Angelina Jolie penned an op-ed to share with other women what went into her decision to have her ovaries and fallopian tubes removed to prevent the risk of ovarian cancer.

Angelina Jolie’s Surgery

“Two years ago I wrote about my choice to have a preventive double mastectomy. A simple blood test had revealed that I carried a mutation in the BRCA1 gene. It gave me an estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer,” Jolie began her essay for The New York Times. “I lost my mother, grandmother and aunt to cancer.”

As with her last essay detailing her decision to undergo the double mastectomy, Jolie wrote this latest essay about removing her ovaries and fallopian tubes to provide insight into the difficult decision, particularly for those out there who, like her, may have an increased risk of cancer. One of the effects of her decision, Jolie notes, is forced menopause.

“It is a less complex surgery than the mastectomy, but its effects are more severe. It puts a woman into forced menopause,” the actress and director wrote. “So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine, and mapping my hormones for estrogen or progesterone replacement.”

Jolie was careful to note that her decision is not one that will be right for everyone, and detailed other routes women could take. However, for her, a 39-year-old who has seen multiple female relatives succumb to cancer, doctors agreed it was her best option.

“I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery. I have spoken to many doctors, surgeons and naturopaths. There are other options,” Jolie wrote. “Some women take birth control pills or rely on alternative medicines combined with frequent checks. There is more than one way to deal with any health issue.”

“In my case, the Eastern and Western doctors I met agreed that surgery to remove my tubes and ovaries was the best option, because on top of the BRCA gene, three women in my family have died from cancer,” she added. “My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives. My mother’s ovarian cancer was diagnosed when she was 49. I’m 39.”

As a mother to six children, being around for them as long as possible is a primary concern. Though Jolie knows that she can’t eliminate all risk, she plans to do what she can to lessen it.

“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,” Jolie said. “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.”