The decision whether to remove or keep ovaries at the time of hysterectomy should not be taken lightly
The balance between keeping and removing ovaries at the time of hysterectomy is centered on the potential risk and fear of the development of ovarian cancer and the risks of going into the menopause once the ovaries are removed.
The ovaries do not “die” after the menopause, they continue to produce hormones for many years after the change and these hormones continue to be beneficial for well being.
Another issue is with the use of hormone replacement therapy. HRT used to be the “panacea” for all illnesses in women over the age of 45. But with the much-publicized HRT scare in the mid 1990s (even though the risks of HRT were overstated), many women are reluctant to take HRT and many doctors are reluctant to prescribe them. Even in women who had their ovaries removed during hysterectomy, one study suggests that only 30% of women who were prescribed HRT continued to use it.
There was a time when nearly all women over the age of 45 were advised to have their ovaries removed when having a hysterectomy this was to prevent ovarian cancer. For this reason in 1999 nearly 80% of women having a hysterectomy had their ovaries removed compared to just 25% in 1965. But this risk should be looked at in perspective and in relation to the individual patient. The risk of developing ovarian cancer has probably been overstated in medical literature.
In women who do not have a first degree relative with ovarian cancer the lifetime risk is 1:70. This risk is halved if a hysterectomy is performed and ovaries left behind, and decreased by a third in women who have been sterilized.
In order to prevent one case of ovarian cancer about 100 pairs of ovaries would need to be removed.
So the benefit of removing ovaries at the time of hysterectomy needs to be weighed against.
The increased risk of heart disease
- Oophorectomy (removal of ovaries) after the age of 50 increases the risk of stroke by 40% in women who do not take HRT (Hormone replacement therapy.
- There is a 2.2 fold increase in ischaemic heart disease in oophorectomised
The increased risk of osteoporosis and the increased risk of fracture
- Women who have had their ovaries removed over the age of 60 have a two fold increase in mortality after low impact hip fractures
- Women also have a 54% more osteoporotic fractures
- Dementia
- Parkinson’s disease
A medical study looking at the balance of risk after removal of ovaries at hysterectomy without the use of HRT suggests that:
If we take 10,000 women and remove their ovaries between the ages of 50-54 and follow them up till age 80
- · Removing their ovaries would have prevented 47 deaths from ovarian cancer
- · 838 deaths from heart related illness
- · 158 deaths from hip fracture.
For the above reasons I would not advocate the routine removal of ovaries at the time of hysterectomy.
It is very important to get into an individualized discussion with your doctor about your ovaries before having them removed at hysterectomy