Elective oophorectomy (EO)or ovarian conservation at the
time of benign hysterectomy?
Hysterectomy
is the second most common surgery performed in US after cesarean section.
There
is considerable debated going on between EO and ovarian conservation, with
strong statements are put forward in favor of each. Currently ACOG recommends
“strong consideration should be made for retaining normal ovaries in
premenopausal women who are not at increased genetic risk of ovarian cancer. [However,] given the risk of ovarian cancer in
postmenopausal women, ovarian removal at the time of hysterectomy should be
considered for these women.”
Elective oophorectomy or ovarian conservation
at the time of benign hysterectomy?
Hysterectomy is the second most common surgery performed in US after cesarean section. According to
CDC data approximately 600,000 hysterectomies are performed each year. A
nationwide studyfurther reported that unilateral or bilateral oophorectomy was
performed in 68 percent of women at the time of abdominal hysterectomy, 60
percent at laparoscopic hysterectomy, and 26 percent at vaginal hysterectomy.
Women have an option of undergoing
elective oophorectomy (EO) along with benign hysterectomy to reduce the risk of
ovarian cancer, thereby reducing a chance of second surgery coupled with
decreased perceived anxiety of breast and ovarian cancer
subsequently.But there are negative side effects of this surgical induced
menopause such as death, total cancer mortality, osteoporosis, cognitive decline,
decreased sexual drive and increased cardiac mishap support conservation of
ovarian function.
There is considerable debated going on
between EO and ovarian conservation, with strong statements are put forward in
favor of each. Currently ACOG recommends “strong consideration should be made
for retaining normal ovaries in premenopausal women who are not at increased
genetic risk of ovarian cancer. [However,] given the risk of ovarian cancer in
postmenopausal women, ovarian removal at the time of hysterectomy should be
considered for these women.”
Arguments in favor of ovarian
conservation:
EO is detrimental for the overall health
of women and decreases the life expectancy due to coronary artery disease. In a
landmark study by Parker et al using Surveillance, Epidemiology, and End
Results (SEER) database, the National center for Health Statistics, the Women’s
Health Initiative, and the National Inpatient Sample it was seen that there is
no clear cut benefit of EO at any age and women died early due to associate
morbidity.
The neuroprotective benefits of estrogen
were seen in multiple studies and was further supported by declining cognitive
functions specially in women undergoing EO under 50 yrs.
EO leads to increase in hip fracture due
to decrease in BMD as estrogen levels plummet. This was specifically seen in
the light of mass discontinuation of hormone replacement therapy among
postmenopausal women when results of Women’s Health Initiation trial published.
A decrease in sexual desire and function, resulting
in quality of life issues and conflict in interpersonal relationship,
depression was seen after oophorectomy
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