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Ovaries after hysterectomy – keep or lose? More study needed
April 26th, 2011
12:02 PM ET

Ovaries after hysterectomy – keep or lose? More study needed

A new study in the Archives of Internal Medicine finds that removing the ovaries during a hysterectomy is not bad for the heart, contrary to what other studies have found.

When a woman has a hysterectomy, surgery to remove the uterus, a decision has to be made about whether to also remove the ovaries. Doctors have known for years that taking out the ovaries reduces the risk of ovarian cancer but various studies have found conflicting results when it comes to the risks and benefits to the heart and bones.

This study looked at more than 25,000 women who are enrolled in the Women's Health Initiative, a long-term study sponsored by the National Institutes of Health. The researchers found that women who had their ovaries removed  were no more likely to suffer or die from heart trouble, hip fractures or cancer than women who kept their ovaries.

But the lead researcher is quick to point out that there is no right answer for everyone.

"It's a personal decision and I recommend that women speak to their doctor about the risks and benefits and make an informed decision based on an individual basis," says Dr. Vanessa Jacoby with the Departments of Obstetrics and Gynecology at the University of California, San Francisco.

About 600,000 women each year undergo hysterectomy to relieve abnormal uterine bleeding, to remove fibroids or for other health reasons. After cesarean delivery, hysterectomy is the second most common surgery performed in women of child-bearing age in the United States. About half of all women who undergo the surgery have their ovaries removed, with higher rates in women who are older. But there is concern that the change in hormones after the procedure may increase the risk for osteoporosis, heart disease and stroke. To combat this, doctors used to advise women to take hormone replacement therapy to boost hormone levels, but with the more recent reports of health risks from HRT, based on data from the same Women's Health Initiative, this practice has fallen out of favor.

But these new findings about heart health directly contradict an earlier study, which, like this one, is large and highly reputable. The Nurses' Health Study found that women who had their ovaries removed when they got a hysterectomy were in fact more likely to die from heart disease and stroke, especially younger women under the age of 50. So what should women do?

The American College of Obstetricians and Gynecologists recommends ovaries be removed during hysterectomy for postmenopausal women who have a family history of ovarian cancer. Younger women with no such family history are encouraged to keep their ovaries.

The author of an accompanying editorial says the conflicting data from these two large studies highlights the importance of talking to your doctor about a family history of heart disease or ovarian cancer.

"What may be right for a younger woman with heart disease in her family might be a different decision than a young woman without heart disease in her family, or somebody who might already have osteoporosis," explains Lauren Arnold, epidemiologist from Washington University School of Medicine in St. Louis, Missouri.

Jacoby says we may not have all of the answers until researchers conduct the highest quality study possible, a randomized clinical trial.


soundoff (47 Responses)
  1. gagirl

    My mother had a partial hysto and left her ovaries in. Two years later she developed ovarian cancer..two years later she died from the cancer...this is a cancer that often gets overshadowed by breast cancer but is just as deadly. Any studies and research that can be done to find a cure....I'm all for.

    April 26, 2011 at 13:07 | Report abuse | Reply
    • redsmom

      My mom died of ovarian cancer too age at 54, I am 35 and have considered having my ovaries removed too, done having kids, but have been told to leave them in for a while due to the hormonal issues. but it freaks me out having them still inside me! decisions decisions

      April 26, 2011 at 16:20 | Report abuse |
  2. francisc

    I had a complete hysterectomy at 48, due to fibroids. My gyne advised taking everything, due to my age. When the pathology was done, they found a rare cancer – cancer of the fallopian tubes. Taking everything saved my life. I still had to have chemo, but there is no doubt that leaving my ovaries in place would have eventually killed me.

    April 26, 2011 at 14:11 | Report abuse | Reply
  3. Chartreux

    Ovarian cancer has a 25% survival rate compared to a 92% survival rate for breast cancer. Breast cancer gets all the research dollars. Pap tests don't screen for ovarian cancer. There's only a blood test that can screen for ovarian cancer and it only shows a positive result if cancer is present.

    Gagirl, talk to your doctor. Ovarian cancer is in your family. Be aware of your own risks and find out if you need surgery. Ovarian cancer is ten times more deadly than breast cancer.

    April 26, 2011 at 14:15 | Report abuse | Reply
    • gagirl

      I was adopted at birth so I don't share my mother's genetics...but that makes me want to get tested even more since I know nothing about my medical history and the state of GA has some of the toughest laws on record when it comes to opening adoption records. I wish now my mom had had everything taken out. They left in her ovaries b/c of her family's heart condition history. It was horrible to watch her waste away. It is sad breast cancer gets all the attention. It's time ovarian cancer get some research funds.

      April 26, 2011 at 15:09 | Report abuse |
    • Terrell

      There is NO screening test for Ovarian cancer. The blood test-ca 125- is NOT a screening test & can be falsly positive or negative, depending on the person's age & other health conditions. Also, the risk of ovarian cancer may be decreased by having your ovaries removed, but it does not eliminate the risk. Many women who have had their ovaries removed have been known to develop primary peritoneal cancer , which act like & is treated like ovarian cancer. Anyone who suspects they may have ovarian cancer should get a referral to a board- certified GYN-Oncologist to be evaluated- I am am a GYN-Oncology nurse @ UAB.

      April 26, 2011 at 20:59 | Report abuse |
  4. luvgodwrd

    I had a hysterectomy back in '01, I believe, and since then, I had a mild stroke in '04 and heart surgery in '09. I had no idea that these could be linked.

    April 26, 2011 at 14:49 | Report abuse | Reply
    • Valerie

      Hello LuvGodWrd,

      I wish you the best of health...Stay blessed!

      Valerie

      April 26, 2011 at 15:34 | Report abuse |
    • AngelaB

      Hello. I had a partial hysterectomy in 03 removing my uterus and right overy. I did real good for a while and dropped weight and in 06 I was rushed to the hospital which felt as bad as full blown labor with no meds. my left overy had an inch and a half sized cist on it. My gyn went on ahead and took it. Since then I have gain 65 pounds and I cant live without HRT. They tried taking me off the vivelle. 0.1 and it seemed like it effected my body functions, blood pressure and started having severe panic attacks and anxiety to the point of hyperventilating. My doctor put me back on them and I seemed to go back to normal except for my blood pressure which I am on medications for that now. I was 35 when the hysterectomy was complete and I feel like my life has been in termoil since and no one understands at all. I don't even feel normal and less of a woman and gaining the weight has torn me apart as well. I am tired a lot too and feel like part of me is missing and my go go juice is just gone and endurance and wild side had vanished. Any thoughts from anyone and encouragement on this would help. Maybe I just didn't adjust well.

      August 23, 2012 at 23:48 | Report abuse |
  5. Geri

    I also had fallopian tube cancer (very rare); I had everything taken out thru surgery and had chemo; that was seven years ago and I am still OK. I wish anyone with cancer the very best; someday I hope a cure will be found for all cancers....

    April 26, 2011 at 15:10 | Report abuse | Reply
    • Valerie

      Geri,

      I am happy you made it through your ordeal...You are blessed.

      Val

      April 26, 2011 at 15:22 | Report abuse |
  6. HollyC

    not to nit pick but of course those who have had their ovaries removed are less likely to get ovarian cancer...they don't have the ovaries to get the cancer in!!

    April 26, 2011 at 15:19 | Report abuse | Reply
    • Michel

      Holly, there is a type of ovarian cancer that occurs outside of the ovaries (primary site peritoneal). It is even deadlier than "regular" ovarian cancer and yes, women whose ovaries have been removed can get it. My mother died from it. I just thought this might clarify the statement in the article.

      April 26, 2011 at 15:34 | Report abuse |
  7. Valerie

    I am 41 and I had a complete hysterectomy at the age of 36 due to fibroid tumors that were extremely large. Since then I thank God that I haven't had any major issues related to have the surgery. I instantly went into menopause, but I take a medication that helps with the hot flashes, but other than that I have my usual aches and pains that come with getting older. I was lucky. I pray for all of us who have suffered...

    April 26, 2011 at 15:20 | Report abuse | Reply
    • eileen

      Hi Valerie
      I'm 48 & I had a total hysterectomy 3 weeks ago,do you mind me asking what medication are you taking to try & prevent the on set of the menopause tanx eileen

      May 1, 2011 at 14:55 | Report abuse |
  8. Nandi

    I had a hysterectomy at 44 due to very large fibroid and choose to leave ovaries in. Heart disease is much more of an issue in my family so it seemed to make better sense. 10 yrs later still ok – my mom is 86 and both grandmothers lived into their 90's. no hard and fast rules on this one and I did take my time thinking about the topic before deciding.

    April 26, 2011 at 15:24 | Report abuse | Reply
  9. rowan729

    I had a hysterectomy with BSO at age 28, due to severe endometriosis (stage IV), previous bad pap smears, etc. Leaving my ovaries in was never even discussed, because it was too risky apparently. There is a wide history of pre-cancers in the repro organs in my family, so I believe we did the right thing, especially after my pathology came back with uteran and fallopian cellular abnormalities.
    I ended up with Ovarian Remnant Syndrome, which required a second surgery to fix, but that's another topic entirely-point is I had mine out at 28 and haven't looked back. I did just estrogen HRT for about 6 months, but stopped due to fears of sparking more endo growth-I deal with the hot flashes and they have gotten easier over the last couple years since the hyst. Everybody is different, but the ovaries certainly are not needed if you are at risk, IMHO.

    April 26, 2011 at 15:55 | Report abuse | Reply
    • Donna

      I had a hysterectomy at age 30 but we left my overies. 10 years later I had them removed due to endometriosis. The HRT just made it worse even after having mt overies out. Took almost 5 years to get over the hot flashes. Hopefully you won't have to wait that long.

      Good luck

      April 26, 2011 at 19:39 | Report abuse |
  10. tll

    Out! I watched my step-mother die from ovarian cancer. The doctor that performed her hysterectomy back in the 60s left one ovary in to 'keep the twinkle in her eye' he said to her. Yeah happy twinkle. Now I'm watching my best friend struggle through a second round of chemo due to ovarian cancer that wasn't diagnosed in time. She too had a hysterectomy but was told to keep her ovaries. I had mine removed. Gone. Its one cancer I do not have to worry about getting.

    April 26, 2011 at 16:25 | Report abuse | Reply
  11. Cindy

    At 31, I had a hysterectomy due to heavy bleeding and cysts. Few years before that I had cysts on both ovaries, so 11/2 ovaries were taked out. I had no choice at the time. Took hormones for couple of years until I read about side effects. Stopped using them, and took vitamin E, exercised, every thing they sad to do to avoid osteoporsis, etc. Never had hot flashes due to vit E. At age of 45, I got osteoporsis, some fractures, and other things. If I had the choice today I'd try to keep the ovaries due to benefits as we get older. Thy roid problems which might be from not having hormones. I believe it's a personal choice to keep or not to keep. Not having monthly friend was the best. But now they have pills to stop periods. Their are long term benifits of keeping ovaries in which I would have if I had to option.

    April 26, 2011 at 16:35 | Report abuse | Reply
  12. Becky

    I'm 44 and have two fibroids the size of a large strawberrys, I'm not sure if i should do the partial or total hyterectomy.
    I just started to have hot flashes so my OB thinks i'lm starting to go through the change. She thinks i should get the total done now.Because cancer runs in my family.Any info I would apprectiate!

    April 26, 2011 at 19:15 | Report abuse | Reply
    • valoree mclean

      Becky,
      I also got fibroids in my 40's and the drs had no recommendations, it was up to me to decide if I wanted surgery. I chose not to have it. If I had it to do all over again I would have had a complete hysterectomy and been done with it. I didn't, ended up with critical anemia and had to have iron infusions and B12 shots due to the bleeding. The hormone pills made my heart skip beats which was really freaky. Don't waist time, have the procedure. If they are going in, have it all taken out. Wish I had. Good luck with whatever decision you make. Either way, you won't be sorry you don't have to deal with the fibroids and the bleeding :-) Valoree

      April 26, 2011 at 20:02 | Report abuse |
  13. MOMOF#

    Considering hysterectomy, by at age 35 I want to leave my ovaries. Has anyone done this and still had the ovaries fail? I've heard this is a silent problem that docs don't want to discuss.

    April 26, 2011 at 19:43 | Report abuse | Reply
    • CJ

      Surgery can have temporary or permanent effects on the ovaries. My effects at age 45 were temporary.

      April 27, 2011 at 08:35 | Report abuse |
    • VP

      Hi MOMOF

      I had a hystorectomy about two years ago and kept my ovaries (I am 36 now). My ovaries stopped working after the hystorectomy and I am still trying to find a doctor that can help with all these terrible symptoms that I am having.

      Good luck

      May 22, 2011 at 08:03 | Report abuse |
  14. Melanie

    Ladies: It's a personal decision, to be sure. But so glad I had a total hysterectomy when I was 45. Didn't know about the heart issues, but would have made the same decision. You can try to watch weight/take medicine for heart issues (which do run in my family), but haven't seen any info on a pill that helps avoid ovarian cancer. I've had family members deal with heart issues and cancer/chemotherapy. There is no comparison: the survivorship for ovarian cancer is dismal. And if doctors don't want to talk about these women's health issues, that's too bad...it's your life and you're paying their fee (i.e., the doctor works for you). Become an informed consumer, ask questions…live a long, healthy life.

    April 26, 2011 at 19:58 | Report abuse | Reply
    • Elizabeth

      There is absolutely a pill to help avoid ovarian cancer: the birth control pill. Women who have taken it for at least 5 years reduce the risk of ovarian cancer by half.

      April 26, 2011 at 20:29 | Report abuse |
  15. Catherine

    Becky...listen to your doc. A total hysterectomy is the way to go. I don't know anyone who has had one, me included, who has ever regretted the decision. The surgery is not bad and the recovery is quick. Your doc knows all the latest research. Listen to your doc...she knows you better than anyone...cut your risk of cancer NOW.

    April 26, 2011 at 20:12 | Report abuse | Reply
  16. Sydney

    I wish the research was more clear and these decisions were easier. It's sad how little progress has been made in screening for ovarian cancer.

    If you have a high cancer risk, obviously removal makes sense. If not, the picture is far less clear and I would suggest a lot of research before deciding. It's something I've had to consider myself due to endometriosis. A possible rise in heart disease/stroke risk really matters, since that's what most women end up dying from, and wasting away from heart disease is not pretty either. That risk is far higher than ever getting ovarian cancer for most women. But worse, there are studies of women with ovaries removed showing higher rates of some other bad outcomes as they age, like higher rates of dementia. Whether this is truly cause and effect isn't clear yet, but it's worrisome.

    Another option may sometimes be to keep your ovaries and be monitored with ultrasound annually. That increases odds of finding any cancer in a treatable stage.

    April 26, 2011 at 21:57 | Report abuse | Reply
  17. SchoolGirl

    I developed endometriosis at the age of 14. After many years of on-again-off-again treatments I just could no longer stand it. I had a complete hysterectomy and salpingooophorectomy (removal of both ovaries and tubes) at the age of 39. Becasue of the endometriosis I had to wait over six months to start hormone replacement therepy. After the six month period I then took HRT until I was 46. My Doc recommended this age because it was the age at which my mother went through menopause. I wouldn't wish surgical menopause on anyone; it was the hardest thing I have ever had to go through. It was also hard when I volluntarily went off of HRT but certainly easier than the surgical menopause. The sad fact is that even though I have had the oophorectomy, I am still at risk of developing ovarian cancer. My Doc explained that I may well still have some ovariarian cells in my parataneum becasue of the adhesions associated with the endo.

    April 26, 2011 at 22:48 | Report abuse | Reply
  18. nola

    It's amazing what little is known about serious women's health issues but when it comes to men's health, they have most of the answers. Viagra, is it REALLY needed? If a man can't get an erection, maybe he should just keep his pants on!

    April 27, 2011 at 05:18 | Report abuse | Reply
  19. Susan

    I am 63 years old. I had cervical cancer at 29. My doctor, God Bless him, told me to have everything removed........which I did, put me on HRT for 25 years, (have lots of heart disease in my family), but I'm still here, and healthy to boot. My doc told me, take the ovaries, they are next for cancer. He made the right decision for me and I thank him. I never had one ounce of trouble with HRT. In fact, it's my opinion it did me a lot of good.

    April 27, 2011 at 07:46 | Report abuse | Reply
  20. Sharon

    I wish my mother hadn't listened to her doctor when he recommended she should keep her one "healthy" ovary after hysterectomy. For years she went to doctor after doctor and through test after test because she knew something was wrong. When it was finally discovered, her ovarian cancer was Stage 3-C. Through many surgeries, chemos, radiation, etc she managed to fight the good fight for 14 years.

    April 27, 2011 at 08:14 | Report abuse | Reply
  21. Dprang

    I had a hysterectomy at age 47 but refused to allow removal of my ovaries. After testing, I had precancerous cervical cancer. So far, no problems with my ovaries... but my doc took off of hrt due to the big hrt study...
    I read about a test for ovarian cancer and did that last year... I am okay.

    At the time, I did not want to mess with my hormones and I am glad to have kept my ovaries. There has to be some quality in life.

    April 27, 2011 at 09:16 | Report abuse | Reply
  22. Lydia

    When my mother was pregnant with me at age 27 they found she had cervical cancer. They recommended that she terminate and have a hysterectomy but she decided to continue and risk it. They ended up taking me 6 weeks early and she had a hysterectomy leaving her ovaries and she has never had a problem since. So I believe it just varies with people. Talk to your doctors and figure out what is best for you.

    April 27, 2011 at 11:28 | Report abuse | Reply
  23. momo47

    My Mom had a hysterectomy at the age of 50. She had both ovaries removed as well as her cervix. She immediately went into menopause and eventually developed osteoporosis, which is inherent in the family. I believe this and the lack of interest by her HMO, and her fear of HRT contributed to her death at the age of 72. I also had a hysterectomy at the age of 45 due to large fibroids and a persistent ovarian cyst. I kept one ovary and my cervix at the suggestion of my gyno. I also take lowest doese HRT and have for 18 years. I have a bone density test every other year. To date, my bones are younger than my age by 15 years! I have no regrets. I don't miss my period, the cramps and the other "gifts" my uterus provided. So,I agree. Everybody's different!

    April 27, 2011 at 13:49 | Report abuse | Reply
  24. Barb

    I am facing hysterectomy on July 25th. I have to make a decision on whether or not to keep my ovaries. I have history of heart disease in the family. I have read that never being pregnant or giving birth changes the dynamic. Could use some help.....

    July 14, 2011 at 14:32 | Report abuse | Reply
    • Barbara

      Hi Barb, I had a partial histrectomy at age 31. I was having pretty bad pains and the doctor discovered I had fibroids. After speaking with quite a few people I decided to have the procedure, but left my ovaries. Judging from differrent people's reaction to wether or not you keep or loose your ovaries, it seems to vary person to person. So that will have to be a personal choice for you to make. For me, I have had no problems, I am now 47. But, after reading the board here, it has been very instumental in figuring out for me why I seem to be very emotional at this age, 47. Maybe my ovaries have stopped working, but I will be visiting my doctor very soon, and now I know what to talk about. Good luck!

      December 11, 2011 at 13:09 | Report abuse |
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  26. yvonne

    im due to go in for a hysterectomy the end of january 2012 i realy dont now whether to get my overies out or not im 48 i will be 49 in september, i have realy heavy large clott periods i have had some abnormal smears.. i have read on the pros and cons about leaving in and taken out can you help me make my mind up there is cancer in family but not overian

    January 16, 2012 at 17:24 | Report abuse | Reply
  27. FIne at 49

    I am 49 and had a hysterectomy last year die to massive fibroids and heavly clotting/bleeding....and kept my ovaries. You will experience a lot of adjustment and changes with the hysterectomy. If your ovaries are healthy and there isn't a cancer risk, keep them as it will keep you in the normal time range for menopause as opposed to going immediately into menopause if you get them out. A much bigger adjustment, especially on top of the surgery. My doctor was in favor of this. Much easier on your body and you keep the health benefits of having your hormones for a few years. Please also visit HysterSisters.com. This is a great resource on what to expect before, during and after surgery......at various timepoints. There is also dialogue by members. I also recommend asking your doctor for physical therapy to help get your muscles back in shape. Best of luck in your recovery!!

    January 16, 2012 at 17:53 | Report abuse | Reply
    • yvonne

      thank you so much that has help im goin to look on hystersister.comand find more out thank you again.

      January 18, 2012 at 16:26 | Report abuse |
  28. Joe

    The rationale for keeping the ovaries, would be to maintain a source of your own sex hormone production. It is possible that your ovaries may continue to produce adequate amounts of estrogen and testosterone until the time you would have had experienced a natural menopause. The normally functioning postmenopausal ovary also may be capable of producing significant amounts of testosterone for several years following menopause. Testosterone is the hormone is closely associated with energy levels, lean body mass, libido and sexual function.

    More at http://www.forerunnershealthcare.com/hysterectomy-surgery-India-low-cost-benefits.html

    June 5, 2012 at 06:40 | Report abuse | Reply
    • megster1971

      "Closely associated with?" Weasel words! Testosterone is an incredibly powerful hormone and when given exogenously to women *can* cause serious health problems, including cardiovascular disease, insulin resistance/diabetes, and even cancer. It can also cause a host of physical changes that many would find disturbing.

      Folks, when it sounds to good to be true? It probably is.

      January 25, 2013 at 22:17 | Report abuse |
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  30. Liza

    I had a hysterectomy almost two years ago, left my ovaries. Now I have been in so much pain can barely walk and to find I have an ovarian cyst the size of an apple! It pulling and twisting so need surgery ASAP! I'm already 40 pounds over weight due to a severe hormone imbalance. So looking for advise on weather or not to get hrt? Very scared already have a typica breast cells.

    September 6, 2012 at 19:31 | Report abuse | Reply
  31. Rebelrp

    Freaking out! 5w ago while moving my second child into college I started getting sever sharp pains in my lower abdomen. Figured I had pulled something and ignored the pain for a week. Dr ordered ultrasounds which showed a 9.5cm cyst had taken over right ovary. Reg gyn said it had to come out along with f/tube, surgeon in her office disagreed will only take the ovary and 'no rush'. Went for 2nd opinion who said ovary and f/tube needs to be removed. Sent me to oncology surgeon because of the size, he wants to take everything out-mom died of ovarian cancer at 56,sister had total hys at 35 for cyst/endo/prolapsed ut. I know it sounds like the right thing to do but I'm scared of all the side affects being forced into meno at 47. I'm horrible at remembering to take pills and now I will have to be on hrt for years.

    October 23, 2013 at 19:18 | Report abuse | Reply

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