Ovaries,Hysterectomy
| Conserving ovaries at hysterectomy may boost long-term survival |
By Megan Rauscher
NEW YORK (Reuters Health) – The results of a Markov decision analytic model indicate that leaving both ovaries intact in women 65 years old or younger has long-term survival benefits in patients at average risk for ovarian cancer who undergo hysterectomy for benign disease.
“Prophylactic oophorectomy is often recommended concurrent with hysterectomy for benign disease,” Dr. William H. Parker from the University of California, Los Angeles, and colleagues note in the August issue of Obstetrics and Gynecology.
The model they developed, however, shows that women who undergo oophorectomy before age 55 have 8.58% excess mortality by age 80. Those who undergo oophorectomy before age 59 have 3.92% excess mortality.
There is “sustained, but decreasing,” benefit of ovarian conservation until the age of 75, “when excess mortality for oophorectomy is less than 1%,” the authors report. “These results were unchanged following multiple sensitivity analyses and were most sensitive to the risk of coronary artery disease,” according to the team.
“The important point,” Dr. Parker said, “is that gynecologists who have been looking at the issue of oophorectomy have focused on one thing — ovarian cancer. Women are living longer and the major killer of women is heart disease, taking 25 times more women’s lives than ovarian cancer.”
“The ovaries produce testosterone and androstenedione for 30 years after menopause,” he continued, “and these hormones are converted into estrogen, continuing the protection of the heart and bones. So, I think we need to look at the bigger picture, including the long-term implications of oophorectomy.”
“Our study shows that oophorectomy may be harmful if performed before age 65 and may be of no benefit at any age,” Dr. Parker told Reuters Health. “These results, of course, do not apply to women at high risk of ovarian cancer,” he emphasized.
Obstet Gynecol 2005;106:219-226.