Conserving Ovaries During Hysterectomy Benefits Long-Term Survival of Women

ACOG NEWS RELEASE
For Release: August 1, 2005
Contact: ACOG Office of Communications
(202) 484-3321
communications@acog.org


Conserving Ovaries During Hysterectomy Benefits Long-Term Survival of Women


Washington, DC -- Leaving both ovaries intact during a hysterectomy for benign (noncancerous) reasons benefits long-term survival for women until at least age 65, according to new research published in the August issue of Obstetrics & Gynecology. The study found that women younger than age 65 clearly benefit from retaining their ovaries and that there was no clear health benefit from a bilateral oophorectomy (removal of both ovaries) for any age woman. The study did not include information about women at high risk of ovarian cancer. According to an accompanying editorial by David L. Olive, MD, this study is not definitive but it "is sure to provide significant impact upon clinical practice."

Over 600,000 hysterectomies are performed annually in the US, 90% of which are performed for noncancerous reasons, including fibroids, endometriosis, and uterine prolapse. Removing the ovaries at the time of hysterectomy has been used as a preventive measure against ovarian cancer. The study's authors conservatively estimate that, today, approximately half of all women have their ovaries removed during a hysterectomy. The percentage of hysterectomies performed with prophylactic bilateral oophorectomies more than doubled over the past 34 years, from 25% in 1965 to 55% in 1999, according to national statistics.

The study was designed to study the major risks and benefits of oophorectomy during hysterectomy among women who have only an average risk of ovarian cancer. The study found that oophorectomy in women younger than age 65 increased the risk of dying from coronary heart disease, the most common cause of death for women, and increased the risk of hip fracture. These increased risks far outweighed any benefits associated with oophorectomy. Because ovarian cancer is relatively uncommon, the data showed no substantial reduction in long-term mortality when oophorectomy was performed before age 65 (excluding women with documented genetic risk or family history of cancer). According to the researchers, hysterectomy itself reduces the risk of ovarian cancer, and the protective effect persists 10-20 years.

Removing the ovaries before a woman reaches menopause causes an immediate and significant loss of ovarian hormones. The researchers note that the ovaries continue to make small amounts of estrogen for years after menopause and that significant levels of ovarian testosterone and androstenedione have been documented in women in their 80s. They also note that after oophorectomy, menopausal women have significantly lower plasma levels of testosterone than women who go through menopause naturally. Testosterone is converted by muscle and fat cells into circulating estrogen. The 'residual' hormones produced by the ovaries after menopause are important in protecting against heart disease and osteoporosis, especially among those women who choose not to take hormone therapy.

Contact: William H. Parker, MD, University of California, Los Angeles, at 310-451-8148, or wparker@ucla.edu.

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Studies published in Obstetrics & Gynecology, the peer-reviewed scientific journal of The American College of Obstetricians and Gynecologists (ACOG), do not necessarily reflect the policies or opinions of ACOG. ACOG is the national organization representing over 49,000 members who provide health care for women.

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