“UPDATE ON MENOPAUSE” ANDREW M. KAUNITZ, MD (MAY 2009)
In the August 2009 installment of Comment & Controversy, a letter from David Priver, MD, was incorrectly edited. The letter should have read as follows:
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 stands by his original reply to this letter, which requires no alteration in response to this correction.