Traditionally gynecologists have been trained to recommend preventative
removal of a woman’s ovaries (oophorectomy) if she is older than
45 when she undergoes a hysterectomy (removal of the uterus) for benign
disease. It has been recommended to prevent ovarian cancer and avert the
potential for other ovarian problems, like cysts, that might require future surgery.
There is general agreement in the medical community that women who have
a breast cancer (BRCA) gene mutation or strong family history of ovarian
or breast cancer benefit from removal of ovaries reducing subsequent cancer
risk to these organs. However, for the general population recent data
reveals that only 2.8% require reoperation after ovarian conservation.
In addition, studies indicate that less than 1% of women who retain their
ovaries at the time of hysterectomy develop ovarian cancer. Therefore,
the rationale of performing oophorectomy to avoid future surgery appears
to be unfounded.
Hazards associated with removal of both ovaries include:
- Increased risk of death from heart attacks, all cancers (except ovarian),
and all causes
- Increased risk of osteoporosis and hip fractures
- Accelerated decline in sex drive due to loss of testosterone
- Oophorectomy performed before the onset of menopause is associated with
an increased risk of parkinsonism, dementia, anxiety, and depression
Ovarian conservation appears to maximize survival among healthy women 40
to 65 years old who undergo hysterectomy for benign disease. Among healthy
women hysterectomized before the ages of 55, calculations suggest that
8.6% more would be alive at age 80 if their ovaries were left in situ
rather than removed.
Consequently, we practice a cautious approach to oophorectomy at the time
of hysterectomy and emphasize the benefits of ovarian conservation as
part of our discussion with women preparing for pelvic surgery. Increasingly
these operations can be accomplished through
minimally invasive approaches, resulting in less pain and a shorter recovery.