Hysterectomy: Out With the Ovaries or Not
Removal of Ovaries During Hysterectomy Is Risky, Often Unnecessary, Study Shows
WebMD News Archive
July 18, 2008 -- There is not enough evidence to justify the routine removal
of the ovaries during hysterectomy -- a common
practice that may convey as many risks as benefits for premenopausal women, a
new analysis suggests.
About half of the 600,000 hysterectomies performed in the U.S. each year
include surgical removal of the ovaries along with the uterus. The most common
reason cited for ovary removal is to prevent ovarian cancer.
But there is growing evidence that ovary removal may be associated with an
increased risk for heart disease and stroke, and other age-related
diseases, such as osteoporosis and even dementia.
The ovaries continue to produce hormones even after menopause that may be
protective against such diseases, says ob-gyn Leonardo J. Orozco, MD, of the
Women's Hospital, San Jose, Costa Rica.
In their newly published analysis, Orozco and colleagues were unable to find
any high-quality controlled trials that examined the risks and benefits of
routine ovary removal during hysterectomy in women with a low risk for ovarian
Ovary Removal Questioned
The analysis appears in the latest issue of The Cochrane Library,
published by the medical research evaluation organization Cochrane
"Until more data becomes available, [ovary removal during hysterectomy]
should be approached with great caution," Orozco tells WebMD.
"Currently, the existing evidence does not support the high number of ovary
removals in clinical practice."
The researchers concluded that there is an "urgent need" for
appropriately designed trials to determine if ovary removal is justifiable for
all women who have hysterectomies.
For women at high risk of ovarian cancer, including those with a strong
family history of the disease and those with a genetic predisposition to get
the cancer, the benefits of ovary removal are clear, says UCLA professor of
obstetrics and gynecology William H. Parker, MD.
But for the vast majority of women who don't have these risks, removal of
the ovaries during hysterectomy may not be justified, he says.
Parker's own 2005 study of hysterectomy patients between the ages of 40 and
80 with an average risk for ovarian cancer found no survival benefit associated
with ovary removal at any age, and a survival disadvantage associated with the
practice up until the age of 65.