Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses’ Health Study
Parker WH, Broder MS, Chang E, et al.
Obstet Gynecol 2009;113:1027–1037..
Oophorectomy is often performed at the time of hysterectomy for benign disease. It is estimated that 50% of women in their early 40s and 80% of women 45 years of age or older will have their ovaries removed. The resultant loss of hormone production in premenopausal women is obvious, but “postmenopausal ovaries continue to produce significant amounts of testosterone and androstenedione, which are converted to estrogen peripherally.” This loss of estrogen production translates into increased cardiovascular risk, so the prophylactic removal of the ovaries to prevent ovarian cancer has to be weighed against heart disease, stroke, and death from cardiovascular events.
On balance it is far better to preserve a woman’s ovaries at hysterectomy, and all comparative studies reach this conclusion. Parker and colleagues followed nearly 30,000 women from the US Nurses Health Study who had undergone a hysterectomy and found that although oophorectomy decreased the risk of ovarian and breast cancer, it increased the risk of stroke, coronary heart disease, and all-cause mortality.
Working on the assumption of a 35-year postsurgical life-span, 1 additional death could be anticipated for every 9 oophorectomies performed. The message is clear: it is in a woman’s interest to preserve her ovaries at hysterectomy, no matter what her age.
Footnotes
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