Oophorectomy in young women may not be so harmful



One headline in the Update on Menopause was misleading. It said: “Bilateral oophorectomy raises young women’s risk of cardiovascular death.” In the article itself, in much finer print, it was explained that the mortality rate does not rise if the woman is given hormone replacement therapy immediately after oophorectomy and continues to take it until she is at least 45 years old.

The article does not mention the rather severe surgical difficulties that are often encountered when a physician attempts to remove the ovaries after hysterectomy. I’m sure every gynecologic surgeon has had numerous cases in which the ovaries were plastered to the posterior peritoneum, immediately adjacent to the ureters. These cases are technically difficult and dramatically increase the risk of ureteral injury—and subsequent lawsuit. Also relevant is the fact that there is an incidence of ovarian cyst formation of about 20% in the years following hysterectomy, necessitating oophorectomy. It is important that the patient be informed of this possibility during counseling.

The happiest posthysterectomy patients I have cared for are those who undergo concurrent bilateral salpingo-oophorectomy and spend years comfortably taking estrogen.

David Priver, MD
San Diego, Calif

Dr. Kaunitz responds:

The ovaries can be preserved at many hysterectomies

Dr. Priver appropriately points out that, in some cases, oophorectomy at the time of hysterectomy may be safer for the patient than ovarian conservation. Concomitant oophorectomy at the time of hysterectomy for benign disease may be indicated for a number of reasons, including endometriosis, BRCA mutation, or, as Dr. Priver indicates, surgical or anatomic reasons. However, in many cases, none of these indications are present. As obstetrician-gynecologists, we cannot always predict whether a young surgically castrated woman will be compliant with estrogen therapy over years or even decades. Given this uncertainty and growing evidence of the risks associated with concomitant oophorectomy in young women, gynecologic surgeons should hesitate to remove the ovaries at the time of hysterectomy unless a specific indication is present.

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