Surgery in Operating Room

Early Removal of Ovaries

The University of Warwick has found through a study that there is a link between the removal of ovaries during hysterectomy and an increase in heart disease, cancer and premature death. This is the largest study of this kind conducted on the subject and covered a 10-year period comparing women who were treated for a benign disease that had both ovaries removed with those who had one or none removed. About 113,679 cases of women aged 35-45 from April 2004 to March 2014 were reviewed. Both ovaries were removed from 1/3 of these patients. The results of this study have been published in the BMJ.

Results were that those women who had one or no ovaries removed were less likely to develop ischemic heart disease (coronary artery disease) or cancer after hysterectomy than those that had both of the ovaries removed. They also found that fewer of the women who retained one or both ovaries compared to those having both removed, died within the duration of the study.

The researchers believe premenopausal women should be advised that this benefit comes at the cost of an increased risk of cardiovascular disease and other cancers and mortality when both ovaries are removed, even though this does protect against subsequent development of ovarian cancer.

Richard Lilford, Professor of Obstetrics and Gynecology and Chair in Public Health at the University of Warwick’s Warwick Medical School, led this particular study. He indicated that the combination of biological plausibility and the massive effect size make a compelling case that women be advised that their risk of ovarian cancer is greatly reduced by surgical removal of both ovaries. Also that the lifetime risk of developing ovarian cancer is 1 in 52 in the UK, and the removal of a metabolically active organ as the ovary may have harmful effects in the long term. Therefore, these long-term disadvantages must be offset by the benefit offered by protection from ovarian cancer.

A national database of hospital admissions that were examined revealed that 40% of women with no specific risk factors for reproductive cancer had their ovaries removed during abdominal hysterectomy in the 35-45 age group. They believe that this might be a higher amount than expected among those women who were aware of the worse health outcomes with bilateral removal. This would possibly decline as the health risks that must be traded for a reduced incidence of ovarian cancer comes into focus as revealed to the women.

There has been a slow decline in the number of hysterectomies performed from 9,000 women in 2014 compared to 13,000 in 2004-5. The data available wasn’t as detailed as the researchers would have liked, however they plan to re-examine the data at a later date to examine trends over the long term.

Dr Fredda Branyon

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