BY R. WAYNE WHITTED, M.D., MPH,
Board-Certified Obstetrics and Gynecology
Women facing a hysterectomy for benign conditions may be better off if they leave their ovaries intact, says a study in Obstetrics and Gynecology. Most of the 600,000 hysterectomies performed yearly in the United States are for benign - non-cancerous - conditions such as fibroids, heavy or irregular bleeding, endometriosis or abnormal pap smears. At least half of the women, especially those past their childbearing years, are advised to have their ovaries removed as a preventive measure against ovarian cancer, a practice known as "prophylactic oophorectomy."
But this advice could be wrong. "For the last 40 years, the prevailing medical wisdom has been to remove the ovaries if women were 45 or older, in order to prevent ovarian cancer," wrote William Parker, M.D., chair of obstetrics and gynecology at Saint John's Health Center and clinical professor at the UCLA School of Medicine. "But our study suggests this practice may be doing more harm than good."
Dr. Parker and his co-authors examined 20 years of published medical data to determine the risks for five conditions that have been linked to the presence or absence of ovaries: ovarian cancer, breast cancer, heart disease, hip fractures and stroke. The data was then entered into a sophisticated computer model to estimate age-specific risks of mortality. The results showed that women with their ovaries lived longer than those who has their ovaries removed.
One analysis in the study looked at 20,000 women age 50-54 who has a hysterectomy-half who has ovaries removed, and half who kept their ovaries. The analysis projected that by age 80, more women who had their ovaries removed-858-died than those who kept their ovaries after hysterectomy. the analysis also showed that while 47 fewer women would have died from ovarian cancer after having their ovaries removed, 838 would die from heart disease and another 158 from complications related to a broken hip. The data applied to women without a genetic predisposition for ovarian or breast cancer.
This observational research gives doctors and women better insight into the benefits and risks of ovarian conservation or removal when the ovaries are conserved at surgery, they may help protect women's health. The ovaries continue to make small amount of estrogen, and two other hormones, testosterone and rostenedione, for years after menopause. These naturally produced hormones may help protect women against health risks, including heart disease and osteoporosis. Doctors do not understand fully the mechanisms of this protection and need to research the subject further.
Dr. Parker and his colleagues concluded that women benefit from keeping their ovaries when undergoing hysterectomies before age 65 and found apparent health benefit to removing the ovaries.
In my practice, I believe in ovarian conservation in appropriate circumstances. Women who face this choice should discuss the issue with their physician and have a clear understanding of the current research before making this important decision.
This health news is brought to you by R. Wayne Whitted, M.D., MPH.