By Shelagh McNally for Fibroids1“When in doubt, take them out,” has been the standard medical procedure towards ovaries during a hysterectomy. Each year in the U.S. more than 600,000 hysterectomies are performed for mostly non-cancerous reasons such as the treatment of fibroids or endometriosis. More than half of these women will have their healthy ovaries removed as a preventive measure against developing ovarian cancer. But according to a provocative new study in the August 2005 Obstetrics & Gynecology Journal, these women may be better off keeping their ovaries.
A study team, lead by Dr. William Parker, a staff gynecologist at Santa Monica-UCLA Medical Center in Los Angeles, reviewed 20 years of published data from a variety of sources and compared hypothetical groups of women between the ages of 40 and 80 years of age. They found that the probability of survival to age 80 after a hysterectomy at ages 50 to 54 went up to 62 percent for those who kept their ovaries but was only 53 percent for those who had an automatic oophorectomy (removal of the ovaries). Overall, the younger a woman was when her ovaries were removed, the lower her chances were for reaching 80 years old. The study also found that while removing the ovaries does eliminate the risk of cancer, a woman loses the healthy benefits of estrogen produced by the ovaries. Keeping the ovaries reduced the percent of women dying by age 80 of heart disease from 15 percent to 7 percent, and those dying of hip fractures from nearly 5 percent to 3 percent.Although the American College of Obstetricians and Gynecologists recommends any oophorectomy be tailored to the individual, the standard approach has become to perform protective oophorectomies on any women after age 45 during a hysterectomy. In 1965 only 25 percent of women undergoing hysterectomies had their ovaries removed but by 1999 that figure had crept up to 55 percent. Many surgeons still feel that the only protection against ovarian cancer is to remove them completely since there is no way to screen for this particular kind of cancer. 'That's similar to saying, 'You might as well remove the elbow so you won't get tennis elbow.' It's true, but at what price?" said Winnifred Cutler, a reproductive biologist and founder of The Athena Institute, a research institute in Chester Springs, Pennsylvania. Cutler first questioned the validity of removing healthy ovaries back in 1984 and her findings were considered quite controversial at the time.
Parker’s study also found that women who had hysterectomies but kept their ovaries reduced their chances of developing ovarian cancer by 40 percent as compared with women who did not have hysterectomies and did not have their ovaries removed. "If you take out the ovaries, the risk of ovarian cancer goes to zero but you lose the protection against heart disease and the prevention of osteoporosis. Twenty-five times more women die from heart disease every year than from ovarian cancer and as many as 18,000 women a year may die prematurely because of ovarian surgery,” commented Parker.
Ovaries remain a vital part of the body even past menopause, pumping out estrogen, testosterone and androstenedione needed for a healthy heart and strong bones. “There never was any good evidence that taking out ovaries was a good idea, yet doctors did it anyway,” said Judy Norsigian, director of Our Bodies, Ourselves, a non-profit women's health advocacy group in Boston.
With the growing concern about automatic oophorectomies, many doctors are exploring alternative treatments and are strongly recommending you seek a second opinion. "I advise any woman who is not in a life-threatening situation to see someone else besides a surgeon to explore non-surgical options first," said Cindy Pearson, executive director of the Washington, D.C.-based health advocacy group, National Women's Health Network.
