Ovarian Conservation Versus Removal at the Time of Hysterectomy for Benign Gynecological Diseases
American Journal of Clinical and Experimental Medicine
Volume 2, Issue 2, March 2014, Pages: 36-41
Received: Mar. 29, 2014;
Accepted: Apr. 9, 2014;
Published: Apr. 20, 2014
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Tarafdar Runa Laila, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Sheikh Salahuddin Ahmed, Bangladesh Institute of Health Sciences (BIHS), Dhaka, Bangladesh
Khairun Nahar, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Parveen Akhter Shamsunnahar, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Sharmeen Mahmood, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Saleha Begum Chowdhury, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Hysterectomy for benign gynecological diseases is a common surgical procedure. Prophylactic bilateral oophorectomy is often recommended concurrent with hysterectomy to decrease the risk of ovarian cancer. Oophorectomy before menopause leads to an abrupt decrease in endogenous estrogen and androgen production leading to different health problems. So women undergoing hysterectomy for benign gynecological diseases are presented with the choice of ovarian conservation or removal. The purpose of this review article is to summarize and critically evaluate the existing evidences regarding the impact of ovarian conservation versus removal on specific health issues of the individual. Information was collected by searching pub med for related studies, abstracts and articles. Studies have shown that benefits of elective oophorectomy also include reduction of breast cancer and development of residual ovary syndrome. On the other hand bilateral oophorectomy is associated with increased risk of cardiovascular disease, osteoporosis, cognitive impairment, dementia, depression, anxiety and decreased sexual function. Estrogen was commonly prescribed after bilateral oophorectomy to treat menopausal symptoms. But recent studies have shown more harm than benefit in postmenopausal hormone therapy. So the decision making regarding elective oophorectomy at the time of hysterectomy for benign indications has become complex. The approach to such decision will include counseling regarding risks and benefits of the procedure and shared decision making between the clinician and the patient. The beneficial effect on ovarian cancer must be weighed against the risks of ovarian hormone withdrawal.
Tarafdar Runa Laila,
Sheikh Salahuddin Ahmed,
Parveen Akhter Shamsunnahar,
Saleha Begum Chowdhury,
Ovarian Conservation Versus Removal at the Time of Hysterectomy for Benign Gynecological Diseases, American Journal of Clinical and Experimental Medicine.
Vol. 2, No. 2,
2014, pp. 36-41.
Hickey M, Ambekar M, Hammond I. Should the ovaries be removed or retained at the time of hysterectomy for benign disease. Human Reproduction Update 2010;16(2):131-141.
Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States 2003. Obstet Gynecol 2007;110:1091-1095.
Bourdrez P, Bongers MY, Mol BW. Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel releasing intrauterine device or hysterectomy. Fertil Steril 2004;82: 160-166.
American Cancer Society, Cancer reference information 2009; Available at http://www.cancer.org (Accessed October 20, 2013).
Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol 2008; 198(1) 34.e1-34.e7.
Jacoby VL, Vittinghoff E, Nakagawa S, Jackson R, Richter HE, Chan J, et al. Factors associated with undergoing bilateral salpingo-oophorectomy at the time of hysterectomy for benign conditions. Obstet Gynecol. Jun 2009;113(6):1259-67.
Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, et al. Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004;291 (14) 1701- 1712.
Labrie F, Martel C, Balser J. Wide distribution of the serum dehydroepiandrosteron and sex steroid levels in postmenopausal women: role of the ovary? Menopause 2011; 18:30-43.
Lasley BL, Crawford SL, Laughlin GA, Santoro N, McConnell DS, Crandall C, et al. Circulating dehydroepiandrosterone sulfate levels in women who underwent bilateral salpingo-oophorectomy during the menopausal transition. Menopause 2011;18:494-8.
Fogle RH, Stanczyk FZ, Zhang X, Paulson RJ. Ovarian androgen production in postmenopausal women. J Clin Endocrinol Metab 2007; 92:3040-43.
Bukovsky I, Halperin R, Schneider D. Ovarian function following abdominal hysterectomy with and without unilateral oophorectomy. Eur J Obstet Gynecol Reprod Biol, 1995; 58(1):29-32.
Jacoby VL, Grady D, Wactawski-Wende J, Manson JE, Allison MA, Kuppermann M, et al. Oophorectomy vs ovarian conservation with hysterectomy: cardiovascular disease, hip fracture and cancer in the Women’ s Health Initiative observational study. Arch Intern Med. 2011; 171(8):760-768.
National cancer Institute. SEER Stat Fact Sheets: Ovary Cancer. Available at http://seer.cancer.gov/statfacts/html/ovary.html (Accessed on September 24, 2013)
14. Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case -control studies.IV. The pathogenesis of epithelial ovarian cancer. Collaborative Ovarian Cancer Group. Am J Epidemiol 1992; 136:1212.
Parkar WH, Broder MS, Chang E, Feskanich D, Farquhar C, Liu Z, et al. Ovarian conservation at the time of hysterectomy and long term health outcomes in the nurses’ health study. Obstet Gynecol 2009; 113:1027-37.
16. Dekel A, Efrat Z, Orvieto R , Levy T, Dicker D, Gal R et al. The residual ovary syndrome: a 20-year experience. Eur J Obstet Gynecol Reprod Biol 1996; 68:159-164.
Plockinger B, Kolbl H. Development of ovarian pathology after hysterectomy without oophorectomy. J Am Coll Surg 1994;178:581-5.
Salim R, Gray G, Chappatte OA. The feasibility and efficacy of laparoscopic oophorectomy in the management of pelvic pain after hysterectomy. J Obstet Gynecol 2007; 27 :718-20.
Lobo RA. Surgical menopause and cardiovascular risks. Menopause 2007; 14:562-566.
Kannel WB, Hjortland MC, McNamara PM, Gordon T. Menopause and risk of cardiovascular disease: the Framingham study. Ann Intem Med 1976; 85: 447-452.
Allison MA, Manson JE, Langer RD, Carr JJ, Rossouw JE, Pettinger MB, et al. Oophorectomy, hormone therapy, and subclinical coronary artery disease in women with hysterectomy: the Women’s Health Initiative coronary artery calcium study. Women’s Health Initiative and Women’s Health Initiative Coronary Artery Calcium Study Investigators. Menopause 2008;15:639–47.
Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 2006; 13 :1021-1028.
Lokkegaard E, Jovanovic Z, Heitmann BL, Keiding N, Ottesen B, Pedersen AT. The association between early menopause and risk of ischaemic heart disease: influence of hormone therapy. Maturitas 2006;53:226-233.
Rocca WA, Grossardt BR, Maraganore DM. The long term effects of oophorectomy on cognitive and motor aging are age dependent. Neurodegener Dis 2008; 5:257-260.
Rocca WA, Bower JH, Maraganore DM, Ahlskog JE, Grossardt BR, de Andrade M et al. Increased risk of parkinsonism in women who underwent oophorectomy before menopause. Neurology 2008; 70(3):200-9.
Hicky M, Davis SR, Sturdee DW. Treatment of menopausal symptoms: what shall we do now? Lancet 2005;366:409-421.
Shuster LT, Gostout BS, Grossardt BR, Rocca WA. Prophylactic oophorectomy in premenopausal women and long term health. Menopause Int 2008; 14:111-116.
Shoupe D, Parker WH, Broder MS, Liu Z, Farquhar C, Berek JS. Elective oophorectomy for benign gynaecological disorders. Menopause 2007; 14:580-5.
Reed SD, Goff B. elective oophorectomy or ovarian conservation at the time of hysterectomy-updated on Oct 19 2012. Available from: http://www.uptodate.com/contents/elective-oophorectomy-or-ovarian-conservation-at-the-time-of-hysterectomy. (Accessed on September 04, 2013)
Davis SR, Davison SL, Donath S, Bell RJ. Circulating androgen levels and self- reported sexual function in women. JAMA 2005;294:91-96.
Shifren JL, Avis NE. Surgical menopause: effects on psychological well-being and sexuality. Menopause2007;14:586-591.
Nathorst-Boos J, Von-Schoultz B,Carlstrom K. Elective ovarian removal and estrogen replacement therapy—effects on sexual life, psychological well-being and androgen status. J Psychosom Obstet Gynaecol 1993; 14:283-293.
Kotz K, Alexander JL, Dennerstein L. Estrogen and androgen hormone therapy and well-being in surgically post menopausal women. J Womens Health(Larchmt)2006;15:898-908.
Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet.2002;360:1903-1913.
Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345:1291-1297.
Li CI, Malone KE, Porter PL, Weiss NS, Tang MT, Cushing-Haugen KL, et al. Relationship between long durations and different regimens of hormone therapy and risk of breast cancer. JAMA.2003;289:3254-3263.
Greendale GA, Reboussin BA, Sie A. Effects of estrogen and estrogen-progestin on mammographic parenchymal density. Ann Intern Med.1999;130:262-269.
FDA News Release. FDA updates hormone therapy information for postmenopausal women. February 10, 2004. Available at http://www.fda.gov/bbs/topics/NEWS/2004/NEW01022.html (Accessed November 5, 2013).
Parker WH, Broder MS, Liu Z, Shoupe D, Farquhar C, Berek JS. Ovarian conservation at the time of hysterectomy for benign disease. Obstet Gynecol 2005; 106:219-26.
ACOG. ACOG Practice Bulletin No. 89. Elective and risk-reducing salpingo-oophorectomy. Obstet Gynecol 2008; 111:231-41.