Ovarian Conservation Versus Removal at the Time of Hysterectomy for Benign Gynecological Diseases

Abstract

Hysterectomy for benign gynecological diseases is a common surgical procedure. Prophylactic bilateral oophorectomy is often recommended concurrent with hysterectomy to decrease the risk of ovarian cancer. Oophorectomy before menopause leads to an abrupt decrease in endogenous estrogen and androgen production leading to different health problems. So women undergoing hysterectomy for benign gynecological diseases are presented with the choice of ovarian conservation or removal. The purpose of this review article is to summarize and critically evaluate the existing evidences regarding the impact of ovarian conservation versus removal on specific health issues of the individual. Information was collected by searching pub med for related studies, abstracts and articles. Studies have shown that benefits of elective oophorectomy also include reduction of breast cancer and development of residual ovary syndrome. On the other hand bilateral oophorectomy is associated with increased risk of cardiovascular disease, osteoporosis, cognitive impairment, dementia, depression, anxiety and decreased sexual function. Estrogen was commonly prescribed after bilateral oophorectomy to treat menopausal symptoms. But recent studies have shown more harm than benefit in postmenopausal hormone therapy. So the decision making regarding elective oophorectomy at the time of hysterectomy for benign indications has become complex. The approach to such decision will include counseling regarding risks and benefits of the procedure and shared decision making between the clinician and the patient. The beneficial effect on ovarian cancer must be weighed against the risks of ovarian hormone withdrawal.