Study Questions Benefits of Elective Removal of Ovaries During Hysterectomy

Note: this is not new news but has been reported over the past few years

PHILADELPHIA -- March 10, 2010 -- An article published in the March/April issue of The Journal of Minimally Invasive Gynecology suggests that bilateral oophorectomy may do more harm than good.
William H. Parker, MD, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, 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 concluded 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 breast cancer, removing the ovaries at the time of hysterectomy should be approached with caution. "Presently, observational studies suggest that bilateral oophorectomy may do more harm than good," said Dr. Parker. "Given that 300,000 US women a year undergo elective oophorectomy, the findings of increased long-term risks have important public health implications." Premenopausal oophorectomy causes a rapid decline in circulating ovarian oestrogens and androgens. Postmenopausal ovaries continue to produce significant amounts of the androgens testosterone and androstenedione, which are converted to oestrogen. Oestrogen deficiency has been associated with higher risks of coronary artery disease and hip fracture, and neurologic conditions. Although approximately 15,000 women in the Unites States die each year of ovarian cancer, 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 coronary artery disease and neurologic conditions. In an accompanying editorial, G. David Adamson, MD, Fertility Physicians of Northern California, Palo Alto and San Jose, California, commented: "Dr. Parker has performed a valuable service to his fellow gynaecologists 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."