More than half of the American women who undergo hysterectomy (surgical removal of the uterus) opt to have their ovaries removed at the same time to reduce ovarian cancer risk. But: New research casts doubt on the wisdom of this. Reasons: Ovarian cancer, though potentially deadly, is relatively rare… and ovary removal increases other health risks, especially for women who have not yet reached natural menopause.
Recently, my colleagues and I published results from a study of 29,380 women who had undergone hysterectomy. Compared with women who had intact ovaries, those who’d had their ovaries removed were 25% less likely to get breast cancer and rarely if ever got ovarian cancer — but they were 17% more likely to develop heart disease and 12% more likely to die during the 24-year follow-up. Among women who never took estrogen, ovary removal before age 50 was associated with double the risk for heart disease and stroke and a 40% increased risk for death. Also…
- A Mayo Clinic study of 4,748 women found a 44% higher risk of dying from cardiovascular disease and a 67% higher overall mortality rate in those whose ovaries had been removed before age 45 than in women who had intact ovaries. Additional research found that ovary removal before menopause increased the risk for bone fracture, cognitive impairment, tremors and declines in sexual function. Estrogen therapy appeared to prevent many, but not all, of these negative outcomes (though estrogen use carries its own risks).
- Analysis of data from several studies found that ovary removal before age 65 increased a woman’s chance of dying before age 80 by 8.5%. Revealing: Researchers estimated that, in a hypothetical group of 1,000 women whose ovaries were removed at ages 50 to 54, compared with a similar group of women with intact ovaries, 84 more women would die from heart disease and 16 more would die from complications of hip fracture by age 80… only five fewer would die from ovarian cancer.
Why: After menopause, ovaries continue to produce hormones (at lower levels), including androgens that convert to estrogen in fat and muscle cells. Loss of these hormones may contribute to the negative effects of ovary removal.
Recommended: It may be prudent to remove ovaries if genetic testing and/or family history suggest a high risk for ovarian cancer or types of breast cancer linked to ovarian cancer. Otherwise, if facing hysterectomy, consider keeping your ovaries — especially if you are premenopausal.
What if your ovaries already were removed? Talk to your doctor about the pros and cons of estrogen therapy, as well as ways to minimize your risk for heart disease and osteoporosis.
