For about 50 years, gynecologists have been recommending the surgical removal of healthy ovaries in women who undergo a hysterectomy for reasons unrelated to cancer. The advice is based on the fact that ovarian cancer is difficult to diagnose until it is advanced, as well as a blatant disregard for the usefulness of the ovaries once a woman has all the children she wants.

A new study shows that this longstanding practice causes two health improvements (fewer cases of ovarian and breast cancers), but more harms (an increased risk of death from all causes, fatal and non-fatal heart disease, and lung cancer). In other words, the women who kept their ovaries lived longer.

The findings are based on data from nearly 30,000 participants of the famed Nurses’ Health Study who had a hysterectomy for benign disease. More than half had a hysterectomy with bilateral oophorectomy (removal of both ovaries); and 44% had a hysterectomy with ovarian conservation. The participants periodically filled out an extensive questionnaire about their health status and were followed over a 24-year period. Results were published this month in the journal Obstetrics & Gynecology.

The women who fared the worst were those who had a bilateral oophorectomy before the age of 50 years and did not go on estrogen replacement therapy. They had an increased risk of all-cause mortality, heart disease, and stroke. “With an approximate 35-year life span after surgery,” estimated the authors, “one additional death would be expected for every nine oophorectomies performed. In no age group was oophorectomy associated with increased survival,”

The authors noted that ovarian cancer is rare. About 1% of American women will die of ovarian cancer.

Maryann Napoli, Center for Medical Consumers© May 2009

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