Hysterectomy: Out With the Ovaries or Not
Removal of Ovaries During Hysterectomy Is Risky, Often Unnecessary, Study Shows
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 cancer.
Ovary Removal Questioned
The analysis appears in the latest issue of The Cochrane Library, published by the medical research evaluation organization Cochrane Collaboration.
"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.