Saving Ovaries at Hysterectomy Saves Lives

surgeryTraditionally 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.