Should I have my ovaries removed when I have a hysterectomy?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

There are many reasons a woman might have surgery to remove her uterus (hysterectomy), including fibroids or uterine bleeding that hasn't responded to other treatments. If you are having a hysterectomy, you may wonder if you should have your ovaries taken out at the same time. Consider the following when making your decision:

• The main reason doctors recommend removing the ovaries is to prevent ovarian cancer.
• It is important to know your risk for cancer when making a decision about whether to have your ovaries removed during your hysterectomy. Your doctor will help you find out your risk by talking to you about your medical history and your family history.
• If you are not at high risk for cancer, having your ovaries removed to prevent cancer is generally not recommended if your ovaries still produce hormones.
• Removing the ovaries may increase your risk of heart disease and osteoporosis.
• If you have your ovaries removed before the age of menopause, you will go into early menopause. This can cause hot flashes and other symptoms.

This Decision Point is for women with no personal or family history of breast or ovarian cancer. If you don't know your risk for breast or ovarian cancer, talk to your doctor. The choices may be different for women at high risk for these cancers. If you are at high risk for breast or ovarian cancer, see:

What should I do if I'm at high risk for breast cancer?

Should I have my ovaries removed to prevent ovarian cancer?

Hysterectomy and oophorectomy are sometimes used as a last-resort treatment for endometriosis. If you are considering the surgery for this reason, see:

Should I have a hysterectomy and oophorectomy to treat endometriosis?

Medical Information

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What is oophorectomy?

Surgery to remove the ovaries is called oophorectomy (say “oh-uh-fuh-REK-tuh-mee”). The ovaries are an important part of the female reproductive system . They store eggs and produce sex hormones, including estrogen.

Of women who have a hysterectomy, about half of them have their ovaries removed at the same time.¹ The main reason doctors recommend removing the ovaries along with the uterus has been to prevent ovarian cancer.

What are the benefits of oophorectomy?

Some experts feel that for women at average risk for ovarian cancer or breast cancer—this means no personal or family history of ovarian or breast cancer—the benefits of keeping the ovaries outweigh the risks. For women at average risk, there seems to be no clear benefit in removing the ovaries at any age. Hysterectomy itself can reduce your risk of ovarian cancer.¹

If you have severe premenstrual syndrome (PMS), oophorectomy will stop the hormone changes caused by your ovaries. This may help you feel better.

Oophorectomy is sometimes recommended when the hormones produced by the ovaries are making a disease such as breast cancer or severe endometriosis worse.

If you are at high risk for breast or ovarian cancer, having your ovaries removed can greatly lower your risk. Women at high risk for these cancers include those who:

• Inherited a BRCA gene change (BRCA stands for BReast CAncer).
• Have a family history of ovarian cancer before age 50.
• Have a type of breast cancer that is affected by estrogen. (Estrogen is made by the ovaries.)

To learn more about your choices if you are at high risk for breast or ovarian cancer, see:

What should I do if I'm at high risk for breast cancer?

Should I have my ovaries removed to prevent ovarian cancer?

If you don't know whether you are at high risk for breast or ovarian cancer, talk to your doctor. If your doctor feels you could be at risk, you may want to think about gene testing. For more information, see:

Should I have a gene test for breast and ovarian cancer?

What are the risks of oophorectomy?

An important long-term issue to consider is your body's early drop in estrogen after an oophorectomy. Without estrogen, you have difficult menopausal symptoms and your bones begin to thin. This increases your risk of osteoporosis in later life.

Having your ovaries removed before age 65 may increase your chance of getting:¹

• Osteoporosis, which can lead to broken bones. Hip fractures are a well-known cause of disability and death in older women.
• Heart disease, which is the number one cause of death in women in the United States.

Women who choose oophorectomy can take estrogen replacement therapy. This treatment does not prevent heart disease, but it may reduce the risk of osteoporosis. If a woman already has bone loss, other medicines can help protect her bones.

If you have your ovaries removed before the age of menopause, you will go into early menopause. This can cause hot flashes and other unpleasant symptoms.

Most women do not have problems after hysterectomy and oophorectomy, but any surgery has risks. The most common problems are:

• Fever. A slight fever is common after any surgery.
• Trouble urinating or loss of bladder control.
• Heavy vaginal bleeding. You can expect some vaginal bleeding for 4 to 6 weeks after a hysterectomy.
• Scar tissue (adhesions) in the pelvic area.

For more information, see the topic Hysterectomy.

Your Information

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Your choices are:

• Have your uterus removed, but keep your ovaries (hysterectomy only).
• Have both your uterus and your ovaries removed (hysterectomy with oophorectomy).

The decision whether to have your ovaries removed when you have a hysterectomy takes into account your personal feelings and the medical facts.

Deciding about having an oophorectomy with a hysterectomy

Reasons to have your ovaries removed

Reasons to keep your ovaries

You have been tested and know you have a BRCA gene change. You have a strong family history of early ovarian cancer. You have a type of breast cancer that estrogen causes to grow. You have severe PMS that could be helped by having your ovaries removed. You have had pelvic pain that involved your ovaries. Are there other reasons you might want to have your ovaries removed?

You are at higher risk for heart disease or osteoporosis than for breast or ovarian cancer. You don't have breast cancer or a family history of ovarian or breast cancer. You are at average risk for breast and ovarian cancer. You are near menopause (around age 50). When menopause is complete, PMS symptoms usually go away. The risks of heart disease and osteoporosis that come with having your ovaries removed outweigh the short-term benefit of stopping PMS or pelvic pain. Are there other reasons you might want to keep your ovaries?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having your ovaries removed when you have a hysterectomy. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have been tested, and I have a BRCA gene change.	Yes	No	NA*
I have a strong family history of osteoporosis, which puts me at high risk if my ovaries are removed early.	Yes	No	Unsure
I have breast cancer.	Yes	No	NA
There is a lot of heart disease in my family but no breast or ovarian cancer.	Yes	No	Unsure
I will worry less about cancer if I have my ovaries taken out.	Yes	No	Unsure
I want to keep my ovaries so I don't suddenly go into menopause.	Yes	No	Unsure
My mother had breast cancer, so I will do anything to lower my risk.	Yes	No	NA
Keeping my ovaries might lower my risk of heart disease and osteoporosis.	Yes	No	Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to remove or keep your ovaries when you have a hysterectomy.

Check the box below that represents your overall impression about your decision.

Leaning toward having my ovaries removed

Leaning toward keeping my ovaries

Return to the topic:

• Hysterectomy
• Oophorectomy

References

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Citations

1. Parker WH, et al. (2005). Ovarian conservation at the time of hysterectomy for benign disease. Obstetrics and Gynecology, 106(2): 219–226.

Other Works Consulted

• Eisen A, et al. (2005). Breast cancer risk following bilateral oophorectomy in BRCA1 and BRCA2 mutation carriers: An international case-control study. Journal of Clinical Oncology, 23(30): 7491–7496.

• Finch A, et al. (2006). Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation. JAMA, 296(2): 185–192.

Credits

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Author	Sandy Jocoy, RN
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer	Kirtly Jones, MD - Obstetrics and Gynecology
Last Updated	August 12, 2008