Two years ago, Angelina Jolie shared the story of her preventative double mastectomy.

Now she has written a second story sharing her decision to also remove her ovaries and fallopian tubes.

She was diagnosed with a gene mutation, she writes in an op-ed for The New York Times, which gave her an estimated 87 per cent risk of breast cancer and a 50 percent risk of ovarian cancer.

"I lost my mother, grandmother and aunt to cancer," she says.

"I wanted other women at risk to know about the options. I promised to follow up with any information that could be useful, including about my next preventive surgery, the removal of my ovaries and fallopian tubes."

While she had been planning this second surgery for some time, a set of abnormal blood results two weeks ago scared her into immediate action.

Her doctor told her that a number of inflammatory markers that were elevated may be a sign of early cancer.

"I went through what I imagine thousands of other women have felt," she writes. "I told myself to stay calm, to be strong, and that I had no reason to think I wouldn't live to see my children grow up and to meet my grandchildren.

"I called my husband in France, who was on a plane within hours. The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarising, and it is peaceful.

"That same day I went to see the surgeon, who had treated my mother. I last saw her the day my mother passed away, and she teared up when she saw me: "You look just like her." I broke down. But we smiled at each other and agreed we were there to deal with any problem, so 'let's get on with it'."

She spent five days in a "haze" waiting for her next set of results.

The results for tumours were negative and her CT scans were clear.

"I was full of happiness, although the radioactive tracer meant I couldn't hug my children. There was still a chance of early stage cancer, but that was minor compared with a full-blown tumour," she says.

"To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it."

While she says that there are other possibles avenues, she says she chose surgery because of the combination of the gene mutation and the three family members who had died.

"My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives," Jolie says. "My mother's ovarian cancer was diagnosed when she was 49. I'm 39.

"Last week, I had the procedure: a laparoscopic bilateral salpingo-oophorectomy. There was a small benign tumour on one ovary, but no signs of cancer in any of the tissues."

To keep her hormones balanced, she has had a progesterone IUD inserted.

"It is not possible to remove all risk, and the fact is I remain prone to cancer," says Jolie, who has six children with husband Brad Pitt.

"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, 'Mum died of ovarian cancer'."

The latest surgery means the actress has gone into menopause and will not be able to have more children naturally.

"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," Jolie says.

"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."