Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women

[Intervention Review]
Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women

Leonardo J Orozco1, Arturo Salazar2, Jane Clarke3, Mario Tristán4

1OBGYN Women's Hospital San José, Costa Rica., Caja Costarricense Seguro Social (CCSS) & Central American Cochrane Center, San José, Costa Rica. 2Training and Research Unit, Central American Branch of the Iberoamerican Cochrane Network/IHCAI Foundation, San José, Costa Rica. 3Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand. 4International Health Central American Institute, "Clinica Centroamerica:" Regional Evidence Based Practice Training Centre , San José, Costa Rica

Contact address: Leonardo J Orozco, OBGYN Women's Hospital San José, Costa Rica., Caja Costarricense Seguro Social (CCSS) & Central American Cochrane Center, Bo california, San José, San Pedro Montes de Oca, 1677-2100, Costa Rica. lorozco@ihcai.org. lorozco@ihcai.org. (Editorial group: Cochrane Menstrual Disorders and Subfertility Group.)

Cochrane Database of Systematic Reviews, Issue 2, 2009 (Status in this issue: Unchanged)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD005638.pub2
This version first published online: 16 July 2008 in Issue 3, 2008. Last assessed as up-to-date: 29 March 2008. (Help document - Dates and Statuses explained).

This record should be cited as: Orozco LJ, Salazar A, Clarke J, Tristán M. Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD005638. DOI: 10.1002/14651858.CD005638.pub2.
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Abstract


Background
Prophylactic oophorectomy alongside hysterectomy in premenopausal women is common. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for other additional gynaecological surgical interventions. The benefits or harms of prophylactic bilateral oophorectomy at the time of hysterectomy in premenopausal women are unknown.


Objectives
To determine whether premenopausal women with hysterectomy without oophorectomy for benign gynaecological conditions versus hysterectomy plus bilateral oophorectomy would have a higher mortality rate and future gynaecological surgical interventions.


Search strategy
We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to October 2007) and the following electronic databases: CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (January 1966 to October 2007), EMBASE (January 1985 to October 2007), LILACS (January 1982 to October 2007), Biological Abstracts (January 1968 to October 2007), NHS Economic Evaluation Database (inception to October 2007), Health Technology Assessment Database (inception to October 2007), and the Meta RCTs (inception to October 2007). Reference lists of relevant articles were also searched.


Selection criteria
Randomised controlled and controlled trials of hysterectomy (using any surgical approach) without oophorectomy versus hysterectomy (using any surgical approach) with bilateral oophorectomy in premenopausal women with benign gynaecological conditions.


Data collection and analysis
Three review authors independently assessed trials for inclusion, determined study quality and extracted data. Study authors were contacted where information was unclear.


Main results
Of the 119 studies identified, only one controlled trial was included. Therefore, a quantitative meta-analysis was not feasible. The results of this study (with two publications) including 362 women were summarised in a narrative format. No randomised controlled trials were found.

Neither publication reported on the primary outcomes stated in this review. The trial showed evidence of very low quality of a positive effect on psychological well-being for both groups at one year follow up. No significant differences were found between the groups of women studied regarding any aspect of their sexuality.


Authors' conclusions
The conclusions of this review are limited by the lack of data. More research of higher methodological quality is needed.


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Plain language summary

Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women
Removing the ovaries at the time of hysterectomy could potentially improve longevity as it reduces the risk of ovarian cancer and the need for future gynaecological procedures. However, women who have had their ovaries removed have also been reported to have an increase in cardiovascular disease. Currently, there are no good quality studies of the benefits or harms of removing the ovaries at the time of hysterectomy. Until well-designed studies that compare women undergoing hysterectomy with women undergoing hysterectomy and removing ovaries are undertaken, removing the ovaries at the time of hysterectomy should be approached with caution.






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