Should Your Ovaries Be Removed During a Hysterectomy?
People undergo hysterectomies for a variety of reasons, and sometimes, this also involves removing their ovaries. The thought behind this was that if the person no longer had a uterus, they wouldn’t need their ovaries, so as long as they’re having major surgery, doctors might as well remove ovaries too to prevent risk of that type of cancer.
However, a recent study conducted at the University of Warwick concluded that there might be a link between removing ovaries during a hysterectomy and the risk of premature death from heart disease. Does this mean that ovaries should be left alone or does removing the risk of cancer still outweigh potential harms? We spoke to a few doctors to find out.
Why was this so common?
According to Dr. Marc Winter, OB-GYN at Saddleback Memorial Medical Center in Laguna Hills, California, the thinking behind the removal of ovaries at the time of hysterectomy has changed dramatically over the last 20 years.
“A growing understanding of the potential long-term health benefits of keeping the ovaries has swung the pendulum toward ovarian conservation until age 51 (the average age a woman goes into menopause) or even at age 65,” Dr. Yen Tran, an OB-GYN at Orange Coast Memorial Medical Center, Fountain Valley, California, told SheKnows.
Who should consider it?
Tran explained that in the general population, the lifetime risk of developing ovarian cancer is less than 2 percent. But that increases to 46 percent in women with BRCA1 gene mutations, up to 23 percent with BRCA2 gene mutations and 14 percent in those with Lynch syndrome (hereditary nonpolyposis colorectal cancer syndrome).
“Based upon this available evidence, it’s reasonable for women with the BRCA mutation and Lynch syndrome to have their ovaries removed as soon as they completed childbearing or by age 35 to 40 years old,” she said.
In these cases, Tran noted, this risk-reduction of ovarian removal is preferred rather than ovarian or fallopian tubal cancer screening or chemoprevention for women who carries the gene mutations.
The American College of Obstetrics and Gynecology advises considering the removal of ovaries at the time of hysterectomy only in women who are postmenopausal or who have a condition that may benefit from removing the ovaries (e.g., endometriosis, pelvic inflammatory disease, chronic pelvic pain).
Since the average age for women to go into menopause is 51, based upon a comprehensive review of observational data, it can be concluded that ovarian conservation at the time of benign hysterectomy until age 51 or older is favorable, Tran explained.
Who should probably opt out of ovary removal?
With the exception of individuals at high risk for developing ovarian cancer — due to a lower risk of developing ovarian cancer in the general population — the available evidence suggests that removal of ovaries at ages younger than 51 years old is associated with increased risk of not only heart disease, but also cognitive impairment, dementia, Parkinson’s disease, depression, anxiety, glaucoma and osteoporosis as well as impacting sexual functions including libido, arousal and orgasm.
The adverse effects of having ovaries removed surgically are greater than natural menopause and may be associated with an abrupt decrease in androgen, estrogen and progesterone output. In fact, people who had their ovaries removed earlier than age 51 without estrogen supplement afterward suffered worse symptoms than those with estrogen supplement, Tran said.
Several studies have been published looking back at women having a hysterectomy and whether or not they had their ovaries removed. All showed a decrease in ovarian cancer with removal of the ovaries, but a higher risk of dying from other causes including heart disease and other cancers, Winter said. Overall, the women who kept their ovaries lived significantly longer. The protective effect appears to last until age 65.
He noted that these studies were not able to control the effect of taking hormones, which may decrease the risk of heart disease, and that other recent studies have shown a large proportion of ovarian cancer — about 70 percent — starts in the fallopian tubes.
Now, Winter said, many gynecologists recommend removal of the fallopian tubes even when the ovaries are preserved. Over time, this should theoretically decrease the mortality rate even further of women keeping their ovaries.
“The bottom line is most gynecologists now advise keeping ovaries and removing the fallopian tubes at the time of hysterectomy unless someone has a strong family history of ovarian cancer,” Winter said.