Should You Have Your Ovaries Removed at the Time of Hysterectomy?: One Day your Ovaries are IN, the next day they are OUT!

If you have a hysterectomy for a cancer of the ovary, the ovaries do need to be removed for the most successful treatment. However, medical teaching has led us to feel one day ovaries are in, and then the next day they are out! But there are some important considerations. At the time of hysterectomy many women need the ovaries removed because of the same medical problem that led them to need a hysterectomy. The removal of both ovaries is called bilateral salpinoophorectomy or BSO
But some women are focused on the fact that 1/70 women will get ovarian cancer in their lifetime, and ovarian and tubal removal will reduce this number significantly. Breast cancer patients may do better with ovarian removal and that is another reason that is a good reason to have your ovaries removed at the time of hysterectomy.

In the Nurses Health Study, published in Obstetrics and Gynecology April 2013, they have begun to look very closely at what happens to women make a decision to just have their ovaries out, electively at the time of hysterectomy,  Studies show that about 50% of women having a hysterectomy, with no specific reason to get their ovaries out, will decide to have their ovaries removed as well. For some they are making this decision based on age, for others based on whether the ovaries are involved with the disease leading to the hysterectomy, and for others it's based on perceived risk. Those with a strong family history of either ovarian or breast cancer should really have their ovaries removed if having a hysterectomy, endometriosis may be better treated with ovarian removal, and chronic pelvic infections may also be best treated with ovarian removal. For the rest it's a matter of discussion.  You might want to think about how close you are to menopause and the natural time the ovaries stop producing hormones. Women, on the average, will go through menopause about 8-9 years after a hysterectomy if their ovaries are removed in their 30s or 40s and are before their natural age of menopause.

The Nurses Health Study reminds women not to look just at the benefits, but look at the risks. With ovarian removal at the time of hysterectomy women are at increased risk of death from coronary heart disease, lung cancer and colorectal cancer, and overall: a 13% increased risk of all cause mortality. These numbers are greater the younger a woman is at the time she loses her ovaries.

This is in contrast to an older study comes out that says, yes women should have their ovaries removed at the time of hysterectomy. Vanessa L. Jacoby, MD, MAS, of the University of California San Francisco, and colleagues studied 25,000 women to come to this conclusion.

Women with specific risk factors can benefit from taking the ovaries out more than just the average woman. In a study reported in May of 2014 called the it was found that BRCA1 and BRCA2 women reduced their overall death rate by 77% if they had ovarian removal. This study was sponsored by the Canadian Breast Cancer Research Alliance and the National Institute of Health and the Ontario Ministry of Research and Innovation. 

Should you remove your ovaries at the time of hysterectomy? Well there are good medical reasons to remove them:1. Non-cancerous cysts or tumors that cannot be treated by partial removal, 2. Twisting (called torsion) and death of the ovary and tube, usually occurs if you have pelvic scaring, 3. Cancer of the ovary(s), 4. Abscess or infection that is not responding to treatment, 5. Final endometriosis surgery, 6. Extreme risk of ovarian cancer due to family or known genetic risk factors, to name a few of the good reasons to have ovaries removed in the right cases. "Softer" risk factors like more distant family members having ovarian cancer have been used for advocating removal. In other cases, if you have used birth control pills or had a tubal ligation in the past you are at less risk to ever get cancer, and maybe you should keep your ovaries.

And you do have to consider hormone therapy if you have ovarian removal with hysterectomy. But what about "just because." Hundreds of thousands of women have lost their ovaries because they were removed when the uterus was removed at hysterectomy. In fact once "over 40" then "over 50" then "over 65" was sort of considered "time" to just take them out at hysterectomy time before they became diseased (1/70 is about the American rate of cancer of the ovaries for these type of women). So once they were "OUT"! And fashions do shift, even in Gyno Gab world: in 2013 they are now: IN? It was thought that it would be healthier for your heart and longer life if you leave them IN! But the newest study said it prevents ovarian cancer, but mostly in women who had their ovaries out before age 40, and they couldn't demonstrate less heart disease just for leaving them in.They didn't see effects much different on ovarian cancer if women used hormone therapy. But the researchers went on to validate what we have recently telling women saying :"Given the very low rate of ovarian cancer after hysterectomy with ovarian preservation, BSO may provide minimal additional benefit," they wrote. They also noted that their findings contradicted those seen in another large cohort, the Nurses' Health Study, suggesting that the safety of BSO may not yet be finally resolved. So revisit that ovarian removal plan with your MD if you have to have a hysterectomy. Because ovaries are "IN!


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