No clear benefit of ovary removal with hysterectomy

NEW YORK (Reuters Health) - While it is common for women undergoing a hysterectomy to also have their healthy ovaries removed, there is no clear evidence that it benefits them, according to a new research review.

A hysterectomy is the surgical removal of the uterus. When women have the procedure for a non-cancerous condition, they may be offered the option of having their healthy ovaries removed as well. Called prophylactic oophorectomy, the procedure is done with the goal of lowering the woman’s future risk of ovarian cancer, and to avoid further surgeries for problems like benign ovarian growths.

In the U.S. alone, at least 300,000 such procedures are performed each year. But for women at average risk of ovarian cancer, there is a lack of high-quality evidence of either benefits or harms, according to the researchers on the new review.

“Consequently, women should know that for the vast majority of women who don’t have (elevated) ovarian cancer risk, removal of the ovaries during hysterectomy may not be justified,” lead researcher Dr. Leonardo J. Orozco, of OBGYN Women’s Hospital San Jose, in Costa Rica, told Reuters Health.

Reporting online in the Cochrane Library, he and his colleagues say their review of the medical literature uncovered only one clinical trial that met their criteria for the review.

In that study, researchers followed 362 women between the ages of 45 and 55 who were having a hysterectomy for a benign condition. Of these women, 106 elected to also have a preventive oophorectomy. Over the next year, the researchers found no clear effect of the oophorectomy on women’s sexual or psychological well-being.

But even this single study provided only “low-quality” evidence, according to Orozco’s team, and, more importantly, it leaves many questions unanswered.

The concern with removing healthy ovaries, Orozco explained, is that the risks of doing so may outweigh the potential benefits.

The ovaries produce estrogens and androgens (“male” hormones) that serve important functions in the body, Orozco pointed out.

Before menopause, for example, women’s higher estrogen levels help protect their heart health. Some studies suggest that women who have their ovaries removed face a heightened risk of future heart disease and stroke, Orozco said -- and, he noted, far more women develop heart disease than ovarian cancer.

Even after menopause, the ovaries continue to produce hormones -- including androgens that are converted to estrogens in body tissues. The consequences of ending this normal ovarian function are not fully understood, according to Orozco.

In practice, he noted, doctors often use the age of 45 as the “cutoff” where they begin to strongly advise preventive oophorectomy in women having a hysterectomy. But this is based more on tradition than strong research evidence, according to Orozco.

“Until more data becomes available,” he said, “prophylactic oophorectomy should be approached with great caution.”

SOURCE: Cochrane Library, online July 16, 2008.