Angelina Jolie has had her ovaries and fallopian tubes removed after routine tests revealed that she was at heightened risk of developing ovarian cancer - the illness her mother died from aged 56.
In a moving article for the New York Times, the 39-year-old actress said she had the surgery last week as preventative measure against the disease.
"My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives," she writes. "My mother’s ovarian cancer was diagnosed when she was 49. I’m 39."
Angelina underwent a double mastectomy two years ago, because she had inherited the faulty BRCA1 gene, which gave her estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.
In the piece published this week, the mum-of-six said she was aware at the time of her mastectomy that she may have to undergo further surgery "but I felt I still had months to make the date".
However two weeks ago, she received a call from her doctor who told her that standard blood tests had revealed "a number of inflammatory markers that are elevated, and taken together they could be a sign of early cancer".
Angelina was hailed for her bravery and frankness when she spoke about her double mastectomy in detail two years ago - and she's taken the same approach now, with an honest and candid account of the surgery process, and how it made her feel.
"I went through what I imagine thousands of other women have felt. 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," the film director and humanitarian worker says.
"I called my husband [Brad Pitt] 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 polarizing, 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.'"
"...Last week, I had the procedure: a laparoscopic bilateral salpingo-oophorectomy. There was a small benign tumor on one ovary, but no signs of cancer in any of the tissues."
Angelina married husband Brad Pitt in an intimate ceremony at their French chateau home last year. The pair have six children together and the Unbroken director previously revealed that her decision to have a mastectomy was influenced by their brood - Maddox, Pax, Shiloh, Zahara and twins Knox and Vivienne.
Two years on, the future of their close-knit family unit has once again motivated her to undergo surgery.
"It is not possible to remove all risk, and the fact is I remain prone to cancer," she says. "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.'"
The actress will now be unable to have more children.
"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," she writes.
But she has words of encouragement for childless women who may find themselves in a similar situation:
"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."
Angelina said she had written about her decision to raise awareness, so that other at-risk women could know more about their options. After she spoke about her double mastectomy in 2013, a UK study revealed National Health Service referrals for genetic testing for breast cancer had more than doubled.
"The Angelina Jolie effect has been long-lasting and global, and appears to have increased referrals to centres appropriately," said a team led by Prof Gareth Evans of the University of Manchester.