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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.


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