Study questions ovary removal during hysterectomy

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Study questions ovary removal during hysterectomy

Every year, an estimated 600,000 women have hysterectomies, mostly for noncancerous conditions such as fibroids, endometriosis, and uterine prolapse. About half have their ovaries removed at the same time (a procedure called oophorectomy). The main reason for doing so is to reduce the chances of getting ovarian cancer. But this form of cancer is relatively uncommon. The average woman's lifetime risk is less than 2%, though risk does rise with age.

Most physicians recommend oophorectomy for all postmenopausal women undergoing hysterectomy, evidently assuming that once her reproductive years are over, her ovaries will likely do more harm than good. But one study has challenged this assumption, suggesting that women generally derive no survival advantage from having their ovaries removed and, if they undergo oophorectomy before age 65, may actually be at greater risk for certain health problems.

The study, in Obstetrics and Gynecology (August 2005), was designed to evaluate the risks and benefits of oophorectomy among women at average risk for ovarian cancer who had hysterectomies for noncancerous conditions. (The study did not address women at increased risk for ovarian cancer.) Using data from various long-term studies, including the Nurses' Health Study and the Women's Health Initiative, researchers at the University of California, Los Angeles, and the University of Southern California created an analytical model of the surgery's effects.

They concluded that for women under age 65, removing the ovaries increased the likelihood of heart disease (the most common cause of death in women) and hip fractures. Risk of premature death also rose: For women between 50 and 54, oophorectomy was associated with a 9% increase in the likelihood of dying before 80. Taking estrogen following oophorectomy (often recommended for women whose ovaries are removed before menopause) lowered these risks somewhat, but not as much as hysterectomy alone, with or without estrogen therapy.

What does it mean? This study was not prospective — that is, it didn't gather its data by following women, over time, who underwent these procedures. Nevertheless, it's a first attempt to evaluate oophorectomy. Although the official position of the American College of Obstetricians and Gynecologists is that the decision should be individualized, oophorectomy after age 55 continues to be routinely performed. In fact, almost 80% of women in the United States ages 45–64 who undergo hysterectomy also have their ovaries removed.

Critics of this practice contend that ovarian hormones, even in the small amounts produced after menopause, are important. The new study, while not definitive, supports this view. More research is clearly needed, but in the meantime, women and their physicians have a lot more to consider in reviewing the pros and cons of removing the ovaries during hysterectomy.

Last updated:	September 05, 2008