Early removal of tubes followed by later removal of ovaries, offers high-risk women a new two-step option of reducing their ovarian cancer risk, whilst avoiding early menopause. Results from a study in high-risk women undergoing surgical prevention in the UK PROTECTOR trial suggests women more concerned about detrimental impact of menopause chose this new two-step operation. Women for whom maximising reduction in cancer risk was more important preferred the standard removal of both tubes and ovaries in one operation. Women managed in specialist settings felt they received better quality care, improved HRT access and were more satisfied. (By Professor Ranjit Manchanda, https://jmg.bmj.com/content/early/2021/02/10/jmedgenet-2020-107501 )