Ovarian conservation at the time of hysterectomy


OBGYN.net Conference CoverageFrom the 34th Annual Meeting - Chicago, Illinois - November 2005

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Barbara Nesbitt: Hi, I am Barbara Nesbitt. I am at the AAGL with my friend, Dr. Bill Parker, who is in private practice in Santa Monica and also on the clinical staff at UCLA. He has written an article that was published August in the Green Journal and it is about conservation of ovaries at the time of a hysterectomy. I am very happy to have the opportunity for you to explain that article and tell us something about it.

William Parker, MD: I will. Up until this article, most physicians have recommended that if you need a hysterectomy for benign conditions, fibroids, bleeding, if you are over 40, you have your ovaries removed at the same time and the rationale, the reason was to prevent ovarian cancer. What we did is we looked at the risk of ovarian cancer which is actually extremely small. In your lifetime, it is maybe 1%. Let us say you are 40 years old, the risk of having ovarian cancer in your 40th year is one in 2,500. It is a very rare disease, it is a scary disease, but it is very rare. If you take your ovaries out at age 40, you take away the hormones that help the heart stay healthy, help the bones stay healthy and some women will go on to die of heart disease which actually kills about 10 times more women than breast cancer and 50 times more than ovarian cancer. So what we did was put all of the statistics in a computer and let the computer generate a model as to which strategy was better: the choice of having your ovaries taken out or leaving them in if you needed a hysterectomy. It clearly showed that up until age 65, it is beneficial to leave your ovaries in. Between 65 and 80, it was no different really, very similar. But at no point was it advantageous to take your ovaries out unless and this is big unless, you have a family history of ovarian cancer or you have the BRCA1 gene or the BRCA2 gene where you are at high risk. So that is a separate group who should have their ovaries removed. For women at low risk or average risk of ovarian cancer, it is better to keep your ovaries, keep your heart healthy, keep your bones healthy and actually have a lower risk of dying from those diseases.

Barbara Nesbitt: Excellent. Most women are not going to be able to read that article in the Green Journal, but you are going to write a synopsis of that article and we are going to have it on our website.

William Parker, MD: Put it up on the website, absolutely.

Barbara Nesbitt: It will help them to understand just what that study shows. Thank you.

William Parker, MD: You are very welcome.

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