Should hysterectomy mean the ovaries come out too?

NEW YORK Wed Apr 27, 2011 4:27pm EDT

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NEW YORK (Reuters Health) - Women who are having a hysterectomy should consider also getting their ovaries removed, suggests a new study.

The report showed that women who had their ovaries taken out had lower rates of ovarian cancer and were not more likely to get heart disease or a hip fracture - which had been a worry in this group because of the quick drop in hormones that happens once the ovaries are gone.

That doesn't mean that all women who are getting a hysterectomy before menopause should also have their ovaries out.

"I've always said to my own patients, this is a woman's individual decision," Dr. William Parker, a gynecologist affiliated with the University of California, Los Angeles, told Reuters Health.

"Ovarian cancer is a terrible disease, but an extremely rare disease," said Parker, who was not involved in the current study. "I think it's important (to consider the options), and I don't think there's a pat answer."

Led by Dr. Vanessa Jacoby from the University of California, San Francisco, the researchers used data from the Women's Health Initiative study to compare women who had their uterus and ovaries removed with those who just had their uterus taken out.

Hysterectomies are often performed in women who haven't hit menopause but have heavy bleeding or are bothered by benign tumors growing in the uterus. More than half a million women have the surgery every year in the U.S.

The current study included more than 25,000 women age 50 to 79. Researchers followed the women for an average of 7 to 8 years to determine how many were diagnosed with ovarian cancer, heart disease, or a hip fracture.

Ovarian cancer was very rare in both groups of women -- 1 in 300 women who only had a hysterectomy were diagnosed with the disease, compared to 1 in 5,000 women who had their ovaries removed with the hysterectomy.

The authors calculated that 323 women would have needed to have their ovaries removed to prevent each case of ovarian cancer.

Both groups of women were diagnosed with heart disease and hip fractures at similar rates, and about the same amount of women in both groups died during the study - 8 of every 1,000 women each year.

Those findings differ from a previous study, co-authored by Parker, which found that women who had their ovaries removed were more likely to be diagnosed with heart disease and die than women who didn't.

Two reasons for the difference, researchers say, may be that Parker's study followed women for a longer period of time and included women who were younger, on average, than the women in the current study.

That makes the studies difficult to compare, said Lauren Arnold of Washington University in St. Louis, who wrote an editorial accompanying the new research in Archives of Internal Medicine.

"It just underscores that there's a lot that goes into the decision about whether to remove the ovaries," Arnold told Reuters Health. "Sometimes the decision is fairly clear cut," such as for women who have a gene that puts them at a high risk for ovarian cancer.

In that case, most doctors recommend women have their ovaries out because the survival rate for ovarian cancer is so low - most women aren't diagnosed until the cancer is advanced, and then fewer than one in three will survive another 5 years, the researchers report.

"But if you don't have an ovarian cancer risk, you have a lot of different factors to weigh," Arnold said.

Parker said that women should also consider if they or anyone in their family has a history of heart disease - which his study suggested would mean that leaving in the ovaries is a good idea.

Jacoby said the question of whether or not to remove the ovaries can be based on a woman's personal feelings about ovarian cancer, heart risks, and her own body.

"The main message that I hope women get is this is a very personal decision and they should really talk to their doctor about the risks and benefits of removing their ovaries," Jacoby told Reuters Health. "There's no right answer."

SOURCE: Archives of Internal Medicine, online April 25, 2011.

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Comments (2)
denschmitz wrote:
Ultimately all this boils down to is: “If you remove X your chances of getting cancer of the X goes down, and you probably don’t need X anyway. We think.”

Apr 27, 2011 10:48pm EDT  --  Report as abuse
jw1981 wrote:
I’m actually not surprised by this finding of no (or few) adverse health effects from ovary removal. What scientists have never been clear on is whether the TYPE of woman requiring this surgery might have a different health profile to begin with. Very often, women undergo hysterectomy with or without ovary removal for non-cancerous reasons such as endometriosis or fibroid tumors. These are estrogen-caused conditions, and are more common in obese women or those with diabetes and other cardiovascular risk factors. So in essence, it could be poorer health that precipitates the need for hysterectomy/ovary removal, not the other way around.

What’s more, age at natural menopause is not a risk factor for heart disease and the WHI estrogen-alone clinical trial did not show a reduced risk of heart disease in the estrogen vs. placebo group in women with hysterectomy, half of whom had ovary removal. Rather, stroke and blood clots were increased in hormones users, as was the risk for dementia and cognitive decline in those over 65. Had this surgery in fact put these women at greater risk for health problems compared with their age-matched counterparts who did not have the surgery, then estrogen use SHOULD have reduced their risk for various diseases, which it did not.

Nevertheless, hysterectomy with ovary removal is all too common and far less necessary than people have been led to believe. It certainly causes an abrupt and miserable menopause for young women and the common conditions it eliminates are better treated with non-surgical options, such as drug therapies, which don’t have the same permanent side effects as surgery. But for the (rarer) cases of increased ovarian cancer (and sometimes breast cancer) risk, particularly for BRCA mutation carriers, this elective procedure does reduce the incidence, and based on the WHI, will NOT place women at greater risk of heart disease, other cancers, or early death.

Apr 28, 2011 4:33pm EDT  --  Report as abuse
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