Oophorectomy during premenopausal hysterectomy: Evaluating the prevalence

Nearly 1 in 3 women undergo oophorectomy during premenopausal hysterectomy in absence of appropriate indication, reports a study published ahead of print May 8, 2017 in North American Menopausal Society (NAMS) journal Menopause.  

Bilateral Oophorectomy before the age of menopause is associated with increased the risk of parkinsonism, cognitive impairment or dementia, and anxiety or depression. These women, particularly those who were below 45 years at the time of oophorectomy face 67% increase risk of all-cause mortality.

Analysis of data from Nurses’ Health Study also revealed that in 24 years follow up, women who were below 45 years at the time of surgery had 17% increased chances of non-fatal CHD.

In-fact, evidence suggests that at no age, oophorectomy shows any survival benefit.

The current study was a cross sectional analysis of data-base from California Office of Statewide Health Planning Development during a span of 6 years. (2008-2011).

Appropriate indications for oophorectomy with hysterectomy in the study were ovarian cyst, breast cancer susceptibility gene carrier status, and other diagnoses.

A total of 57,776 benign premenopausal hysterectomies with oophorectomies were performed during the 6-year study period.

Out of these 57,776, 21,783 were found to be ‘inappropriate’ as no indication was found among the records.

Through the 6 years of study, the researchers observed a decreasing trend to perform oophorectomy with hysterectomy, but the percentage remain unchanged.

Women with Hispanic and African American ethnicity were more likely to undergo oophorectomy as compared to white women. (P < 0.001).

The authors concluded that, “the rate of inappropriate oophorectomy in California has not changed since the 2008 American College of Obstetricians and Gynecologists guidelines, and over one-third undergo oophorectomy without an appropriate indication documented”.

What does this mean for daily clinical practice?

Prophylactic Hysterectomy should only be done in cases were preponderance of evidence suggests that it will be beneficial to patient.

All patients should be counselled in detail before the surgery regarding the pros and cons of retaining the ovaries at the time of hysterectomy.

ACOG also recommends in favor of retaining normal ovaries in premenopausal women who are not at increased genetic risk of ovarian cancer.

In women with endometriosis, pelvic inflammatory disease, and chronic pelvic pain a decision should be taken after balancing the risk of reoperation vs the benefits of ovarian retention.

ACOG further recommends considering prophylactic salpingectomy in those women who are at population risk for ovarian cancer, and who opt for retention of ovaries.