Each year, hundreds of thousands of women who undergo hysterectomies have their ovaries removed along with their uterus, a practice meant to protect them from ovarian cancer. But a new study has found that women who keep their ovaries live longer.
While women who had their ovaries removed developed fewer breast cancers and almost entirely eliminated their risk of ovarian cancer over 24 years of follow-up, they were more likely to develop heart disease than women who kept their ovaries, and they were more likely to die.
The new findings — from an analysis of data in the famous Nurses’ Health Study, published in the May issue of the journal Obstetrics & Gynecology — raises questions about a widespread practice. Some 300,000 American women a year, about half of those who have hysterectomies, have their ovaries removed.
“This finding is contrary to 35 years of teaching in gynecology,” said the lead author, Dr. William H. Parker of the John Wayne Cancer Institute in Santa Monica, Calif.
“In the 1970s, it was decided that taking out the ovaries to prevent ovarian cancer would be the new strategy,” he said. “This study shows that you’re more likely to die if you have your ovaries taken out, unless you’re among a group of women with a family history that places you at high risk for ovarian cancer or breast cancer.”
While ovarian cancer is difficult to detect and often deadly, it is also rare, Dr. Parker explained, noting that only 34 of the study participants who kept their ovaries died of ovarian cancer during the follow-up period. “Heart disease kills more than 20 times the number of women every year,” he said.
The study analyzed data on 29,380 women who had participated in the Harvard Nurses’ Health Study: 16,345 who had hysterectomy with both ovaries removed, and 13,035 who had hysterectomy but kept their ovaries.
After 24 years of follow-up, women in the first group had 895 cases of breast cancer — a 25 percent lower risk than those who kept their ovaries — and 96 percent less risk of ovarian cancer (just 5 cases). But they were 12 percent more likely to die during the follow-up period. Their risk of heart disease was 17 percent higher than the risk faced by women with ovaries. They also had a 17 percent greater risk of dying of cancer. And in an unexpected finding, they were at greater risk for lung cancer.
The risks of heart disease and death appeared to be even greater for women who had their uterus and ovaries removed before age 50 and did not take estrogen, compared with women who had a hysterectomy before 50 but kept their ovaries.
The study may add to the debate over estrogen and the role it plays in heart disease in women. Dr. Parker and other experts suggested that women who kept their ovaries lived longer because even though the ovaries make less estrogen after menopause, they produce androstenedione and testosterone, which are converted into estrogen by fat and muscle.
Dr. Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital and a professor at Harvard School of Medicine, said the study did not mean that women undergoing hysterectomies should never have their ovaries removed.
“A woman with a strong family history of ovarian cancer or breast cancer should still be given the option of having her ovaries removed,” said Dr. Schiff, who was not involved in the study. “The individual patient should be given the information, and decide what’s best for her.”
But that is a change from the past, he said, adding, “We used to just arbitrarily say, ‘If you’re over 45, have your ovaries taken out.’
Comment from Leslie
Well, Holy Hormones Honey! What does this say for the millions of women who have had their ovaries removed during a hysterectomy based on their doctor’s advice? The same as lumpectomies vs. mastectomies? The analogy can be applied to so many other incidents as barbaric surgeries finally catch up with science/common sense. When will we stop being guinea pigs in the name of medicine?