- Researchers say the removal of ovaries during a hysterectomy may increase the risk of heart disease in younger women.
- They add that ovary removal also heightened the risk of cancer in older women.
- Experts say the removal of ovaries may not be necessary for women at low risk for cancer.
Removing ovaries during a benign hysterectomy might increase the risk of developing cardiovascular disease in premenopausal women as well as the risk of cancer in postmenopausal women.
That’s according to a study published today in Annals of Internal Medicine.
Researchers examined the medical records of nearly 143,000 women who underwent a benign hysterectomy.
They compared the long-term outcomes of those who had a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes) to those who did not. A benign hysterectomy is done for non-cancerous reasons.
The researchers reported that women with their ovaries removed had a lower risk of ovarian cancer, but other health conditions could develop. These varied based on age and menopause status.
For women who had ovaries removed at the time of their hysterectomy, the findings included the following:
- a higher risk of hospitalization due to cardiovascular disease in premenopausal women
- perimenopausal and postmenopausal women had a higher risk of developing cancer
There were also more deaths when measured at 10 and 20 years after surgery, except for women over 65 after 20 years.
The researchers noted that these results suggest physicians should adopt a cautious approach to removing ovaries in women at low risk of developing ovarian cancer.
“The study results 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,” Swarup told Healthline.
Pros and cons of removing ovaries
A salpingo-oophorectomy is the removal of the ovaries and fallopian tubes.
A woman can also have just a salpingectomy, which is the removal of the tubes, or an oophorectomy, which is the removal of the ovaries.
There is an option to remove just one ovary or one fallopian tube, but those particular surgeries were not covered in the study.
An oophorectomy is sometimes the treatment for:
- pelvic inflammatory disease
- chronic pelvic pain
- ectopic pregnancy
- benign tumors
- large ovarian cysts
The procedure can also reduce the risk 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.”
The average age of menopause in the United States is 51 years old, according to the North American Menopause Society.
There are some risks of removing the ovaries, according to Breastcancer.org:
- the start of early menopause, which can increase the risk of osteoporosis
- decreased sex drive and vaginal dryness
- physical symptoms such as joint pain, heart palpitations, muscle spasms, insomnia, urinary tract or yeast infections, and urinary incontinence
- emotional symptoms, such as anxiety, depression, and mood swings
“My current recommendation is ovarian preservation up to age 60,” said Dr. G. Thomas Ruiz, and] 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.
Dr. Adi Katz, the director of gynecology at Lenox Hill Hospital in New York has been removing the fallopian tubes only up until age 65, unless there is a medical reason to remove the ovaries, such as genetic mutation or advanced endometriosis.
“In my practice I have been performing removal of the fallopian tubes during hysterectomy since I finished fellowship in 2012,” Katz told Healthline. “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 affects cardiovascular risk
“Estrogen has a protective effect on the cardiovascular system once women undergo menopause their risk of heart attack increase,” Katz explained. “Estrogen has an effect on cholesterol, blood vessels dilation and flow.”
In a study conducted in China, researchers reported that women who had hysterectomies with ovary and tubal removal had an almost 20% higher risk of cardiovascular disease and ischemic stroke than women who did not have surgery.
“Removing ovaries in a younger woman 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. This would lead to increased LDL and lower HDL, increasing cardiovascular disease risk.”
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