You’re having a hysterectomy. Should your ovaries be removed, too?

Until quite recently, women over the age of 40 to 45 were routinely recommended to have their healthy ovaries removed at the time of hysterectomy. The common wisdom was, “Just take them out, what do you need them for anyway?”

Well, we now know our ovaries produce meaningful hormones for us both before and after menopause. So why remove ovaries?

The only reason to remove normal, healthy ovaries is for the prevention of ovarian cancer and for hormonal ablation (ridding a woman’s body of estrogen). For most healthy women who are facing a hysterectomy or other pelvic surgery in which a bilateral oophorectomy (removal of both ovaries) is being entertained, a thorough discussion with the surgeon should be undertaken in which the risks, benefits, and alternatives to surgical options are reviewed.

In the not-too-distant past, women whose ovaries were routinely removed at the time of hysterectomy were also recommended to use hormone replacement therapy to control menopausal symptoms and prevent cardiac disease. But this was in the days before the Women’s Health Initiative Study. This study not only raised significant safety issues concerning the use of post-menopausal estrogen, but also raised issues concerning the ability of estrogen to protect against cardiac disease.

In 2009, the routine removal of ovaries could no longer be recommended. A sentinel study was published that demonstrated that removal of the ovaries can increase the risk of cardiac disease and death long term.

It is important to remember that cardiac disease is still the leading cause of death in women—not cancer. Each year 14,700 women will die from ovarian cancer, but heart disease causes 327,000 deaths a year—more than 20 times the ovarian cancer death rate. This study of 30,000 women found that in women whose ovaries were removed, the risk of long term death overall increased by 12%, the risk of heart disease increased by 17%, and the risk of lung cancer increased by 26%. These adverse effects of bilateral oophorectomy are presumably due to the lack of estrogens and androgens that are produced by the ovary, even after menopause.

It’s true that the risk of ovarian cancer and breast cancer is decreased if women remove their ovaries. But for most healthy women who are not at elevated risk for breast or ovarian cancer, the risks of routinely removing the ovaries may outweigh the benefit. Any woman who is considering having her ovaries removed should thoroughly review with her physician and surgeon her individual risk for developing breast and ovarian cancer. The evaluation of risks and benefits of removal of the ovaries should include a discussion of cardiac risk and elevated risk for death overall of the ovaries are removed. Women who have a genetic predisposition to ovarian cancer or breast cancer, a family history of breast or ovarian cancer, or a personal history of breast cancer will need to carefully consider bilateral oophorectomy.