A Critical Evaluation of the Evidence for Ovarian Conservation Versus Removal at the Time of Hysterectomy for Benign Disease

Abstract

Women undergoing hysterectomy for benign disease are presented with the choice of ovarian conservation or removal. The beneficial effect on ovarian cancer must be weighed against the risks of ovarian hormone withdrawal. Wide variations in practice patterns exist. The purpose of this review article is to summarize and critically evaluate the existing primary evidence regarding the impact of adnexal conservation versus removal on the specific health issues of ovarian cancer, coronary heart disease (CHD), sexual and cognitive function, and osteoporotic hip fractures. Elective bilateral salpingo-oophorectomy (BSO) in women under 50 years is associated with an increased risk of CHD and sexual dysfunction. In women older than 50 years, there is no observed association between BSO and CHD, sexual dysfunction, osteoporotic hip fractures, or cognitive function. Oophorectomy is associated with a lower risk of death from ovarian cancer. Elective BSO should be discouraged in women under 50 years old. In postmenopausal women, however, BSO can reduce ovarian cancer rates without an adverse impact on CHD, sexual dysfunction, hip fractures, or cognitive function.