Many women falsely believe that a total hysterectomy implies that their
ovaries will be removed during the procedure. Up until recently it was common
practice to prophylactically remove ovaries to decrease the risk of ovarian
cancer concurrent with hysterectomy for benign disease in women beyond
45 years of age. A recent study looked at maximizing survival demonstrated
that ovarian conservation should be practiced until at least age 65. Interestingly
women who had their ovaries removed were more likely to succumb to coronary
heart disease, or hip fracture, especially if they did not receive estrogen
afterwards to compensate for it being lost with this surgery. Unnecessary
fears can be alleviated by clarifying that for benign uterine disease
(eg. Fibroids) only the uterus needs to be removed, and the ovaries will
be spared. They will continue to function producing female hormones until
they cease at their biologically programmed age of menopause (average
age ~51). Consequently, following hysterectomy most women appreciate the
benefits, primarily relief from their problem periods, yet maintain their
desired feminine characteristics.
However, recommendations differ for women at increased risk for ovarian
cancer. In women carrying breast cancer genes, known as BRCA, multiple
studies have demonstrated that prophylactic removal of the fallopian tubes
and ovaries improves overall survival as well as reducing cancer specific
mortality due to both breast and ovarian malignancies. An 80% reduction
in cancer risk in a recent major study makes compelling evidence to offer
this intervention to at risk women once they have completed childbearing.
A different study reassures us that offering estrogen short term to these
women after their surgery alleviates distressing premature menopause symptoms
like hot flashes, night sweats, and vaginal dryness, without compromising
the reduction in risk of developing breast cancer. In most cases, this
operation can be accomplished via outpatient, minimally invasive laparoscopy,
which results in less pain and allows most women to return to regular
activities within one week.
So if you are at average risk for breast or ovarian cancer then hold on
to your ovaries. If you have a mother or sister with breast cancer, then
suggest to them to get BRCA tests. If your family member is a BRCA carrier
then you should also be tested. If you are negative then be reassured
you are at average risk. However if you are a BRCA carrier then you should
consider prophylactic surgery to lower your risk of developing cancer.