Women who opt to remove one or both ovaries during a hysterectomy may be doubling their risks for heart disease, cancer, and premature death. This finding is tragically ironic since removal of the ovaries is typically associated with significant decreases in the risk for ovarian cancer, one of the biggest killers of cancer-related deaths for women.
In one of the largest studies ever conducted, scientists at the University of Warwick's Medical School analyzed data from over 113,000 patients who underwent a hysterectomy at anytime during a ten-year span, from 2004 to 2014. The women’s age ranged from 35-45. About a third of the cohort had no ovaries as these were taken out along with the uterus during the hysterectomy.
When they compared mortality and health data between the women who retained their ovaries versus women who either only had one or no ovaries, the researchers noted a striking trend. Specifically, women who had conserved their ovaries had a reduced risk of developing ischemic heart disease (coronary artery disease) or cancer after hysterectomy, than those whose ovaries were removed. This also correlated with mortality: more women died after the hysterectomy that included ovary removal than women who retained their ovaries.
"The combination of biological plausibility and the massive 'effect size' make a compelling case that women can be advised that their risk of ovarian cancer is greatly reduced by surgical removal of both ovaries. However, the lifetime risk of developing ovarian cancer is one in 52 in the UK, and the removal of a metabolically active organ such as the ovary may have harmful effects in the long term,” said Richard Lilford, Professor at the University of Warwick's Medical School, and the study’s senior author. "If so, these long term disadvantages (combined with the unpleasant shorter term effects of acute oestrogen deprivation) must be offset against the benefit conferred by protection from ovarian cancer.”
In other words, women and their physicians may have to weigh the protection offered by the removal of the ovaries with the risks of this procedure to their long-term health. The data from this study make it clear that there are big costs associated with such a dramatic procedure, and as such, women should consider this decision with great care.
The results of the study may be more pertinent in pre-menopausal women who don’t have a history or family history of breast and/or ovarian cancer. In these women, the long-term health risks of taking out their ovaries may be greater than they realize. But according to the study, 40 percent of women who had their ovaries removed during the hysterectomy had no prior medical history of reproductive cancer.
"This might be a higher proportion than would be expected among women who were fully aware of the worse health outcomes with bilateral removal that we've reported. In that case, we might expect the proportion of women who select bilateral ovarian removal to decline as the health risks that must be traded for a reduced incidence of ovarian cancer come into sharper focus,” said Lilford.
Of course, women should be making informed decisions with their physicians for all major surgeries. In addition, research to tease apart the effects of hormone replacement therapies and other factors are still needed to understand women’s reproductive health risks after menopause.
Additional sources: University of Warwick