Midlife and Menopause

Hysterectomy and Ovarian Conservation

The following article, written by William Parker, MD gives an overview of a research study he and his colleagues conducted to look at the long-term survival of women who had hysterectomies.

Women often have their healthy ovaries removed when they are having a hysterectomy in order to prevent ovarian cancer from developing in the future.  About 50% of women who have a hysterectomy between ages 40-44 have their ovaries removed, and 78% of women between ages 45-64 undergoing a hysterectomy have their ovaries removed.  All together, about 300,000 American women have their healthy ovaries removed every year.

If the ovaries are removed before menopause, a sudden decrease in the hormones made by the ovaries, including estrogen, testosterone and androstenedione, results.  Even after a woman enters menopause, her ovaries continue to make considerable amounts of testosterone and androstenedione, which are then changed into estrogen by other cells in the body. 

Some studies had already show that women who keep their ovaries have a lower risk of heart disease.  While ovarian cancer accounts for 14,700 deaths per year in the U.S., heart disease causes 326,900 deaths, and stroke causes 86,900 deaths each year.  If a woman is not at high risk for ovarian cancer, then keeping the ovaries might benefit her overall health and survival.

We designed a study to see whether it was better for women who needed a hysterectomy to keep their ovaries or have them removed during the surgery to remove the uterus.

The Study

We used the database from the Nurses’ Health Study (NHS), which included 122,700 registered nurses in 1976 when it began.  Over the past 24 years, 29,380 of the women had a hysterectomy for benign (noncancerous) reproductive disease.  Of these women, 16,345 had a hysterectomy and removal of their ovaries (oophorectomy), and 13,035 had a hysterectomy with ovarian conservation (ovaries kept).  We considered what diseases and conditions the women had, or died from, in the years after their surgery. The results showed that women who had their ovaries removed had a higher risk of death from any cause, primarily from heart disease and lung cancer.  Removing the ovaries at any age did not improve life-span for this group of women. 

During the 24 years of follow-up, 34 of the 13,305 women (0.26%) who kept their ovaries died from ovarian cancer. While breast cancer and ovarian cancer were less frequent in women who had their ovaries removed, the overall risk of death from all types of cancer was higher among women who had their ovaries removed. There was 25% less breast cancer in woman who had their ovaries removed, but no difference in death from breast cancer (with early detection and treatment, most woman – about 75% - survive breast cancer).

When we considered just the women who never used estrogen therapy after surgery, we found that women who had their ovaries removed had a higher risk of stroke and lung cancer, and women who had their ovaries removed before age 50 had a higher risk of heart disease, stroke and death from any cause.

Interpretation

For the past 35 years, doctors have recommended that women who needed a hysterectomy also consider having their ovaries removed in order to prevent the future development of ovarian cancer.  Since ovarian cancer is difficult to detect and difficult to cure, most women having a hysterectomy chose to have their ovaries removed as well.

Our study questions the routine removal of women’s ovaries by showing that heart disease, stroke and lung cancer are more common in women who have their ovaries removed.  And, since heart disease, stroke, and lung cancer are each much more common than ovarian cancer, more women who have their ovaries removed will die of these conditions than can be saved from getting ovarian cancer.

As is true with all medical decisions, it is important to discuss these issues with your doctor.  People often make very different decisions based on the same medical information.  Certainly, women with a strong family history of ovarian cancer, or women who know they have the genetic mutation (BRCA) that greatly increases their risk of ovarian and breast cancer, should strongly consider having their ovaries removed. If you have a family history of heart disease or stroke, maybe keeping your ovaries makes more sense. 

You can find additional information about the research here and here.

The full citation for this study is:

Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses’ Health Study.  William H. Parker, Michael S. Broder, Eunice Chang, Diane Feskanich, Cindy Farquhar, Zhimae Liu, Donna Shoupe, Jonathan S. Berek, Susan Hankinson, JoAnn E. Manson.  Obstetrics & Gynecology, Vol. 113, No. 5, May 2009.

Written by: William Parker, MD
Last revised: April 2009

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