This is a matter dear to my heart – and one I argued with my own GYN about prior to and up to the moment of my own hysterectomy.
Me: “When you get in there, if my ovaries are not diseased or irreversibly damaged by the tumors, I insist that you save them!”
He countered with: chances are great that following hysterectomy your ovaries will cease functioning – at your age, menopause is just around the corner anyway. By removing them we remove any possibility of ovarian cancer down the road. You can always take the HRT route.
Me again: “I respect your thoughts and concern, but it’s my body and my decision. I keep my ovaries if at all possible!”
For me, the period wise thing to do was to keep my ovaries. And, I did. They continue to function. I still cycle. Not as regularly as I did when younger (peri-menopause does that, you know), but I do feel the affects of the hormones my ovaries continue to crank out. And, I know I made the right decision.
While surfing the web for ideas (actually, I was bored and was looking for something interesting to read) I stumbled upon a report on Fox News entitled “When Removing the Uterus, Leave the Ovaries”. The byline indicated it originated with Reuters so I headed there, searched “hysterectomy” and found the article by Kerry Grens – which directed me to Obstetrics & Gynecology.
Obstetrics & Gynecology, also known as The Green Journal, has been around 60 years and is the official publication of the American College of Obstetricians and Gynecologists. The goal of the journal “is to promote excellence in the clinical practice of obstetrics and gynecology and closely related fields.”
The April, 2013, issue of Obstetrics & Gynecology provides an interesting report about a study conducted to determine the effects of removing ovaries (oophorectomy) vs saving them (ovarian conservation) at the time of a hysterectomy for benign disease.
It’s noted that the participants of this study were nurses – 30,117 women – and the follow-up process was long-term: 28 years.
An excerpt follows.
Each year approximately 610,000 U.S. women undergo hysterectomy for benign disease and 23% of women aged 40–44 years and 45% of women aged 45–49 years have concomitant elective oophorectomy to prevent the subsequent development of ovarian cancer.1,2 Bilateral oophorectomy, when compared with ovarian conservation, is associated with a decreased risk of ovarian cancer but may increase risks of death from coronary heart disease (CHD) and all causes.3,4 Although some studies are not consistent with these findings, they include small numbers of women, have short-term or delayed onset of follow-up, or compared oophorectomy with natural menopause.5,6The Nurses’ Health Study is an ongoing prospective observational study of women and health outcomes. In a previous investigation over 24 years of follow-up, we found that bilateral oophorectomy, compared with ovarian conservation, at the time of hysterectomy was associated with a lower risk of incident ovarian and breast cancer but a higher risk of incident CHD, stroke, lung cancer and total cancers, and mortality from all causes.7…we found that at no age was there an overall survival benefit associated with bilateral oophorectomy compared with ovarian conservation at the time of hysterectomy for benign disease. Our analysis…found that at the time of hysterectomy, bilateral oophorectomy was associated with a marked reduction in mortality from ovarian cancer and a lower risk of mortality from breast cancer when oophorectomy was performed before age 47.5 years. Among the 30,117 study participants followed over 28 years, 44 women with ovarian conservation and four with oophorectomy died from ovarian cancer. However, these risks were overshadowed by the significantly increased risks of dying from other causes: a 23% increase in CHD mortality, a 29% increase in lung cancer mortality, a 49% increase in colorectal cancer mortality, and a 13% increase in all-cause mortality.
Additionally, it was found that
- oophorectomy before age 50 years in women who never used estrogen therapy was associated with a 41% increased risk of all-cause mortality
- lung cancer and cardiovascular disease mortality were also elevated only in the women who never used estrogen therapy
- oophorectomy increased the risks of cardiovascular disease and all-cause mortality in low-risk women
- oophorectomy may have a greater effect on otherwise healthy women
- for women who never smoked and never used estrogen therapy, oophorectomy before age 50 years was associated with a 200% increase in mortality
- oophorectomy may be associated with increased risk of colorectal cancer
- oophorectomy may affect lung cancer risk
- 80% of both cardiovascular disease deaths and all deaths occurred 15 or more years after hysterectomy
A reminder to women with a known genetic tendency toward ovarian and breast cancer was issued and a warning to women who undergo elective oophorectomy at the time of hysterectomy:
At the time of hysterectomy, women with known high-penetrance susceptibility genes for ovarian and breast cancer (BRCA, Lynch) should strongly consider oophorectomy because the lifetime risk of ovarian cancer is high.18 In contrast, approximately 300,000 U.S. women without these mutations, and many more worldwide, have bilateral oophorectomy at the time of hysterectomy for benign disease every year. Consequently, the association of oophorectomy with increased mortality in the overall population has substantial public health implications.
For more information on the study and its findings, please visit Obstetrics & Gynecology: April 2013 – Volume 121 – Issue 4 – p 709–716