Commentary

Why conserve the ovaries if they are likely to fail?


 

References

UPDATE ON MENOPAUSE ANDREW M. KAUNITZ, MD (MAY)

Dr. Kaunitz talks about the increased risk of cardiovascular death in women younger than 45 years who undergo oophorectomy but do not initiate hormone therapy. He recommends that the ovaries be spared at the time of hysterectomy, if at all possible. He does not mention a significant study that evaluated the time from hysterectomy to ovarian failure.1 After hysterectomy, the ovarian vessels spasm, leading to an 84% decrease in ovarian perfusion. Twenty-five percent of ovaries fail within 6 months, and 40% fail within 3 years. I think this significant information should be taken into account along with the patient’s age and pelvic pathology when considering whether or not to preserve the ovaries.

Steven Drosman, MD
Genesis Center for Clinical Research
San Diego, Calif

Reference

  1. Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril. 1987;47:94-100.

Dr. Kaunitz responds: Menopause may begin early in women who retain their ovaries at hysterectomy

Not all reports have confirmed the association,1 but Dr. Drossman is correct: Onset of menopause appears to occur earlier in women who have undergone hysterectomy with ovarian conservation than it does in women whose uterus and ovaries are both intact.2-7

The clinical take-home points stemming from this observation are:

  • Be proactive in the diagnosis of early menopause and use of estrogen therapy following hysterectomy in premenopausal women
  • Counsel premenopausal women who are contemplating hysterectomy about the likelihood of early onset of menopause, including the probability that estrogen therapy will be recommended at that time.

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