When a woman needs to have a hysterectomy (have her uterus removed), doctors often will recommend removing the ovaries (oophorectomy) at the same time. This is especially true for older women. In the United States, almost half of women over 40 who have a hysterectomy have their ovaries removed.
Women who have the abnormal breast cancer genes BRCA1 and BRCA2 have a higher than average risk of both breast and ovarian cancer. For these women, having their ovaries removed is an option they can choose that can lower the risk of breast and ovarian cancer, whether or not they need a hysterectomy.
Premenopausal women diagnosed with breast cancer also may choose to have their ovaries removed as part of their overall treatment plan because oophorectomy reduces the risk of the breast cancer coming back or a new breast cancer developing. But for most women who have an average risk of ovarian and breast cancer, the overall health benefits of opting to remove the ovaries isn't clear.
The article reviewed here looked at two small research studies that followed the health of more than 360 women who had a hysterectomy. Some of the women had their ovaries removed at the same time and some didn't. The researchers found that there was no difference in overall health after the surgery between the women who did have their ovaries removed at the time of hysterectomy and the women who didn't.
In women with an average risk of ovarian and breast cancer, removing the ovaries at the same time as hysterectomy greatly reduces the risk of ovarian cancer and somewhat lowers future breast cancer risk. But removing the ovaries also has some negative health effects. If the ovaries are still producing normal amounts of estrogen at the time of surgery, removing them can cause troublesome menopausal symptoms such as hot flashes to develop abruptly. Removing the ovaries also can contribute to more serious health problems in the future, including a higher risk of osteoporosis or having a heart attack.
Most medical decisions require you and your doctor to consider the overall health benefits of each option, weighing the benefits against the risks. If your doctor recommends that you have a hysterectomy, you should talk about the benefits and risks of removing the ovaries at the same time. Ask your doctor for an assessment of your unique situation and your individual risk of both ovarian and breast cancer. If your risk of ovarian or breast cancer is higher than average, removing your ovaries during hysterectomy surgery may make sense for you. If your risk of ovarian and breast cancer are considered average, the study reviewed here suggests that there may be no overall health benefit to removing the ovaries during hysterectomy. Together, you and your doctor can evaluate your choices and make the decision that's best for YOU based on your overall health profile.
SAN JOSE, Costa Rica, July 15 (MedPage Today) -- There's no evidence that removing the ovaries when a hysterectomy is performed has any health benefit for women, researchers here said.
But there's also no evidence of harm, Leonardo Orozco, M.D., of the OBGYN Women's Hospital San Jose, and colleagues reported in a Cochrane Review.
That's because they found only one controlled trial of the widespread practice, and that study addressed only sexual and psychological health, Dr. Orozco and colleagues said.
"There could be a real benefit of harm associated with oophorectomy, but it has not been identified," Dr. Orozco said in a statement. "Until more reliable research is available, removal of the ovaries at the time of hysterectomy should be approached with caution."
Currently, clinicians usually avoid prophylactic oophorectomy in women at low risk for ovarian cancer if the patient is under 40 and they routinely perform it if the patient is over 55. The decision is usually individualized for women in the intervening years, the researchers noted.
Between 1988 and 1993, CDC data show, the ovaries were conserved in up to half of women undergoing hysterectomy at 40 or older and one estimate is that about 300,000 women in the U.S. have a prophylactic bilateral oophorectomy each year.
The most common reason to remove the ovaries is to reduce the risk of ovarian cancer, the researchers said. One estimate suggested that between 4% and 14% of women who develop ovarian cancer will have had hysterectomies in which the ovaries were left.
Removing the ovaries changes the hormone balance, which affects both bone and lipid metabolism in ways similar to natural menopause. And there is some evidence that removing the ovaries -- especially before the age of 35 -- markedly increases the risk of myocardial infarction, the researchers said.
However, of the 119 abstracts screened for the review, only two referred to a controlled clinical trial, both of them reporting aspects of the same study, Dr. Orozco and colleagues said. The remaining 117 abstracts were excluded.
The two reports concern 362 women recruited between March 1996 and December 1999 at two centers in Sweden for a study comparing hysterectomy versus hysterectomy plus bilateral salpingo-oophorectomy.
Both reports dealt with the sexual and psychological well-being of the study
participants, including such things as anxiety, depressed mood, general health and vitality, sexual experience and responsiveness, and degree of sexual satisfaction.
They also included measurements of sex steroids, plasma estradiol and sex hormone-binding globulin, free androgen index, and free plasma estradiol index both preoperatively and after a year of follow-up.
Although the study had several limitations, the results suggest that removing the ovaries during an elective hysterectomy doesn't negatively affect sexual and psychological well-being in adequately estrogenized premenopausal women, the researchers said.
However, Dr. Orozco and colleagues said, the studies said nothing about the possible benefits and harms identified for this review, including mortality (from such causes as cancer, myocardial infarction, stroke, and thromboembolism), future gynecological interventions, and adverse events.
Because of the lack of evidence, they argued, "the benefits or harms of performing a bilateral oophorectomy remain unclear."
They added that the existing evidence "does not support" the high numbers of prophylactic oophorectomies in clinical practice.
"There is an urgent need for (randomized controlled trials) to resolve this question," they concluded.
The study was supported internally by the Central American Branch of the Iberoamerican Cochrane Network and the International Health Central American Institute, but there was no external support. The researchers reported no conflicts.
Primary source: Cochrane Systematic Reviews Source reference: Orozco LJ, et al "Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women" Cochrane Database of Systematic Reviews 2008; Issue 3. Art. No.: CD005638. DOI: 10.1002/14651858.CD005638.pub2.
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