Ovary Removal: Weighing the Benefits and Risks for Women's Health

Ovaries removed during a benign hysterectomy may raise the risk of cardiovascular disease in premenopausal women and the risk of cancer in postmenopausal women, according to research published in the Annals of Internal Medicine . The study looked at the medical records of roughly 143,000 women who had a benign hysterectomy. The researchers compared the long-term outcomes of patients who underwent bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes) to those who did not. A benign hysterectomy is performed for causes other than malignancy.

The researchers found that women who had their ovaries removed had a decreased risk of developing ovarian cancer, although other health problems could occur. These differed according to age and menopause status.

“The study results in support the current recommendations for conserving ovaries in premenopausal women without a high risk for ovarian cancer,” said Dr. Monte Swarup, an OB/GYN in Chandler, Arizona, and the founder of the HPV information site HPV HUB. “The decision to remove ovaries is based on several factors specific to the patient. If the patient is at high risk for ovarian cancer, surgery might lower the risk.”

Benefits and Drawbacks of Ovarian Removal

The ovaries and fallopian tubes are removed during a salpingo-oophorectomy. A woman can also have a salpingectomy, which removes the tubes, or an oophorectomy, which removes the ovaries. There is the option of removing just one ovary or one fallopian tube, however, these surgeries were not included in the study. An oophorectomy is sometimes used to treat:

• Inflammation of the pelvis
• Ectopic pregnancy, benign tumours, and chronic pelvic pain
• Ovarian cysts of a considerable size

The surgery may also lower the chances of developing ovarian cancer.

“Every treatment needs to be customized to the patient taking into consideration their medical diagnosis, benefits, and risks, as well as their short-term and long-term goals,” said Dr. Asima Ahmad, the chief medical officer and co-founder of Carrot Fertility as well as a reproductive endocrinologist and fertility expert.

“When discussing hysterectomy, I do not have a uniform patient recommendation,” Ahmad told Healthline. “In general, for a premenopausal woman with no known increased personal risk or family history of cancer, we may choose not to remove the ovaries at the time of the surgery. This will avoid an abrupt drop in her endogenous estrogen and medically induced early menopause.”

According to the North American Menopause Society, the average age of menopause in the United States is 51 years old. According to Breastcancer.org, there are various dangers associated with ovaries removal:

• Early menopause, which increases the risk of osteoporosis, decreased sex drive, and vaginal dryness
• Physical symptoms include joint pain, heart palpitations, muscle spasms, insomnia, urinary tract or yeast infections, and incontinence
• Emotional symptoms include anxiety, despair, and mood swings.

“My current recommendation is ovarian preservation up to age 60,” said Dr. G. Thomas Ruiz, an OB/GYN Lead at MemorialCare Orange Coast Medical Center in California. “This study makes a case for extending that to age 65. The current practice in gynecology is to remove the tubes and uterus and preserve the ovaries. Removing the tubes significantly decreases a woman’s risk of ovarian cancer,” Ruiz told Healthline.

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Dr. Adi Katz, the director of gynecology at New York's Lenox Hill Hospital, has been removing fallopian tubes only until the age of 65, unless there is a medical reason to remove the ovaries, such as a genetic mutation or extensive endometriosis. “In my practice, I have been performing removal of the fallopian tubes during hysterectomy since I finished a fellowship in 2012,” said Katz. “Overall, in the absence of risk factors (family history of ovarian cancer, multiple family members with breast cancer, or concerning radiological studies) I recommended preserving the ovaries until age 65.”

How Ovary Removal Impacts Cardiovascular Risk

According to a study conducted in China, women who had hysterectomies with ovary and tubal removal had a nearly 20% higher risk of cardiovascular disease and ischemic stroke than those who did not have surgery.

“Removing ovaries in younger women eliminates the benefits of estrogen,” Ruiz said. “Estrogen promotes good cholesterol, HDL, and helps lower bad cholesterol, LDL. Even though we encourage younger women who undergo bilateral oophorectomy to start hormone replacement therapy, not all can (use hormones). Others stop because they don’t think they need estrogen. It would lead to increased LDL and lower HDL, increasing cardiovascular disease risk.”

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Source-Medindia