All hysterectomies are not alike. Whether performed abdominally or vaginally, with or without the cervix, and inclusive or exclusive of the tubes and ovaries, one surgeon's discarded tissue specimens are another surgeon's salvaged organs. What most women don't realize however, is that there is no one right answer, and that they too should be decision makers in their own hysterectomies.
According to a recent study in the Journal of Minimally Invasive Gynecology, more than half of all U.S. women who undergo hysterectomy also undergo oophorectomy, or removal of their ovaries. The classic thought behind taking them out in a sort of hysterectomy deluxe , kill two birds with one stone fashion, is that removing ovaries can also remove the potential risk of developing ovarian cancer. Last year, 14,600 U.S. women died from ovarian cancer, according to the National Cancer Institute.
The fallacy in this argument, of course, is that not every ovary will develop cancer if left alone. Most women in in the remaining 45 percent of hysterectomy cases without oophorectomy do not go on to wish they had taken their ovaries out when they had the chance. In fact, for these women, whether pre-menopausal or post-menopausal, remaining ovaries can act as hormonal shields from depression, hip fractures, strokes, and heart disease, which killed over 316,000 U.S. women in 2006, according to the Centers for Disease Control and Prevention.
The study argues that for otherwise healthy woman without breast or ovarian cancer, elective removal of the ovaries may do more harm than good. This is important information given that other similar studies have found elective oophorectomy to be on the rise in U.S. women.
Researchers at the University of Pittsburgh McGee Women's Hospital recently found that while age-adjusted ratios for elective oophorectomy with hysterectomy have decreased since 1974, the actual proportion of said oophorectomies has done just the opposite. National rates are trending upward in recent years, despite solid research that shows estrogen's heart and bone-protecting benefits. The former study calls for a change, using patient education and involvement to create a more selective surgical process.
There are, of course, exceptions to the rule. For patients with current or past histories of breast and/or ovarian cancer, any estrogen is too much estrogen. This is because estrogen can act like fertilizer in some of these cancers. For this reason, you've probably heard about women with positive family histories of breast cancer electing to remove their ovaries or breasts even though they themselves haven't been diagnosed with disease. If the genes are there, taking away the potential fertilizer may take away the risk altogether. For these women undergoing hysterectomy, the addition of an oophorectomy may be a welcomed bonus.
If hysterectomy is a procedure you are currently considering, be sure to discuss these options with your Ob/Gyn to determine which choice is best for your individual situation.
Sources:
Lowder JL, Oliphant SS, Ghetti C, et al. Prophylactic bilateral oophorectomy or removal of remaining ovary at the time of hysterectomy in the United States, 1979-2004. Am J Obstet Gynecol 2010;202.
William H. Parker, MD. Bilateral Oophorectomy versus Ovarian Conservation: Effects on Long-term Women's health. The Journal of Minimally Invasive Gynecology. Volume 17, Issue 2, Pages 161-166 (March 2010).
http://www.cancer.gov/cancertopics/types/ovarian
http://www.cdc.gov/dhdsp/library/fs_women_heart.htm