.com/wp-content/uploads/2014/06/157759675-copy.jpg?quality=75&w=2400)
![UNHCR Special Envoy Angelina Jolie Visits Ecuador Angelina Jolie walks through the jungle led by Plinio, the President of Providencia community on April 22, 2012 in Ecuador.](https://api.time.com/wp-content/uploads/2014/06/143302540-copy.jpg?quality=75&w=2400)
![Actress and U.N. goodwill ambassador Angelina Jolie was in Libya Angelina Jolie visits Libya to help agencies bringing aid to Libyans in Tripoli and Misrata on Oct. 11, 2011 in Misrata, Libya.](https://api.time.com/wp-content/uploads/2014/06/129039519-copy.jpg?quality=75&w=2400)
![UNHCR Goodwill Ambassador Angelina Jolie speaks during an annual meeting of UNHCR's governing executive committee in Geneva Angelina Jolie speaks during an annual meeting of UNHCR's governing executive committee in Geneva Oct. 4, 2011.](https://api.time.com/wp-content/uploads/2014/06/rtr2s7mb.jpg?quality=75&w=2400)
![UNHCR Goodwill Ambassador Angelina Jolie Visits Displaced People In Afghanistan Angelina Jolie, meets with Khanum Gul, 35, a mother of 8 and her youngest son, Samir at their makeshift home at Tamil Mill Bus site in Kabul city, Afghanistan in Feb. 2011.](https://api.time.com/wp-content/uploads/2014/06/109714137.jpg?quality=75&w=2400)
![Actress Angelina Jolie gestures as she speaks with media during a visit to flood victims at Jalozai relief camp in Pakistan's northwest Khyber-Pakhtunkhwa province Angelina Jolie speaks with media during a visit to the Jalozai flood victim relief camp in Pakistan's northwest Khyber-Pakhtunkhwa province on Sept. 7, 2010.](https://api.time.com/wp-content/uploads/2014/06/rtr2i0qm.jpg?quality=75&w=2400)
![Actress Angelina Jolie visits the Green Zone in Baghdad Actress Angelina Jolie visits the Green Zone in Baghdad Feb. 7, 2008.](https://api.time.com/wp-content/uploads/2014/06/rtr1wsxh.jpg?quality=75&w=2400)
![Actress Angelina Jolie's back is seen as she arrives to attend the premiere of the film "A Mighty Heart" in New York Actress Angelina Jolie's back is seen as she arrives to attend the premiere of the film "A Mighty Heart" in New York, June 13, 2007.](https://api.time.com/wp-content/uploads/2014/06/rtr1qrzi.jpg?quality=75&w=2400)
![The United Nations Association Annual Dinner Angelina Jolie accepts the Global Humanitarian Award at the United Nations Association of the United States of America annual gala dinner at the Waldorf Astoria Hotel Oct. 11, 2005 in New York.](https://api.time.com/wp-content/uploads/2014/06/55900091.jpg?quality=75&w=2400)
![UN Goodwill Ambassador Angelina Jolie Speaks About Refugee Children Angelina Jolie speaks at the National Press Club on March 8, 2005 in Washington DC. Jolie answered questions about her work as the Goodwill Ambassador for the United Nations and her work with refugees and orphans.](https://api.time.com/wp-content/uploads/2014/06/52312139.jpg?quality=75&w=2400)
![North American cinema personality Angeli Angelina Jolie arrives at the El-Geneina airport in West Darfur as the Goodwill Ambassador for the United Nations High Commission for Refugees on Oct. 25 2004.](https://api.time.com/wp-content/uploads/2014/06/51557928-copy.jpg?quality=75&w=2400)
![Angelina Jolie Actress Angelina Jolie visits Bella refugee camp Aug. 22, 2003 in Ingushetia, near the Chechen border in Russia's North Caucasus region.](https://api.time.com/wp-content/uploads/2014/06/2418109.jpg?quality=75&w=2400)
![American actress Angelina Jolie (C) receives gifts American actress Angelina Jolie (C) receives gifts](https://api.time.com/wp-content/uploads/2014/06/519513521.jpg?quality=75&w=2400)
MORE: The Angelina Effect
But cancer experts say that Jolie did the right thing. While her decision to remove both her breasts before she developed breast tumors was controversial, her latest choice to have her ovaries removed is less so, although equally difficult from both an emotional and physical point of view. “This surgery decision is more straightforward than the decision to have the breasts removed,” says Dr. Karen Lu, chair of gynecologic oncology at MD Anderson Cancer Center. “And it’s definitely a stronger recommendation than for the bilateral prophylactic mastectomy.”
For women like Jolie, who harbor either of the BRCA1 or BRCA2 mutations (Jolie is positive for BRCA1), their risk of breast cancer is anywhere from 80% to 90% higher than that of women without the genetic aberrations. But there are ways that doctors can screen for even the smallest tumors in the breast and therefore get a heads up when the cancer is growing. That allows many women to choose to keep their breasts and have a lumpectomy followed by radiation, with more frequent and vigilant screening for any additional or recurrent growths.
There isn’t that luxury with ovarian cancer, which is often caught once the cancer has progressed and is harder to treat. Women with the BRCA mutations have an up to 50% greater chance of developing this type of cancer, and there are no good ways of screening for it; a blood test that picks up a protein common to ovarian tumors isn’t specific to the cancer, so it could provide false positive or false negative results. In most cases, the cancer is well advanced before doctors, or patients, even know it’s there. “It is incurable in most cases for the vast majority of women,” says Lu.
That’s why the National Comprehensive Cancer Network, and the American Congress of Obstetricians and Gynecologists strongly recommend that women with BRCA1 mutations have their ovaries and fallopian tubes removed by age 40, and those with BRCA2 mutations by age 45.
MORE: Angelina Jolie’s Double Mastectomy: What We Know About BRCA Mutations and Breast Cancer
That doesn’t mean it isn’t still a difficult one to make. For women who learn they have a BRCA mutation in their 20s or 30s, for example, and have no history of cancer — yet —they have to decide whether they want to have children at all, or whether they want to continue adding to their family if they already have, or whether they are ready to enter menopause. For such pre-vivors of cancer, who are at higher risk of the disease but haven’t yet developed tumors, the choice between invasive surgery, and a theoretical risk of something occurring in the future, is agonizing.
For them, there may be other options soon. Researchers at MD Anderson, for example, are testing whether women and keep their ovaries for a little longer if they have their fallopian tubes removed first, since there are signs that ovarian cancer may start in the tubes. Jolie writes about promising studies that suggest birth control pills can lower the risk of ovarian cancer in women with BRCA mutations, but the data is still conflicting.
For now, the option that gives women with BRCA their best chance of avoiding ovarian cancer is surgery.”We are absolutely trying to develop medicinal approaches to reducing risk, and understand the disease better,” says Dr. Larry Norton, medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan Kettering Cancer Center. “But right now, as of this minute, there is no medicinal or herbal approach to reduce risk anywhere close to what we can do with surgery.”
“I feel deeply for women for whom this moment comes very early in life, before they have had their children,” Jolie writes. “But it is possible to take control and tackle head-on any health issue. 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.”
MORE: Angelina Jolie’s Double Mastectomy: It’s Not the Only Option
More Must-Reads from TIME
- Welcome to the Noah Lyles Olympics
- Melinda French Gates Is Going It Alone
- What to Do if You Can’t Afford Your Medications
- How to Buy Groceries Without Breaking the Bank
- Sienna Miller Is the Reason to Watch Horizon
- Why So Many Bitcoin Mining Companies Are Pivoting to AI
- The 15 Best Movies to Watch on a Plane
- Want Weekly Recs on What to Watch, Read, and More? Sign Up for Worth Your Time
Contact us at letters@time.com