New study questions benefits of elective removal of ovaries during hysterectomy

March 9, 2010, Elsevier

Removal of the ovaries (bilateral oophorectomy) while performing a hysterectomy is common practice to prevent the subsequent development of ovarian cancer. This prophylactic procedure is performed in 55% of all U.S. women having a hysterectomy, or approximately 300,000 times each year. An article in the March/April issue of The Journal of Minimally Invasive Gynecology suggests that this procedure may do more harm than good.

William H. Parker, MD, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, provides a comprehensive analysis of the medical literature relating to the benefit of oophorectomy at the time of hysterectomy. His investigation includes studies of post-hysterectomy cancer incidence, all cause mortality, cardiovascular disease, osteoporosis and hip fractures, coronary artery disease, and a number of other conditions. He concludes that, on balance, removal of the ovaries is not generally warranted for all women undergoing hysterectomy. In women not at high risk for development of ovarian or , removing the ovaries at the time of hysterectomy should be approached with caution.

Dr. Parker states, "Presently, observational studies suggest that bilateral oophorectomy may do more harm than good. Given that 300 000 U.S. women a year undergo elective oophorectomy, the findings of increased long-term risks have important public health implications…Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision."

Premenopausal oophorectomy causes a rapid decline in circulating ovarian estrogens and androgens. Postmenopausal ovaries continue to produce significant amounts of the androgens testosterone and androstenedione, which are converted to estrogen. Estrogen deficiency has been associated with higher risks of coronary artery disease and , and neurologic conditions. Although approximately 15,000 U.S. women die each year of , 350,000 women die of coronary artery disease. Therefore reducing a woman's risk of ovarian cancer with oophorectomy may be outweighed by increased risks of and neurologic conditions.

In an accompanying editorial, G. David Adamson, MD, FRCSC, FACOG, FACS, Director of Fertility Physicians of Northern California, Palo Alto and San Jose, CA, and past-president of both the American Society for Reproductive Medicine and the American Association of Gynecologic Laparoscopists, comments, "Dr. Parker has performed a valuable service to his fellow gynecologists and to women everywhere who have to make the difficult decision regarding ovarian conservation or removal at the time of hysterectomy. Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should."

More information: The article is "Bilateral Oophorectomy versus Ovarian Conservation: Effects on Long-term Women's Health" by William H. Parker, MD. The editorial is "Ovarian Conservation" by G. David Adamson, MD. Both appear in the Journal of Minimally Invasive Gynecology, Volume 17, Number 2 (March/April 2010).

Related Stories

Recommended for you

An under-the-radar immune cell shows potential in fight against cancer

February 23, 2018
One of the rarest of immune cells, unknown to scientists a decade ago, might prove to be a potent weapon in stopping cancer from spreading in the body, according to new research from the University of British Columbia.

Study tracks evolutionary transition to destructive cancer

February 23, 2018
Evolution describes how all living forms cope with challenges in their environment, as they struggle to persevere against formidable odds. Mutation and selective pressure—cornerstones of Darwin's theory—are the means ...

Lab-grown 'mini tumours' could personalise cancer treatment

February 23, 2018
Testing cancer drugs on miniature replicas of a patient's tumour could help doctors tailor treatment, according to new research.

Cancer risk associated with key epigenetic changes occurring through normal aging process

February 22, 2018
Some scientists have hypothesized that tumor-promoting changes in cells during cancer development—particularly an epigenetic change involving DNA methylation—arise from rogue cells escaping a natural cell deterioration ...

NEJM reports positive results for larotrectinib against TRK-fusion cancer

February 22, 2018
In 2013, the labs of University of Colorado Cancer Center investigator Robert C. Doebele, MD, PhD, and Dana-Farber Cancer Institute investigator Pasi A. Jänne, MD, PhD reported in Nature Medicine the presence of TRK gene ...

Putting black skin cancer to sleep—for good

February 22, 2018
An international research team has succeeded in stopping the growth of malignant melanoma by reactivating a protective mechanism that prevents tumor cells from dividing. The team used chemical agents to block the enzymes ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.