Hysterectomy: Spare Ovaries, Boost Health?
Ovary Removal Decreases Ovarian Cancer Risk but Increases Risk of Heart Disease and Death, Study Says
Ovary Removal or Not? Perspective continued...
Among women in the U.S., ovarian cancer kills 14,700 women a year, but heart disease kills nearly 327,000 women and stroke, nearly 87,000, the authors note.
"What our study shows is taking out a woman's ovaries during hysterectomy isn't always the best option and that women need to be sure they discuss the risks and benefits about leaving their ovaries or taking out their ovaries with the doctor," Parker says.
His latest study confirms the findings of his study published in 2005, in which he and colleagues did a computer model type of study, feeding the results of several different studies into the computer and finding survival benefits with keeping the ovaries for women younger than age 65 at the time of surgery.
Other research has also found that routine removal of the ovaries increases the risk for heart disease, stroke, osteoporosis, and dementia.
It's presumed that the protective effect of keeping the ovaries is because of estrogen, Parker says. After menopause, the ovaries continue to make testosterone (which is converted into estrogen by fat cells) and small amounts of estrogen.
The study was funded by a research arm of Ethicon Women's Health, a company that makes treatments for women's health problems. Parker has served as a consultant for the company.
Ovary Removal or Not? Second Opinions
The study conclusion -- that preventive removal of the ovaries should not be automatic -- makes sense, says Alan DeCherney, MD, the editor-in-chief of Fertility and Sterility and director of the program in reproductive and adult endocrinology at the National Institutes of Health's National Institute of Child Health and Human Development in Bethesda, Md.
"I agree with the conclusion," he tells WebMD. "It's an important health lesson. Every patient is an individual."
For women, the message from this study, he says, is this: "If you don't have a reason to have your ovaries removed, they should be left in."
In 2008, the American College of Obstetricians and Gynecologists issued a practice bulletin for its members on ovary removal. In it, it suggests "strong consideration" be given to retain normal ovaries in premenopausal women who are not at increased genetic risk of ovarian cancer, but that ovarian removal at the time of hysterectomy be considered for postmenopausal women.
DeCherney suspects the guidelines will be revisited in the wake of the current study.
Another fertility specialist, Richard Paulson, MD, chief of reproductive endocrinology and infertility at the University of Southern California's Keck School of Medicine, says the study strongly suggests that "for women at low risk of ovarian and breast cancer, there is no reason for taking the ovaries out."