Removing Ovaries During Hysterectomy May Increase Risk of Early Death

By Lisa M. Jones, M.d., Abc News Medical Unit

Sept. 13, 2006 — -- Each year about 600,000 women in the United States undergo hysterectomies, the surgical removal of all or part of the uterus.

Many of these women also have their ovaries removed at the same time on the recommendation of their doctors, even if those ovaries are healthy. That's because gynecologic surgeons, who perform most hysterectomies, have long believed that removing healthy ovaries during a hysterectomy could prolong a woman's life by lowering her chance of developing often-deadly ovarian cancer.

Surgeons now might want to rethink that belief. Ovary removal could actually increase a woman's risk of death, according to a new study published in the British journal Lancet Oncology.

A team of researchers at the Mayo Clinic in Rochester, Minn., examined the health records of 4,500 Minnesota women. They selected the medical records of 1,000 women whose ovaries had been surgically removed between 1950 and 1987, and compared them with more than 2,000 women who did not have their ovaries removed.

"Women who had healthy ovaries removed were not surviving better," said Dr. Walter Rocca, a biostatistician and neurologist at the Mayo Clinic and lead author of the study.

But the finding applies only to a certain group: Women who had their ovaries removed before age 45 and who did not take hormone replacement therapy. These women were almost twice as likely to die during the study period as the group as a whole. Heart disease, brain disease and cancer accounted for much of the increase in risk in the ovary removal group.

Women who had their ovaries removed after the age of 45, and those women who took hormone replacement therapy, did not have an increased risk of death. Still, the findings are important, doctors said.

"This is the first time an increase in mortality has been demonstrated from ovary removal at a young age," said Dr. David Archer, an obstetrician-gynecologist at East Virginia Medical School in Norfolk, Va.

The reasons for the increased death risk are unclear.

"Our bodies are very complex," said Dr. Bobbie Gostout, an ob-gyn at the Mayo Clinic and a consultant on this study.

Many surgeons have already stopped taking out healthy ovaries during hysterectomies, in part because of worries about hormone replacement therapy. Women who have their ovaries removed often want HRT to stave off the effects of menopause and other hormonal changes. But HRT has been linked to increased rates of breast cancer and heart disease.

Yet doctors may be overestimating the risks of hormone replacement therapy in young women, since the study didn't reveal an increased risk of death in the HRT group.

"This study should prompt doctors and patients to have a dialogue about hormone replacement," said Dr. Jennifer Wu, an ob-gyn at Lenox Hill Hospital in New York.

Gostout also believed it was important to reassure women who have already had their ovaries removed.

"Your individual risk is tiny," she said.

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