Study: Despite Risk, OB’s Urge Ovary Removal With Hysterectomy

A new study by Massachusetts doctors underscores a common phenomenon in medicine: patients often get treatment advice that contradicts what may actually be best for them.

In this case, researchers found that “many OB/GYNs continue to advise pre-menopausal women to have their ovaries electively removed along with hysterectomies, despite indications that the benefits of retaining the ovaries may exceed risks of doing so, including ovarian cancer.”

doctor and patientThe study, co-authored by Drs. Oz Harmanli of Baystate Medical Center and Tufts University School of Medicine with Julia Shinnick, Keisha Jones, and Peter St. Marie, is summed up in the news release:

…one-third of OB/GYNs surveyed continue to recommend elective removal of the ovaries for hysterectomy candidates younger than 51 years old, and the majority recommend the procedure for hysterectomy candidates 51 to 65 years old. The procedure is seen as an effective way to head off ovarian cancer; however, the benefits of retaining the ovaries, mainly in the form of continued estrogen production and its effects on the body, may supersede any risks. The American Congress of Obstetricians and Gynecologists (ACOG) has made recommendations opposing elective ovary removal before menopause.

“We believe many women are electively having their ovaries removed based on recommendations from their doctors that may not be consistent with best practice,” said Dr. Harmanli, chief of Urogynecology and Pelvic Surgery at Baystate Medical Center. “Retaining the ovaries before menopause can confer cardiovascular, sexual and other benefits. Hormone therapy is not risk free and can’t always replace what’s lost with oophorectomy (ovary removal), and in this survey we see solid proof that the best advice is not always being given.”

Some researchers advise conservation of ovaries at the time of hysterectomy, based on some evidence that ovaries continue to help decrease mortality up to age 65. Another finding of this survey was that over 90% of OB/GYNs do not follow this advice.

Demographic characteristics of the respondents did not appear to play any role in their opinions, neither did a physician’s age, sex, location or years in practice.

The study also found that a woman’s personal history of breast cancer or a family history of ovarian cancer does affect a physician’s decisions to perform elective oophorectomy. Other factors, such as a woman’s history of osteoporosis, cardiovascular disease, sexual dysfunction, and previous contraceptive use, affect their decisions less—despite some recommendations to consider these factors.

An anonymous, self-administered survey was mailed to 1,002 randomly selected practicing obstetrician-gynecologists in the United States in April 2012.

Dr. Mache Seibel, a professor at the University of Massachusetts Medical School specializing in menopause and mental health, sent me this comment on the study via email:

This article shows the continued dilemma in getting the most recent information to both women and their doctors. While I agree that a woman with any family history of ovarian cancer or who possesses certain genetic predispositions to ovarian cancer such as the BRCA gene should strongly consider having her ovaries removed whether or not she has a hysterectomy, the dictum of decades ago that “a garden that doesn’t grow flowers grows weeds” seems totally anachronistic. This is particularly try for women between the ages of 50 and 59 as demonstrated in the July 18, 2013 issue of the American Journal of Public Health which showed that over a 10 year span, starting in 2002, between 18,601 and 91,610 postmenopausal women died prematurely because of the avoidance of estrogen therapy…

For those women who do decide to have their ovaries removed, I strongly urge them to consider estrogen therapy to lower their risk of heart disease, osteoporosis and even breast cancer.

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  • Lori

    I just had a hysterectomy in late Nov. 2013. I had everything removed except my ovaries. I had a large non-cancerous tumor on my uterus. I also had a small benign cyst on one of my ovaries, but doctors said it would go away because it was caused by bleeding as my periods were heavy……?????? I’m a little leery about that, but I went back to the doctor for my 6 months check up and the cyst was gone????? Does any one know how they disappear like that? Should I be concerned?

  • Suzy

    The prophylactic removal of ovaries is banned in England. I wish I knew this before my doctor pushed this on me. Instead of a sl ow, up-down, many-year road of menopause, I had instant (medical menopause) that has deteriorated my health. This practice should be banned in the US.

  • D. Fin

    I am post meapausal and have systs on ovaries. I’m scheduled for total hystorectomy. Removal of both ovaries, tubes, uteris, and cervix. I want to know what are my health risks after its all removed and will I have any sexual drive and sex pleasure? D. Fin

  • stefanie coppedge

    Any advice? I am a 41 yr old – I have had ovarian cysts for the last 17 years. I’ve been through laparoscopys – I’ve had 3 cysts burst in these very long 17 years. I now have the tumors on my uterus- My husband had a vasectomy years ago – we were blessed with 4 children, so having children is no longer an issue – my grandmother died of ovarian cancer – I’ve done the testing – there’s just so much information – I’m not sure what the best route is… Removing my ovaries is clearly the priority with my situation and family history – I’m just not sure on removing my uterus – a full hysterectomy- I’m scared of all of it to be honest. I don’t have any friends who have had a hysterectomy or removal of one ovary let alone both! Any advice would be great – I know the ovaries gotta go – but do I need to keep my uteres?

  • Christa Hillhouse

    I had my uterus removed (am 51) and kept my ovaries, they’re mine and I wanted them! My doctor, whom I do trust, said she would have a good look at them during surgery and if they were okay she would leave ‘em alone. I have no history of ovarian cancer in my family that I know of. Also my mom didn’t go through menopause until she was in her 60′s and I did not want to force my body into menopause. I am 4 months post-op and I feel great. Honestly I would have had my uterus removed years ago if I would have known I would feel this good without it!

  • kamwick

    At 52, I had already had breast cancer, so I was happy with the recommendation to have my ovaries removed. Less estrogen to feed cancer. However, if I had had no history of cancer, and no family history, I would definitely want to keep them if I were premenopausal. That said, some ovaries “shut down” on their own after hysterectomy…..good to have all info possible before making these decisions. Make your own decision, and no need to jump on either bandwagon.

  • Mary

    My male obgyn was wonderful. He urged me to keep my ovaries if he found during the hysterectomy they were healthy. He explained to me why I should keep them and that since my family did not have a history of cancer it would be to my benefit to keep them. I had my surgery at 47.

  • jwillis

    i also had to fight to keep my ovaries when a very large fibroid forced me to have a hysterectomy at 45. My ob/gyn (A WOMAN!) urged me strongly to have my ovaries removed…but while i have no family history of any reproductive cancers, i do have a strong family history of osteoporosis and cardiovascular disease! It seemed like common sense to me that it would be riskier to lose my ovaries than to keep them. I ended up seeking the advice of an oncological surgeon..who actually agreed with me and ended up doing my hysterectomy:-) It’s super important to take your time and think carefully about your health. You are your own best advocate.

  • LaurenG

    Wow! I’m glad I was able to keep my ovaries after having a hysterectomy. I begged my doctor to let me keep them (if they were not ravaged with fibroid tumors). Women should not be afraid to speak up and tell their doctors what they want. Doctors are very intelligent but they don’t know EVERYTHING.

    • c

      Agree. Though my doc hinted to remove them he left decision for me. After much research I decided it was best to keep my ovaries as long as they appeared normal which thankfully they were fine. Also there is a strong lack of post op exercises,care given to women. Heck folks do not even ask if you’re sexually active they just assume it. This needs to stop . A provider and patient should be open,comfortable in being open to discuss all issues pre/post operatively with each other. research ladies–be your own advocates.

    • Can’t catch a break

      Good grief. You don’t have to beg your doctor. He/she does not own your body – you do. You’ll regret if you don’t keep your ovaries which produce 15 – YES 15! – different hormones needed for your health and wellbeing – even after menopause. If your doctor doesn’t know this, fire them.