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Saturday, May 11, 2013

Should I keep my ovary when I about to get hysterectomy (surgery to remove uterus)?

In the case of pelvic cancer, your surgeon usually recommends a complete removal of uterus and ovaries as part of cancer surgery.    However, you may undergo hysterectomy for benign (non cancer) indications.   In this case, your surgeon may recommend preservation of your ovary/ovaries especially when you are young and without menopausal symptoms.

My patients often ask what would be their chances of having future surgery to remove the ovaries if they preserve them during the initial hysterectomy surgery for benign indications (heavy uterine bleeding, painful menstruation, uterine fibroid, etc).   A study published in May 2013 by Casiano evaluated this question.



The study compared the risk of oophorectomy (removal of ovary during hysterectomy) of 4,931 women in Olmsted County, Minnesota, who underwent ovary-sparing hysterectomy for benign indications (case group) between 1965 and 2002, with 4,931 age-matched women who did not undergo hysterectomy (referent group). The incidence of oophorectomy after hysterectomy is only 9.2% at 30-year follow-up and is only 1.9 percentage points higher than the incidence of oophorectomy in referent women with intact reproductive organs.

In other words, as you elect to keep your ovaries during your hysterectomy for benign reasons, you have 9.2% chance of being reoperated again to remove your ovaries in the next 30 years.  This is only 1.9% higher than women who never had hysterectomy needing to have their ovaries remove in the next 30 years.  

Some of you may just want to remove your ovaries during hysterectomy even when you are young and have no cancer for fear of ovarian cancer.  Do keep it in perspective that your ovaries have many benefits reducing risks of heart disease, dementia, osteoperosis, hot flushes, and others.   Thus, do discuss this important decision to remove or preserve your ovaries during hysterectomy with your surgeon.

- Casiano ER, et al.  Risk of oophorectomy after hysterectomy. Obstet Gynecol. 2013;121(5):1069-74
- Parker WH, et al. Ovarian conservation at time of hysterectomy - the Nurses' health study.  Obstet Gynecol 2009; 113: 1027-37

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