Women’s Health

Hysterectomy is frequently performed to treat various common gynecologic problems. The disease or condition being addressed is most often confined to the uterus and the question arises whether or not to remove normal appearing ovaries at the time of surgery. The answer is based on age, family history and informed patient preference.
The ovaries are the main producers of the "female" hormones estrogen and progesterone and also manufacture small amounts of the "male" hormone testosterone. These hormones are important in the body’s physiologic functioning as well as psychological and sexual well being. Following menopause, the ovaries produce significantly less of these hormones, but continue to make smaller amounts for many years. When the ovaries are surgically removed, a woman has an immediate and abrupt loss of hormones. Typical symptoms of hormone loss include hot flashes, fatigue, mood changes (this includes anxiety, irritability, apathy and depression), insomnia, difficult or "cloudy" thinking, increased memory loss, vaginal dryness, and decreased sexual desire and response. Hormones are also important for cardiovascular (heart and blood vessels) and bone health. They may also have a protective effect on cognitive function when given immediately following natural or surgical menopause (they appear to have the opposite effect when started years later). This effect is not well established.
Many women desire removal of normal ovaries to protect against the risk of developing ovarian cancer in the future. This is a more important consideration in women who have a strong family history of ovarian cancer, particularly a first degree relative or known BRAC gene mutation. (Learn more about your risk of ovarian cancer at wcn.org or thegcf.org)

For the remainder of the population, ovarian cancer is a real, but relatively uncommon risk. The lifetime risk of developing ovarian cancer is 1 in 70.This translates to approximately 16, 000 women who die each year from ovarian cancer. In comparison, we lose 490,000 women to heart disease, 70,000 to lung cancer, 48,000 within a year following a hip fracture, 40,000 to breast cancer, and 28,000 to colon cancer.

It is estimated that .5 % of women who choose to keep their ovaries at the time of hysterectomy are later found to develop ovarian cancer (this means 99.5% of women do not develop ovarian cancer). In addition, hysterectomy has been shown to slightly decrease the risk of ovarian cancer; the risk reduction is about .6. Some women prefer removal of their ovaries to avoid the possibility of another surgery involving the ovaries, even if it is not cancer.Interestingly, the risk of reoperation for any ovarian issue has been shown to be just under 3 %.
Early removal of the ovaries has been shown to increase a woman’s risk of cardiovascular disease, particularly if she does not take hormone replacement.As mentioned, cardiovascular disease is a major cause of death in women. If ovaries are removed before the age of 45, the increased risk is 44 %; after the age of 50 the risk is still increased by 40%.

Similar observations have been seen with bone health. In women who were menopausal at the time of ovarian removal, studies have shown a greater than 50 % increase in fractures related to osteoporosis and twice the risk of death within one year following a hip fracture. This is in contrast with the theory that menopausal ovaries "are not doing anything".

Here is another way to consider the implications of elective removal of normal ovaries. In a hypothetical woman who is between 50 to 54 years old and has no risk factors, the probability of living to 80 years old is increased by 9 % if she has her ovaries. The risk of dying from ovarian cancer at this age is less than .5 %.
These risk/benefits seem to be lost when a woman reaches about 65 years old. This means that there is no longer any significant benefit to keeping ovaries at this age. This echoes the recommendations of the American Congress of Obstetrics and Gynecology (ACOG). Presently, ACOG advises that a woman under 65 years old who has no increased risk for ovarian cancer conserve her ovaries if they appear normal at the time of surgery.

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9745 North 90th Place
Scottsdale, AZ 85258
Tel:  480-661-1485
Fax: 480-661-1495

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